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Dry mucous membranes (not reliable if the child is mouth breathing or just after a drink).Altered responsiveness (irritable, lethargic)*.1 Clinical dehydrationĬlinical features suggesting dehydration include: The current NICE guidelines for IV fluid prescription in children and young people outline the diagnosis of dehydration or shock based on the presence of the clinical features listed below. The volume status of the child should be assessed looking for features of clinical dehydration or shock. To determine the indication for IV fluids it is important to take a focussed history and examine the child. Adapted from NICE algorithms for IV fluid therapy in children and young people in hospital. Algorithm for deciding the type of IV fluids by indication in infants and children. Obstructive: cardiac tamponade, tension pneumothorax, congenital heart diseaseįigure 1.Cardiogenic: congenital heart disease, arrhythmia.Distributive: sepsis, anaphylaxis, neurological injury (neurogenic).Hypovolaemic: gastroenteritis, burns, diabetic ketoacidosis, heatstroke, haemorrhage.Types of shock and their underlying causes include: Resuscitation is required if the patient is shocked. Replacement fluid therapy is required if there is an existing fluid deficit and the oral route is not possible or impractical.Įxamples of clinical situations where this may occur include: Routine maintenance fluid therapy is required if the current oral intake is not sufficient to remain hydrated.įor example, if the patient is ‘nil by mouth’ for any significant period, full maintenance fluids will be required.Īlternatively, if the patient can obtain some of their intake orally, but is not completely meeting their fluid requirements, they may be given a percentage of full maintenance fluids based on their intake. In these cases, it is necessary to determine the indication for fluids, type of fluid and volumes/infusion rate required.īroadly there are three indications for IV fluids in infants and children: routine maintenance, replacement and resuscitation. However, there are certain situations where the oral route is contraindicated or impractical. oral rehydration solution) via the oral or nasogastric route should be used. You might also be interested in our prescribing question bank which contains over 250 questions.
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