Patient selection: pediatric patient with recent acute gastroenteritis, severe dehydration and circulatory compromise
Initial response:
(1) Infuse a rapid intravenous bolus of normal saline at 20 mL per kg body weight.
(2) Measure serum sodium in mmol/L.
(3) Measure additional serum or blood tests.
(4) Culture blood, urine and stool.
If the circulation has not been restored after initial saline bolus then give additional saline up to a 20 mL/kg (maximum total bolus saline 40 mL/kg).
If bolus fluid infusion has not restored circulation then admit to ICU. Evaluate for intubation and ventilation.
Plan rehydration based on serum sodium:
(1) If the serum sodium > 150 mmol/L, then start oral rehydration slowly (over 12 hours) and add maintenance fluids.
(2) If the serum sodium <= 150 mmol/L, then start oral rehdyration over 3-4 hours.
Admit the patient to the hospital. Monitor the patient for rehydration every 1-2 hours.
If oral rehydration is inadequate then provide fluids by nasogastric tube or intravenous infusions.
Start feedings once stable.
