In a 2-week-old infant with signs of dehydration and poor feeding, what fluid bolus should you give?

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Multiple Choice

In a 2-week-old infant with signs of dehydration and poor feeding, what fluid bolus should you give?

When a very young infant shows dehydration with signs of poor perfusion, the goal is to rapidly restore intravascular volume with an isotonic crystalloid while minimizing the risk of overload. A starting dose of about 10 mL/kg of normal saline given quickly (over several minutes) is the safest and most effective way to improve perfusion in a neonate, since it raises circulating volume without the dangers that come with larger boluses in such a small patient. If perfusion doesn’t improve after that first bolus, repeat another 10 mL/kg bolus while closely watching heart rate, color, cap refill, urine output, and for any signs of fluid overload. Dextrose-containing fluids are not used for initial volume resuscitation because they don’t reliably expand intravascular volume and can cause hyperglycemia; reserve them for other indications.

When a very young infant shows dehydration with signs of poor perfusion, the goal is to rapidly restore intravascular volume with an isotonic crystalloid while minimizing the risk of overload. A starting dose of about 10 mL/kg of normal saline given quickly (over several minutes) is the safest and most effective way to improve perfusion in a neonate, since it raises circulating volume without the dangers that come with larger boluses in such a small patient. If perfusion doesn’t improve after that first bolus, repeat another 10 mL/kg bolus while closely watching heart rate, color, cap refill, urine output, and for any signs of fluid overload. Dextrose-containing fluids are not used for initial volume resuscitation because they don’t reliably expand intravascular volume and can cause hyperglycemia; reserve them for other indications.

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