Fluid management for children presenting to the emergency department: Guidelines for clinical practice

Summary 

Acute illness in children is frequently accompanied by fluid balance disturbances with many children experiencing hypovolaemia and/or dehydration of varying severity. Much of the evidence supporting fluid choice and management regimens stems from studies conducted on adults and well children. However, it is clear from more recent work concentrating on infants and children that physiological immaturity and the effects of acute illness impact significantly on their fluid requirements and responses to treatment. Guidelines exist for fluid resuscitation, fluid replacement and maintenance therapy, which are suitable in most circumstances for infants and children presenting to the ED with hypovolaemia and dehydration secondary to acute illness.

Small numbers of children presenting to the ED will have unique fluid requirements (e.g. children with cardiac disease, DKA, etc.) and these circumstances along with blood loss and other trauma-related fluid management issues (e.g. burns) is outside the scope of this paper and will not be discussed.

Keywords: Pediatric fluid management, Unwell child, Dehydration, Hypovolaemia