Fluid Management

Before Giving IV fluids - THINK - does this child need IV fluids? Be particularly careful with infants and in severe malnutrition (avoid if possible)

Includes:

Does not include:

Maintenance Fluids

Calculating fluid requirement for 24 hours:
Assuming no dehydration and no extra losses (e.g. from a surgical drain or from an NGT) a child will require over 24 hours:

Fluid amount per 24 hours:
  • 100mls/kg for the first 10kg of body weight
  • + 50mls/kg for the second 10kg of body weight
  • + 20mls/kg for every kg thereafter

Or fluid speed per hour:

  • 4 mls/kg for the first 10 kg
  • 2 mls/kg for the second 10 kg
  • 1 mls/kg for every kg thereafter

    Example 1
    A 14 kg boy will need Example 2
    A 35kg girl will need

    If there are other ongoing losses (e.g. from and NGT or from a drain) these should be added to the total daily fluid requirements

    These fluid requirements are the same whether the child takes the fluid orally, by NGT or IV drip.

    Calculating oral fluids requirements per feed:

    Example 3
    A 7 kg baby who is too breathless to breast feed, but is able to drink expressed milk from a spoon or cup will require:

    Feeds (EBM) can also be given 3 hourly via NG tube. Show the mother how many syringes or cups to be given at each feed.

    Calculating How Fast The IVI Should 'Drip'

    To work out how fast the IVI should drip the first you need to first determine two things:
    1. What type of giving set do you have?
      There are three types of giving sets available at QECH

    You can now work out how many "drops per minute" the IVI should drip:

    Formula: (desired rate ml/hr x giving set drops per ml)/60 = no. of drops per min

    This can be simplified for each of the giving sets:

    Type of giving Set
    15 drops per 1 ml Desired rate ml/hr ÷ 4 = no. of drops per min
    20 drops per 1 ml Desired rate ml/hr ÷ 3 = no. of drops per min
    60 drops per 1ml Desired rate ml/hr = no. of drops per min

    Example 1

    Maintenance fluids for a 7.2kg boy. With a ‘60 drops per 1 ml’ giving set.

    Example 2

    Maintenance fluids for a 33kg girl. With a '20 drops per 1 ml' giving set.

    How to make up fluids containing 5% or 10% Dextrose

    If you want to give a child IV fluids containing 5% dextrose or 10% dextrose and there is no suitable fluid available you will have to make it up by mixing 50% Dextrose or 25% Dextrose depending on what is available and another IV fluid. NEVER use 5% Dextrose solutions.

    Desired Dextrose
    Concentration
    Amount of 50% Dextrose Amount of other fluid
    5% Dextrose 1 part 50% Dextrose 9 parts Ringers or N. Saline
    10% Dextrose 1 part 50% Dextrose 4 parts Ringers or N. Saline
    12.5% Dextrose 1 parts 50% Dextrose 3 parts Ringers or N. Saline

    Desired Dextrose
    Concentration
    Amount of 25% Dextrose Amount of other fluid
    5% Dextrose 1 part 25% Dextrose 4 parts Ringers or N. Saline
    10% Dextrose 2 parts 25% Dextrose 3 parts Ringers or N. Saline
    12.5% Dextrose 2.5 parts 25% Dextrose 2.5 parts Ringers or N. Saline
    Examples:

    To make up 100 mls of R/L with 10% dextrose in a burette:

    To make up 400 ml of R/L with 5% dextrose without a burette.

    Glucose and Electrolyte content of IV fluids (contents per litre)

    Sodium
    mmoll
    Potassium
    mmo//l
    Calcium
    mmol/l
    Chloride
    mmol/l
    Lactate
    mmol/l
    Dextrose
    Energy
    kcal/l
    ½ Strength Darrows/ 5% Dextrose 61 17 51 27 50g 200
    Ringer's Lactate 130 5 2 111 29 0 0
    Normal Saline 0.9% 154 154 0 0
    5% dextrose 50g 200