Referrals pathways for Regional Paediatric model
- all fluids should be calculated as maintenance + deficit correction + ongoing losses
- maintenance fluid requirements are calculated using the 4,2,1 rule (4ml/kg/hr for the first 10kg, 2ml/kg/hr for the second 10kg, and 1ml/kg/hr after that, with a maximum of 100ml/hr maintenance). Refer to the RCH intravenous fluids CPG and RCH maintenance fluid calculator.
- correction fluids can be calculated according to the RCH guidelines for gastroenteritis. Please ensure the intravenous fluid rates are used if looking at the RCH CPG, not the nasogastric rates.
All paediatric IV fluids at BHS are based on and compliant with the Standards for Paediatric Fluids: NSW Health (2nd edition).
An excellent review article of IV fluid volumes and types is available: McNab JPCH 2016.
Pre-mixed bags for IV fluids should be used in almost all circumstances for paediatric patients at BHS. Those available in BHS are:
|Pre-mixed IV fluid*||Standard uses|
|0.9% NaCl + 5% Dextrose ||Maintenance fluids|
|0.9% NaCl + 5% Dextrose + 20 mmol KCl ||Maintenance or replacement fluids (especially with likely Na/K losses e.g. gastroenteritis)|
|0.45% NaCl + 5% Dextrose ||Maintenance fluids (beware hyponatraemia - use under specialist consultation)|
|0.45% NaCl + 5% Dextrose + 20 mmol KCl ||Maintenance or replacement fluids (beware hyponatraemia - use under specialist consultation)|
|10% Dextrose||Neonates maintenance fluids (day 1-2 of life)|
|10% Dextrose + 0.225% NaCal + 10 mmol KCl/500ml||Neonates maintenance fluids requiring added electrolytes (day 2+ of life; available in SCN only)|
* note that there is emerging evidence for the use of Plasma-Lyte 148 in maintenance and replacement fluids, although this is not yet endorsed as standard practice.
* hyponatraemic fluids such as 0.225%, 0.22% or 0.18% (1/5) NaCal should be avoided unless under consultation with a Consultant Paediatrician (other than in neonates as listed above).
Almost all paediatric patients require dextrose to be added to IV fluids given the high glucose demand and metabolism of children compared with adults. All neonates should receive 10% dextrose and other children should receive 5% dextrose (plus additives) at all times, unless specified by the Paediatric Unit.
- Paediatric patients fasting for theatre & other situations still require dextrose.
- All fluid boluses for volume should be done using normal saline (0.9% NaCl), even in neonates
- Fluid boluses should be given as 10-20ml/kg in children, and 10ml/kg in neonates
- Dextrose (10% dextrose) can be used for correction of hypoglycaemia
- Colloids should be avoided for the use of fluid boluses in children
- Aggressive fluid boluses, even in sepsis, may lead to harm and must be undertaken with caution
- IV fluid resuscitation therapy, Long JPCH 2016
- Note that nasogastric fluids are given at different rates & we use different fluid types
- NGT fluid rates can be calculated using the RCH gastroenteritis CPG
- NGT fluids for rehydration/hydration are ORS or breast milk/artificial formula
- Never give IV fluids down a nasogastric tube
- BHS has an Enteral Fluids Chart for all enteral fluid orders (different to the IV Fluid Chart)