Inpatient Clinical Pathway for Children who Require Continuous Administration of IV Fluids
Out-of-scope Locations
- PICU, N/IICU, CICU, CCU, Day Medicine
Out-of-scope Conditions
- Heart failure
- Parenteral Nutrition
- Hypoglycemia
-
Suspected Metabolic
Disease - Confirmed SIADH
- DKA
- Diabetes Insipidus
- Adrenal insufficiency
- Abnormal renal function
- Nephrotic syndrome
- Severe anemia
- Neurosurgical patients
- Pre- and post-
chemotherapy hydration - Tumor Lysis Syndrome
- Burns
- Healthy Euvolemic Child NPO for Procedure/Sedation/Anesthesia
Isotonic fluid boluses until euvolemia restored
Initial Sodium Level | IVF Recommendations | KCl Considerations | Calculating Maintenance Rate 4-2-1 Rule |
---|---|---|---|
Low
Review SIADH Risk Factors
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High |
Dextrose 5% and 0.45% NaCl with KCl at maintenance rate |
Frequent Reassessment
- Reassess hydration status, oral intake, and ongoing losses q6-12hr, adjust IVF accordingly
- Monitor for electrolyte changes
- Sodium persistently high (> 155 mmol/L) or low (< 130 mmol/L) consider Nephrology Consult
- Adjust fluid composition and rate to make up for ongoing losses
Review Electrolyte Composition of Various Body Fluids
Evidence
- Clinical Practice Guideline: Maintenance Intravenous Fluids in Children
- Intravenous Fluid Management in the Pediatric Hospital Setting: Is Isotonic Fluid the Right Approach for all Patients?
- Hypotonic Versus Isotonic Fluids in Hospitalized Children: a Systematic Review and Meta-analysis
- Isotonic Versus Hypotonic Maintenance IV Fluids in Hospitalized Children: a Meta-analysis
- Intravenous Fluid Regimen and Hyponatraemia Among Children: a Randomized Controlled Trial
- Randomised Controlled Trial of Intravenous Maintenance Fluids