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Principles of fluid management for pediatric patients

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The preferred mode of rehydration for children should be enteral—using oral rehydration fluids containing replacement electrolytes. Intravenous (IV) replacement must only be used if a child cannot tolerate the volume of enteral fluid required, is nil-by-mouth or has an absorption problem.

Most indications for IV fluid replacement are the same for children and adults. Few indications specific to pediatrics are: 

  • Increased fluid losses in neonates with jaundice, undergoing phototherapy to conjugate bilirubin.
  • Increased losses due to decreased thickness of the stratum corneum—greater risk in premature neonates.
  • Decreased absorption of enteral feeds due to immature gastrointestinal function.

Isotonic fluids – sodium chloride 0.9% plus glucose 5%, should be given to pediatric patients with established hyponatremia. While fluid restriction can be used to reduce the amount of free water and compensate for the hyponatremia.

Source: Clinical Pharmacist. 2012, July. DOI:10.1211/PJ.2021.1.64703

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