Child resuscitation: IV crystalloid 🚨 👶
🚨 👶 PAEDIATRIC HIGH ALERT — EDUCATIONAL DRAFT, NOT A PRESCRIBING ORDER. Drug choice, indication, formulation, dose, route and monitoring require current BNF/BNFC, product SmPC and local NHS protocol. Source reviewed 3 November 2026; independent clinical/pharmacy sign-off pending.
🧬 Mechanism and reason for use
- Isotonic crystalloids may restore intravascular volume in hypovolaemia; septic/cardiogenic shock requires careful reassessment and multidisciplinary support.
- Term neonates, children and young people with clinical indications for IV resuscitation; DKA uses separate specific fluid pathway.
💊 Indication-specific UK regimen / dosing boundary
- NICE NG29 child/young person: glucose-free isotonic crystalloid containing Na 131–154 mmol/L at 10 mL/kg over less than 10 minutes, reassess immediately; coexisting cardiac/renal disease may require smaller volumes.
- Term neonates: NICE NG29 permits 10–20 mL/kg over less than 10 minutes; neonatal specialist protocol takes precedence.
- After about 40–60 mL/kg as initial resuscitation, NICE recommends expert/PICU advice; earlier escalation is appropriate when response is poor.
🔎 Before writing a prescription
- Use measured/estimated child weight and correct infusion device, account for age, perfusion, cardiac/renal disease, glucose and electrolytes; distinguish resuscitation from maintenance.
🧪 Monitoring and reassessment
- After every bolus: perfusion, work of breathing, hepatomegaly, pulse/BP, urine, mental state, signs of overload.
🚨 Serious pitfalls / when to escalate
- DKA fluid management is a separate algorithm; avoid uncontrolled repeated boluses or adult-sized bags.
📖 UK reference documents
Editorial status: Source checked for the specific statements above on 3 November 2026. References may be updated. This card has not had formal independent pharmacist/consultant approval; no unlisted indications, paediatric extrapolation or automatic renal-dose adjustments are implied.
