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Hypovolaemic dehydration — MRCPCH FOP MCQ

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HardEmergency paediatricsHypovolaemic dehydrationMRCPCH FOP

A 1-year-old boy has diarrhoea and vomiting with lethargy. He has sunken eyes, cold peripheries, capillary refill 5 seconds and weak pulses. What is the most appropriate management?

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Correct answer: B — Immediate isotonic intravenous fluid bolus with reassessment

Cold peripheries, weak pulses and prolonged capillary refill indicate shock from dehydration, requiring immediate isotonic fluid bolus and reassessment. Oral rehydration alone is not suitable in shock. Hypotonic boluses risk hyponatraemia and are not used for resuscitation. The pearl is that shock is a clinical diagnosis and should be treated before laboratory results return.

Reference: NICE CG84 Diarrhoea and vomiting; APLS