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Paediatric fluid resuscitation — DIPIMC MCQ

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ModeratePaediatric and Obstetric EmergenciesPaediatric fluid resuscitationDIPIMCDipIMC

A 4-year-old with an estimated weight of 16 kg is shocked following gastroenteritis, with prolonged capillary refill, tachycardia and cool peripheries. You decide to give an intravenous fluid bolus. What is the most appropriate initial bolus?

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Correct answer: C — 10 mL/kg of 0.9% sodium chloride, giving 160 mL

Current paediatric guidance recommends an initial bolus of 10 mL/kg of an isotonic crystalloid such as 0.9% sodium chloride with reassessment after each bolus, which for a 16 kg child is about 160 mL. Larger 20 mL/kg boluses are no longer routine first-line practice in many settings and risk fluid overload, while 5 mL/kg is inadequate. Glucose solutions are not used for volume resuscitation. Pearl: reassess the child after each bolus and seek senior help early if repeated boluses are required.

Reference: APLS; JRCALC Clinical Guidelines