Calculation guidance for intravenous therapy for children over 4 weeks & under 16 years

Clinical signs of dehydration based on Parenteral Fluid Therapy Wallchart for children and young people - May 2014
CHILD
Degree of Signs are ordered in RESUSCITATION = B
Dehydration each column by severity
Fluid bolus volume for shocked patients = I Given over less than 15 minutes.
Moderate, 5% Dry mucous membranes (be wary in the mouth breather) Required bolus volume (ml) = body weight (kg) x 20 = I ml
but if the setting is trauma or DKA x 10 = I ml
Diminished skin turgor (pinch test 1-2 sec)
Altered neurological status (drowsiness, irritability) Record this bolus volume I (mI) in prescription box below and identify this fluid bolus volume with letter B
Deep (acidotic) breathing Use only sodium chloride 0.9% - repeat if necessary - REASSESS - call for senior help
For DKA / neonates, use separate prescription protocols.

Severe, 8% Decreased peripheral perfusion

REPLACEMENT: REDISTRIBUTION
Cool/mottled/pale peripheries Fluid deficit calculations (maximum 8%) = D
Yesterday’s Date % of dehydration x bodyweight in kg x 10 = 11 ml
Capillary refill time > 2 sec
Grand total in Grand total out Balance Circulatory collapse Amount given as fluid bolus volume = I ml
Residual deficit (11 minus 1 ) = 111 ml
Do not use more than 8% dehydration in calculations.
Give residual deficit over 48 hours ( 111 divided by 48 ) = 1V ml/hr
Prescribe the calculated Maintenance and Deficit fluids individually.
Additional ongoing losses volume (e.g. vomiting, diarrhoea, drainage) = O
Recent Weight kg Weighed / / Calculate at least every 4 hours (unless otherwise instructed)
Estimated Replace lost volume with an equal volume of fluid (usually 0.9% saline +/- KCL) = V ml

Date Time Weight Na K Urea Creatinine Glucose Chloride Bicarbonate

ROUTINE MAINTENANCE = M
(kg) (mmol/L) (mmol/L) (mmol/L) (micromol/L) (mmol/L) (mmol/L) (mmol/L) Maintenance Fluid - in females > 40kg max 2000 ml/day, in males > 60kg max 2500 ml/day (equivalent to 80 & 100 ml/hour respectively)
First 10kg; 4ml/kg/hr = VI ml/hr
Second 10kg; 2ml/kg/hr = VII ml/hr
For each kg over 20kg; 1ml/kg/hr = VIII ml/hr
Maintenance total (V1 + V11 + V111) = IX ml/hr
Consider reducing maintenance volume to 2/3 if risk of hyponatraemia is high. = IX ml/hr
Prescribe the calculated Maintenance and Deficit fluids individually.
Indications - all that apply: Fluid Bolus volume, Deficit, On-going loss volume, Maintenance, Drug Prescription * Medicines must be recorded in Drug Kardex ** Model name, Serial number.

Date Time Volume Infusion Fluid/Type Additives * Rate ml/hr Prescriber’s Administered Checked Batch/Lot No. Pump Start Finish Volume
Range Signature By By & Expiry Date Details ** Time Time given

REASSESSMENT Date Time Is infusion prescription still suitable? Doctors Signature Is patients hydration improving? Special Instructions:
Yes or No Are oral fluids now appropriate?
12 hour Is potassium needed?
Reassessment Yes or No What about Urine output?
 ADULT INTRAVENOUS FLUID PRESCRIPTION CHART

Daily Assessment Approximate daily healthy adult fluid and electrolyte requirements
1. Does the patient need IV fluids? Sodium: 50-100 mmol/day
2. Check U &Es done in last 24 hours Potassium: 40-80 mmol/day
3. Check fluid balance Fluid requirement: 1.5-2.5 litres/day

Fluid prescription guidance

0.9% Saline: Na=154mmol/litre; 4% dextrose/0.18%saline: Na= 30mmol/litre
Date: Hartmann’s: Na= 131mmol/litre; K= 5mmol/litre.
Na
K • Hartmann’s is a safe 1st choice in the initial 24 hours following surgery and for
Urea initial volume replacement (except in liver failure)
Creatinine • Replace abnormal GI losses with additional premixed bags of 0.9% saline and
KCL
• For maintenance and standard diabetic sliding scale fluid regimens: consider
the use of premixed bags of 4% dextrose/0.18% saline and KCl according to
daily assessment, at a maximum rate of 1 litre/12 hours (83mls/hour) in order
to reduce the risk of hyponatraemia
• Never use 4% dextrose/0.18% saline for a fluid challenge/ resuscitation

Commenced

Date Fluid Additives Volume Duration Signature Date Time Batch Signature 1 Signature 2
and Number
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number