see: [[Paediatric fluids]], [RCH NGT fluid guide](https://www.rch.org.au/clinicalguide/guideline_index/Nasogastric_Fluids/), [[dehydration]], [[hyponatremia (paeds)|paediatric SIADH]]
[RCH NGT insertion guide](https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Enteral_feeding_and_medication_administration/)
> [!Key points]
> - whenever possible, use oral or NG for fluids
> - shocked children require [[Paediatric fluids|IV fluids]]
> - Rapid rehydration useful in [[Gastroenteritis]]
> - aim 10 or 25 mL/kg/hr oral
> - use eg Gastrolyte, HYDRAlyte, Pedialyte, ORS
> - avoid rapid rehydration protocol if [[dehydration|dehydrated]] due to respiratory illness eg bronchiolitis; more appropriate for slow NGT or IVF
# Calculate volume and rate
## volume
- ==2/3 maintenance== is appropriate for most unwell children
- use [[Paediatric fluids#Maintenance mL H|4,2,1 rule]]
# Approach to rehydration
![[Pasted image 20230818215558.png]]
# Rapid NGT rehydration guide
Used to correct moderate dehydration in common illnesses where the goal is to expedite clinical improvement for discharge to home care (eg gastroenteritis).
- Not suitable for children with dehydration from respiratory illnesses, meningitis or significant electrolyte abnormalities
- Not suitable if <6 months, significant comorbidities present, or abdominal pain. See slow nasogastric rehydration section below
- Children with **severe** dehydration need IV fluid resuscitation
- Use ==ORS== at **10-25 mL/kg/hr for 4 hours** (See hourly rate range table below).
- There is limited evidence regarding the rate of rapid nasogastric rehydration that is both safe and effective
- A range is provided as local practices and protocols regarding maximum rehydration rate vary
- Use clinical judgment (see [dehydration](https://www.rch.org.au/clinicalguide/guideline_index/Dehydration/)) and seek senior clinician support if unsure
> if you have starvation/ [[Ketones|ketosis]] , ORS isn’t enough to fix this
| Weight on Admission | 10 mL/kg/hr <br>(replace 4% deficit) | 25 mL/kg/hr <br>(replace 10% deficit) | Total infusion time |
| ------------------- | --------------------------------------- | --------------------------------------- | ------------------- |
| 7 kg | 70 mL/hr | 175 mL/hr | 4 hrs |
| 8 kg | 80 mL/hr | 200 mL/hr | 4 hrs |
| 9 kg | 90 mL/hr | 225 mL/hr | 4 hrs |
| 10 kg | 100 mL/hr | 250 mL/hr | 4 hrs |
| 12 kg | 120 mL/hr | 300 mL/hr | 4 hrs |
| 14 kg | 140 mL/hr | 300 mL/hr* | 4 - 4.5hrs* |
| 16 kg | 160 mL/hr | 300 mL/hr* | 4 - 5.5 hrs* |
| 18 kg | 180 mL/hr | 300 mL/hr* | 4 - 6 hrs* |
| 20 kg | 200 mL/hr | 300 mL/hr* | 4 - 6.5 hrs* |
# slow rehydration guide
- Preferred in children with moderate dehydration and conditions where high/rapid fluid volumes are not appropriate
- **In the first 24hrs:** replace 5% fluid deficit over the first 6 hours. Clinically reassess, and if ongoing hydration support is required give daily maintenance volume over the next 18 hours. To calculate rate, see Slow Nasogastric Rehydration table below.
- **Subsequent 24 hrs:** Replace remaining deficit if still indicated, in addition to daily maintenance volume
Table: Rate of slower NG rehydration (Moderate dehydration – replaces 5% deficit plus maintenance)
| Weight | mL/hr <br>*0 – 6 hrs* <br>(Deficit replacement –based on 5% deficit) | mL/hr <br>*7 – 24 hrs* <br>(Full 24-hour maintenance volume, over remaining 18 hours) |
| ------ | ------------------------------------------------------------------------ | ------------------------------------------------------------------------------------------- |
| 3 kg | 25 | 15 |
| 4 kg | 35 | 20 |
| 5 kg | 40 | 25 |
| 6 kg | 50 | 30 |
| 7 kg | 60 | 40 |
| 8 kg | 70 | 45 |
| 9 kg | 75 | 50 |
| 10 kg | 85 | 55 |
| 12 kg | 100 | 60 |
| 15 kg | 125 | 70 |
| 20 kg | 165 | 80 |
| 30 kg | 250 | 95 |