How to Calculate Baby Dehydration How to Calculate % Baby Dehydration

IV fluids - for children beyond the newborn menstruum

Run into as well

Resuscitation: Care of the seriously unwell child
Dehydration
Maintenance Fluids Calculator

Follow specialised fluid guidance for:

• Neonates
• Trauma, including burns
• Astringent electrolyte abnormalities, including hypernatraemia, hyponatraemia, diabetic ketoacidosis and pyloric stenosis
• Cardiac, liver and renal damage
• Inborn errors of metabolism (known or suspected)
• Oncology hyperhydration

Key points

1. Whenever possible, the enteral road should exist used
2. In most situations, the preferred fluid type is sodium chloride 0.9% (with glucose five% +/- potassium for maintenance fluid)
3. Virtually sick children will retain water and require less than total maintenance fluids
4. Series weights are the best measure of astute changes in fluid status

Background

• This guideline merely applies to children aged i month to eighteen years who cannot receive enteral fluids.  Whenever possible the enteral route should be used
• Fluids with a similar sodium concentration to plasma are well-nigh appropriate
• Rubber apply of IV fluid in children requires conscientious prescribing and monitoring
  See flowchart outlining approach to condom IV fluid prescription
• Bank check the compatibility of IV fluid with any 4 drugs that are being co-administered

Assessment

Red flags

• Abnormal serum sodium <135 mmol/50 or >145 mmol/L (or significant modify of >0.five mmol/50/60 minutes on a repeat mensurate) – run into hyponatraemia or hypernatraemia and notify senior clinician
• Consider increased antidiuretic hormone (ADH) secretion - especially with acute CNS and pulmonary conditions, although any unwell child is at risk
• Short gut or other significant gastrointestinal pathology
• Fluid resuscitation >20 mL/kg required
• Situations where specialised fluid direction is required(see listing above)

Examination

Hydration Status

• Appraise for dehydration
• Signs of fluid overload including oedema (eg periorbital, genital, sacral, peripheral) should besides be evaluated, especially in children already receiving Four fluid treatment

Weight

• All children on Iv fluids should exist weighed at the showtime of handling so at to the lowest degree daily
• Children with severe aridity or ongoing losses need to be weighed more often

Management

Investigations

Serum electrolytes and glucose

• All children should have serum electrolytes and glucose checked earlier starting Iv fluid handling and at least every 24 hours if Four fluids are connected at more than than 50% maintenance
• For more unwell children and children with big fluid losses or aberrant electrolytes, check the electrolytes and glucose iv-6 hours after starting fluid therapy, and then according to the clinical situation

Fluid Rest

• Repeated weights are the best measure of fluid status. Besides document intake/inputs and ongoing losses (including urine output), with at least 12 hourly subtotals

Treatment

Resuscitation Fluid

For treatment of shocked children, see Resuscitation: Care of the seriously unwell kid

Treat shock with bolus IV fluids to restore circulatory volume:

Requite a bolus of 10–20 mL/kg of sodium chloride 0.nine% as fast as possible, and reassess to determine if additional IV fluid is required

Do not include this fluid volume in subsequent calculations

Alternative resuscitation fluids such as Plasma-Lyte 148, Hartmann'southward, packed red blood cells, or albumin may sometimes be used on senior advice

Rehydration

To restore hydration, the degree of aridity must first be calculated.  For children with mild or moderate dehydration, enteral (oral or NG) rehydration is preferable.  IV fluid rehydration may exist required for children with severe dehydration or those who cannot tolerate enteral intake

Adding of Fluid Requirements

Full fluid requirement = Maintenance + Replacement of deficit + Replacement of ongoing losses

Calculating fluid deficit

The virtually accurate style to calculate a child's fluid arrears is:
Deficit (mL) = [Premorbid weight (kg) minus current weight (kg)] ten 1000

If a pre-morbid weight is not available, utilise:
Arrears (mL) = weight (kg) ten % dehydration x 10

Supersede deficit over 24–48 hours

• For children with ≤five% dehydration, replace arrears in the commencement 24 hours
• For children with >5% dehydration, replace deficit more slowly. Give 5% in the first 24 hours and the residual over the following 24 hours
• Serial clinical assessment of hydration status must exist made at regular invervals for all children with dehydration (See worked example under the flowchart below)

If electrolytes are deranged, consult senior clinician and relevant guideline, and consider slower replacement of deficit

Ongoing Fluid Losses

Ongoing losses should be measured and replaced if clinically indicated, based on each previous hour (if pregnant) or four-hour menstruation (eg a 200 mL loss over the previous four hours is replaced by giving 50 mL/hr for the next 4 hours)

Alimentary canal losses are ordinarily replaced with sodium chloride 0.nine% + potassium chloride 20 mmol/Fifty

Maintenance

Total maintenance fluid rates may exist calculated using the table beneath as a starting indicate.  This calculation applies for well children only. Fluid rates need to be adjusted for ALL unwell children

Weight (kg)	Full maintenance mL/day	mL/hour
3–10	100 ten weight	4 10 weight
10–20	1000 plus 50 x (weight minus 10)	40 plus two ten (weight minus 10)
20–threescore	1500 plus 20 x (weight minus 20)	60 plus one x (weight minus 20)
>sixty	2400 mL/day is the normal maximum corporeality	100 mL/hr

This calculation:

• Estimates the volume required per kg to maintain hydration in healthy children
• Accounts for insensible losses (from breathing, through the skin, and in stool)
• Allows for excretion of the daily backlog solute load (urea, creatinine, electrolytes, etc) in a volume of urine with similar osmolarity to plasma

Note:

The maintenance fluid requirement calculation in this tabular array applies to all ages including immature infants.  Babies demand a higher book of enteral milk (150–180 mL/kg/day) to meet nutritional and growth requirements, but this higher volume should not be used as a basis for intravenous fluid prescribing
Intravenous fluid prescribing for an babe should be based on the water requirement (ie 100 mL/kg/day upward to 10kg then adjust as clinically indicated (eg restrict to 2/3 maintenance)

Fluid Brake

ii/three maintenance rates should exist used in most unwell children unless they are dehydrated.  Unwell children are likely to secrete backlog ADH so volition demand less fluid to avert water overload and hyponatraemia
Children with the following conditions are at loftier risk of excess ADH secretion and may crave further fluid brake – seek senior advice:

• Acute CNS conditions (meningitis, tumours, head injuries)
• Pulmonary conditions (pneumonia, bronchiolitis, mechanical ventilation)
• Post-operatively and in trauma

Hourly fluid rates tin be calculated using this Maintenance fluids calculator or the table beneath.

Weight (kg)	Full maintenance (mL/hour) Well child eg fasting for elective surgery	ii/3 maintenance (mL/hour) Most unwell children
v	twenty	13
10	40	27
15	50	33
20	60	40
25	65	43
30	70	47
35	75	50
xl	80	53
45	85	57
l	90	60
55	95	63
≥60	100	67

Choice of Fluid

The preferred fluid type for IV maintenance is sodium chloride 0.ix% with glucose 5%

Alternative maintenance fluid options include:

• Plasma-Lyte 148 with glucose five% (contains 5 mmol/L of potassium) - generally stocked in tertiary paediatric centres and intensive care
• Hartmann'south with glucose 5%

Glucose v% should exist given in maintenance fluids for children with no other source of glucose

High glucose containing fluids

• Glucose 10% (+/- additional sodium chloride) is ofttimes used in neonates and sometimes used in children with metabolic disorders. See worked adding (at bottom of page) for how to prepare Four fluid containing glucose 10%, however wherever possible pre-mixed bags should exist used. Always follow local injectable guidelines
• Glucose xv–xx% solutions are very occasionally used in neonates and in children with metabolic disorders. These should ideally be given via primal venous admission
• >20% glucose solutions are rarely required in children; inappropriate use tin cause severe adverse events.Only use in an ICU setting in discussion with senior staff

The inclusion of potassium in maintenance fluids should be considered once normal baseline electrolytes and renal function have been confirmed

• Use premixed fluid numberless containing potassium
• Avoid the addition of full-bodied solutions (sodium chloride, potassium chloride or glucose) to numberless of fluid, unless in that location is a clinical need, as this is a rubber run a risk
• The standard concentration for nigh circumstances is 20 mmol/Fifty of potassium chloride

Non-standard fluids

• Should only be prescribed with clear clinical indication, in consultation with a senior clinician
• Bank check the serum sodium and blood glucose regularly

Hypotonic Fluids containing a sodium concentration less than plasma are Not recommended for routine use in children. These fluids are associated with morbidity/mortality secondary to hyponatraemia

• Practice Not give glucose 4% with sodium chloride 0.18%
• Sodium chloride 0.45% solutions are only rarely indicated. If necessary, they should exist prescribed in consultation with a senior clinician

Consider consultation with local paediatric team when

• Unsure of which/how much fluid to use
• Electrolyte abnormalities
• Using a non-standard fluid
• Significant co-morbidities are present
• Fluid resuscitation >20mL/kg required

Consider transfer when

Children with severe electrolyte or glucose abnormalities
Daze requiring ≥40 mL/kg 4 fluid boluses
Children requiring care above the level of comfort of the local hospital

For emergency advice and paediatric or neonatal ICU transfers, meet Retrieval Services

Arroyo to Iv fluid prescription

Worked example for fluid replacement

An babe with severe gastroenteritis requires fluid rehydration and is not tolerating enteral fluids. A determination is made to proceed with IV fluid treatment
The infant weighed 10 kg prior to this illness merely her electric current weight is 9 kg.  She has clinical signs consistent with severe dehydration of 10%

The most accurate way to calculate a child'due south fluid deficit is:
Deficit (mL) = [Premorbid weight (kg) minus current weight (kg)] x yard

If a pre-morbid weight is non bachelor, use:
Deficit (mL) = weight (kg) x % dehydration x 10

To calculate the fluid deficit volume for this baby:

Fluid deficit (mL)	= [10 kg – 9 kg] x 1000
	= 1000 mL

In the first 24 hours supervene upon 5% dehydration. For this infant that is 500 mL (ie 500 mL ÷ 24 = 20.5 mL/60 minutes). Supervene upon the remaining deficit (hither another 500 mL ÷ 24 = xx.5 mL/hr) if however indicated after clinical reassessment, over the following 24 hours.

Side by side you summate the babe'south maintenance fluid requirement and check it using the figurer:

Hourly maintenance charge per unit (mL/hr)	= 4 x pre-morbid weight (kg)
	= 40 mL/hr

Total fluid requirement = Maintenance + Replacement of deficit + Replacement of ongoing losses

The starting total hourly fluid rate	= 40 mL/hr + twenty.5 mL/hr
	= lx.5 mL/hr

A re-assessment of the child's fluid condition, including any ongoing losses, should exist completed inside six hours

Boosted notes/other considerations

Electrolyte content of intravenous fluids

Fluid	Na mmol/L	Cl mmol/L	K mmol/L	Ca mmol/L	Lactate mmol/L	Mg mmol/L	Acetate mmol/L	Gluconate mmol/50	Glucose %	Osmolality mOsm/Fifty
Normal man plasma	135 - 145	96 - 106	3.v – 5.0	2.1 – 2.6	0.5 – i.8	0.seven – ane.2	0		iii.5 – eight.0	275 – 295
Sodium chloride 0.nine%	154	154	0	0	0	0	0	0	0	308
Sodium chloride 0.9% + glucose 5%	154	154	0	0	0	0	0	0	5	586
Sodium chloride 0.9% + glucose 5% + potassium 20 mmol/L	154	174	20	0	0	0	0	0	five	626
Plasma-Lyte 148 + glucose v%	140	98	5	0	0	1.v	27	23	5	584
Compound Sodium Lactate (Hartmann's)	130	110	v	2	xxx	0	0	0	0	274
Sodium chloride 0.45% + glucose five% *	77	77	0	0	0	0	0	0	5	428
*Note – Fluids with a sodium concentration <125 mmol/Fifty are not recommended for routine use

Worked calculation to catechumen 5% glucose to x% glucose

IV fluid bags contain a significant overfill book; a 1 50 Baxter make bag of 5% glucose contains an average volume of 1035 mL (51.75 grams of glucose). To set up a 10% solution, withdraw 120 mL from the ane L handbag of v% glucose and discard. Add 110 mL of 50% glucose. The concluding solution will contain 100 grams in 1025 mL (approximately x% glucose)

Last updated October 2020

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Source: https://www.rch.org.au/clinicalguide/guideline_index/Intravenous_fluids/

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