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Pediatric Medicine

Answer 4
  1. IV fluid bolus of 0.9 normal saline at 10 mL/kg. The patient has isonatremic dehydration. Acute IV fluid resuscitation should consist of isotonic fluids to restore intravascular volume. Although hypotonic solutions may have a role in correcting intravascular volume depletion, they should not be provided as IV fluid boluses given their hypotonicity.6 Fluid boluses with hypotonic solutions increase the risk of fluid shifts, which may cause seizures. Of the IV fluids listed, isotonic saline (0.9 normal saline) would be the most appropriate to initially replete the infant’s intravascular volume.7 Given the infant’s apathy and inability to breast or bottle feed, oral rehydration would not be an appropriate first-line therapy to correct the dehydration if IV fluid is readily available.

    De Bruin WJ, Greenwald BM, Notterman DA. Fluid resuscitation in pediatrics. Crit Care Clin 1992;8:423-38.

    7. Duke T, Molyneux EM. Intravenous fluids for seriously ill children: time to reconsider. Lancet 2003;362:1320-3.

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