see also: [[dehydration]], [[paediatric NGT]], [[hyponatremia (paeds)]], [RCH IV Fluids](https://www.rch.org.au/clinicalguide/guideline_index/Intravenous_fluids/) ([Devonthink link](x-devonthink-item://38B57DF5-599D-40EA-801E-3E3C5AC05491)), [Neonatal IVF RCH](https://www.rch.org.au/clinicalguide/guideline_index/Neonatal_intravenous_fluids/) see also: [[hypernatremia#Free water deficit / fluid deficit|Free water deficit (adults)]] [Rapid rehydration guideline](x-devonthink-item://D9534279-0D6C-41C3-BC99-B911632C31B0) - Vol over 4 hours = patient weight x 50mL - give NG if <2, IV if >2 > [!warning] Shock > 10-20mL/kg of 0.9% fast > not included in subsequent fluid calculations > [!TLDR] Rehydration > **Total fluid requirement** = maitenance + replace deficit + replace ongoing losses > > - **Deficit (mL)** = (premorbid weight kg - current weight) x1000 > - or = weight x % dehydration x 10 # replace deficit Replace deficit over 24–48 hours - For children with ≤5% dehydration, replace deficit in the first 24 hours - For children with >5% dehydration, replace deficit more slowly. Replace the 5% deficit in the first 24 hours and the remainder over the following 24 hours - Serial clinical assessment of hydration status must be made at regular invervals for all children with dehydration (See worked example under the flowchart below) ## Ongoing Fluid Losses Ongoing losses should be measured and replaced if clinically indicated, based on each previous hour (if significant) or 4-hour period (eg a 200 mL loss over the previous 4 hours is replaced by giving 50 mL/hr for the next 4 hours) Gastrointestinal tract losses are commonly replaced with sodium chloride 0.9% + potassium chloride 20 mmol/L # Maintenance (mL/H) > note: **full maintenance is for well children only!** > ==2/3 maintenance should be used in most unwell children== to prevent [[hyponatremia (paeds)|hyponatremia]] ==0.9% NaCl + 5% dextrose== or Plasma-Lyte 148 with glucose 5% (contains 5 mmol/L of potassium) or Hartmann's with glucose 5% **mnemonic**:: 4-2-1 maintenance fluids mL/H - 1-10 kg: 4x weight - 10-20 kg: 40mL + 2x(weight -10) - 20-60 kg: 60mL + 1x(weight-20) - \>60: 100mL/H | Weight (kg) | Full maintenance mL/day | mL/hour | | ----------- | ---------------------------------------- | ----------------------------- | | 3–10 | 100 x weight | 4 x weight | | 10–20 | 1000 plus 50 x (weight minus 10) | 40 plus 2 x (weight minus 10) | | 20–60 | 1500 plus 20 x (weight minus 20) | 60 plus 1 x (weight minus 20) | | >60 | 2400 mL/day is the normal maximum amount | 100 mL/hour | | Weight (kg) | Full maintenance (mL/hour) <br>Well child eg fasting for elective surgery | 2/3 maintenance (mL/hour) <br>Most unwell children *unless dehydrated* | | ----------- | -------------------------------------------------------------------------- | ----------------------------------------------------------------------- | | 5 | 20 | 13 | | 10 | 40 | 27 | | 15 | 50 | 33 | | 20 | 60 | 40 | | 25 | 65 | 43 | | 30 | 70 | 47 | | 35 | 75 | 50 | | 40 | 80 | 53 | | 45 | 85 | 57 | | 50 | 90 | 60 | | 55 | 95 | 63 | | ≥60 | 100 | 67 | ![[Pasted image 20230818215558.png]] # Neonatal IVF > [!warning] Resus fluids > bolus 10mL/kg of 0.9% NaCl ## neonatal maintenance IV fluids - 10% glucose for first 24-48 hours of life - after, consider adding sodium and potassium (eg 0.9% NaCl + 10% glucose) ## Fluid requirements for term bubs |**Day**|**Pre-Term:** <br>**32 to 36 weeks**|**Term:** <br>**>36 weeks**| |---|---|---| |**1**|60  mL/kg/day|60 mL/kg/day| |**2**|80|90| |**3**|100|100-120| |**4+**|120|100-120|