Inpatient Clinical Pathway for Children who Require Continuous Administration of IV Fluids
For patients > 28 days and < 18 years of age
- Out of Scope Locations
- PICU, NICU, CICU
- CCU
- Day Medicine
- Out of Scope Conditions
- Parenteral Nutrition
- Hypoglycemia
- Suspected metabolic disease
- Liver failure
- Adrenal insufficiency
- Abnormal renal function
- Heart failure
- Neurosurgical patients
- SIADH
- DKA
- Nephrotic syndrome
- Severe anemia
- Pre-chemotherapy hydration
- Diabetes insipidus
- Assess % Dehydration
- Dehydration Assessment Tool
- Compare current weight to baseline weight
- > 5% dehydration use bolus therapy to restore to euvolemia
- < 5% dehydration using enteral fluid (ORT) or NS boluses
- ED Dehydration/Gastroenteritis Pathway
Consider strategy for maintenance IVF
Initial Sodium Category | IVF Recommendations | |
---|---|---|
Low Sodium If patients remain hyponatremic consider risk of SIADH |
|
If sodium remains persistently high (> 155 mmol/L) or low (< 130 mmol/L) while following these guidelines: If patient is at risk for SIADH or hyponatremic, consider reducing infusion rate to two-thirds maintenance rate with potassium [see alternative]. Patients on prolonged IV fluids should be monitored for Dextrose 5% and lactated Ringer’s solution is an appropriate alternative to D5 normal saline. |
Normal Sodium (Or Sodium Value Unknown) |
||
High Sodium |
Dextrose 5% and 0.45% NaCl |
6-12 hours and adjust fluids accordingly
- 4 ml/kg/hr for the first 10 kg PLUS
- 2 ml/kg/hr for the second 10 kg PLUS
- 1 ml/kg/hr for each kg over 20 kg
- Maximum rate of 120 ml/hr
*Note:
Add potassium to all maintenance fluids if:
- Renal function is normal based on urine output and creatinine (if checked)
- And potassium level is normal (if checked)
- Lactated ringers contains 4 mEq/l potassium
Patients < 10 kg
Add 10 mEq/L potassium chloride
Patients ≥ 10 kg
Add 20 mEq/L potassium chloride
Revised: May 2022
Authors: L. Copelovitch, MD; L. Zaoutis, MD; L. Utidjian, MD; J. Edelson, MD; L. Simon, MD; J. Hart, MD;
M. Bruno, MD; B. Weinerman, MD; D. Whitney, MD, E. Salmon, MD; T. Nelin, MD
Evidence
- Clinical Practice Guideline: Maintenance Intravenous Fluids in Children
- Intravenous Fluid Management in the Pediatric Hospital Setting: Is Isotonic Fluid the Right Approach for all Patients?
- Hypotonic versus isotonic fluids in hospitalized children: a systematic review and meta-analysis
- Isotonic versus hypotonic maintenance IV fluids in hospitalized children: a meta-analysis
- Intravenous fluid regimen and hyponatraemia among children: a randomized controlled trial
- Randomised controlled trial of intravenous maintenance fluids