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Severe Dehydration — RACP Paediatrics MCQ

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EasyEmergency PaediatricsSevere DehydrationRACP Paediatrics

A 6-year-old child presents with severe dehydration from gastroenteritis. He is lethargic with sunken eyes, absent tears, and a capillary refill of 4 seconds. Weight is 20 kg. What is the initial fluid bolus?

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Correct answer: C — 20 mL/kg of 0.9% sodium chloride over 15–20 minutes

Severe dehydration with signs of shock requires rapid IV fluid resuscitation with isotonic crystalloid (0.9% NaCl or Hartmann's solution) at 20 mL/kg over 15–20 minutes. This may be repeated up to a total of 40–60 mL/kg if needed. Once perfusion improves, the remaining deficit is replaced over 24–48 hours. Dextrose-containing solutions are not appropriate for bolus resuscitation.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Dehydration and Fluid Management