Inpatient Pathway for Continuous Administration
of IV Fluids General Pediatrics
Child Requiring IV Fluids
Exclusion Criteria
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Assess Percent Dehydration
Rehydration
Compare current weight to baseline weight
(preferred method) or use
Dehydration Assessment Tool
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< 5% Dehydration
≥ 5% Dehydration
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Fluid Selection for Maintenance Needs
Euvolemia or < 5% dehydration achieved
Refer to pre-bolus sodium
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No Risk Risk of Elevated ADH
< 10 kg ≥ 10 kg

Dextrose
5% 0.45% NaCl
Maintenance rate with potassium*

Dextrose
5% 0.45% NaCl
two-thirds Maintenance rate with potassium*

Preferred
Dextrose
5% 0.45% NaCl
two-thirds Maintenance rate with potassium*

Alternative
Dextrose
5% 0.9% NaCl
Maintenance rate with potassium*

Rationale for Using two-thirds Maintenance Rate
High Sodium Normal Sodium Low Sodium
146-155 mmol/L
Hypernatremic
dehydration
136-145 mmol/L
Isonatremic
dehydration
128-135 mmol/L
Hyponatremic
dehydration
Dextrose 5% and 0.45% NaCl
Maintenance rate with potassium*

Preferred
Dextrose
5% 0.45% NaCl
two-thirds
Maintenance rate with potassium*

Alternative
Dextrose
5% 0.9% NaCl
Maintenance rate with potassium*

If sodium > 155 or < 128 mmol/L, recheck sodium and consider nephrology consult for assistance with acute management.
Ongoing Losses Replacement
Adjust fluid composition and rate to make up for ongoing losses, if applicable (Electrolyte Composition of Various Fluids)
Sodium bicarbonate: Consider addition only if severe ongoing losses of bicarbonate-containing body fluid
Frequent Reassessment
Reassess hydration status, oral intake, and ongoing losses every 6-12 hours and adjust fluids accordingly
Maintenance IV Fluid Rate: 4-2-1 Rule
Use patient's weight in Kgs:
  • 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).

Patients < 10 kg
Add 10 mEq/L potassium chloride

Patients ≥ 10 kg
Add 20 mEq/L potassium chloride

Posted: October 2014
Revised: June 2015, reviewed May 2017, January 2018
Authors: C. Bonafide, MD, MSCE; L. Copelovitch, MD; L. Zaoutis, MD; L. Utidjian, MD; E. Orenstein, MD; J. Edelson, MD; A. Palladino, MD; L. Simon, MD; S. O’Neill, PharmD