Types of fluid to be used in Pediatric (According to Age)

  • Neonate
    • 0-48 hours
      < 1kg: 5% Dextrose
      >1kg: 10% Dextrose
    • 2nd DOL- 1 Month
      • 10% EP
  • 1 month- 3 years
    • 5% EP
  • >3 years
    • ½ DNS + 1ml KCL in each 100ml fluid

Remember: You need to change the fluid or rate according to the patient condition.

IV Fluid and feed calculation in Neonate

Day of Life

Preterm (<37 WOG)
ml/kg/day

 Term (>37 WOG)
ml/kg/day
1st 80 60
2nd 100 80
3rd 120 100
4th 140 120
5th 160 140
6th 180 150
7th 180 150

 

  • IV Fluid calculation (Example)
    • Preterm, 1st DOL, Birth Weight: 3.1 kg
      • 3.1 x 80 = 248ml/24 = 10.33
      • Give 10% Dextrose @ 10.33 ml/ hr
  • Adjust the fluid rate if baby is feeding or under
    medication and ionotropes.

    • Total fluid requirement – (Feed-Medicine – Ionotropes)
      • Medicine and ionotropes are dissolved in fluid so, you need to subtract them from the total
        fluid requirement to prevent fluid overload.

        • For example:
          Let’s take above case. Medicine Volume= 10ml
          and Ionotropes= 1ml/hr
          [(248- 10)ml / 24 ] – 1ml/hr = 8.9 ml/hr
  • Note: 
    • In Preterm, Perinatal Asphyxia: Add 1ml Calcium gluconate in each 100ml fluid
    • In Perinatal Asphyxia, Bronchopulmonary dysplasia, Congenital heart disease, TTN, RDS :
      Give only 2/3rd fluid
    • If baby is under phototherapy : Add 20% extra fluid ( in single phototherapy) and 30% (in Double
      Phototherapy
  • From 6th DOL to 28th Day of Life, rate of fluid should
    be 180 ml/kg/day in Preterm and 150ml/kg/day in
    term. After that, use Holliday Segar method for maintenance fluid.

Feed calculation in Neonate

  • Formula for IV fluid calcuation and Feed calculation is
    same. Use the above mention formula to calculate Feed (Breastmilk + Lactogen )in Neonate
  • Feeding are given every 2 hourly or 3 hourly. So, you need to divide the total feed accordingly.
    • For example:
      • Term baby, 2nd DOL, Birth weight: 3 Kg
      • Total feed: 240 ml and you want to give feed
        every 3 hourly
        So, 240ml/8 = Give 30ml/ 3hrly

IV Fluid and feed calculation in Children

  • Use Holliday Segar Method to calculate maintenance
    fluid

    • Holliday Segar Method
      For the first 10 kg of body weight, 4 mL/kg/hr
      PLUS
      For the second 10 kg of body weight,
      2mL/kg/hr PLUS
      For remaining weight above 20 kg, 1 mL/kg/hr
    • For example:
      3Y/M, Weight: 23Kg
      Fluid Calculation:
      (10x 100ml + 10 x 50ml + 3 x 20ml ) =
      1560ml
      1560ml/24
      Give IV fluid at 65ml/hr

Note: Formula for fluid and feed calculation is same which is Holliday Segar Method.

 

How to determine the rate of fluid?
(Microdrops and Megadrops)

In intravenous (IV) therapy, the rate at which fluids are delivered into a patient’s bloodstream is measured in terms of drops per minute.

These “drops” are typically categorized into either “microdrops” or “megadrops” (also commonly known as “macrodrops”), which vary in size and are determined by the specific drip chamber in use.

Microdrops:
Microdrip sets are used when small, precise amounts of fluid need to be delivered. These are generally used for medication delivery, or when the patient is dehydrated or requires a slow and precise amount of fluid.

As per your specification, 1 milliliter (ml) contains approximately 60 microdrops.

Megadrops/Macrodrops:
Macrodrip sets, often simply referred to as “drip sets,” are used when larger amounts of fluid need to be delivered, and precision is not as important. These sets are commonly used for fluid replacement, like in cases of blood loss.

1 ml contains approximately 20 megadrops/macrodrops.

Note: Rate of fluid is caluculated by counting drops only when if you don’t have Infusion Pump available.

You can calculate the rate of fluid (in microdrops or megadrops per minute) based on the volume to be infused (in ml), the drop factor (drops/ml), and the time for infusion (in minutes).

Here’s the formula:

Rate (drops/minute) = (Volume in ml * Drop Factor) / Time in minutes

If the infusion time is given in hours, convert it to minutes (1 hour = 60 minutes) before using the formula.

Let’s say you want to infuse 1000 ml over a period of 8 hours.

First, convert the time to minutes: 8 hours = 480 minutes.

For microdrops (where 1 ml = 60 microdrops):
Rate = (1000 ml * 60 microdrops/ml) / 480 minutes = 125 microdrops/minute

For megadrops (where 1 ml = 20 megadrops):
Rate = (1000 ml * 20 megadrops/ml) / 480 minutes =
~41.67 megadrops/minute

These rates tell you how quickly the fluid should be dropping for the given volume and time period. To ensure you have the right flow rate, you can count the number of drops that fall in one minute and adjust the flow rate as needed.

IV Fluid Bolus in Shock (NS/RL)

  • Use Normal Saline
    • Neonate: 10ml/kg over 20 minutes
    • Child: 20 ml/kg over 20 mintues
  • Access the dehydration or blood pressure, if not
    improved repeat the bolus for 3-4 times.
  • Remember: Normal saline cause hypercholeremic acidosis so avoid giving multiple boluses. Instead, use RL if you need more fluid or, give blood transfusion to correct shock.

Fluid Therapy in Acute Gastroenteritis

  • Plan A (No Dehydration)
    • Frequent breastfeeding + ORS or clean water
    • If not exclusive breastfed, give ORS, soup, rice water, yoghurts drink or clean water
    • Extra fluid intake
      • Up to 2 years: 50 to 100ml after each loose stool and between them
      • 2 years or more: 100 to 200ml after each loose stool and between them
  • Plan B (Some Dehydration)
    • Daily fluid requirement
      • Use Holliday Segar Method (PLUS)
      • Deficit replacement
        • 75ml/kg ORS to be given over 4 hours
        • If patient vomit, give IV Ringer Lactate(RL) at
          same dose and duration (PLUS)
      • Replace losses
        ORS should be administered in volumes equal
        to diarrheal losses. Maximum of 10ml/kg per
        stool
  • Plan C (Severe Dehydration)
    • If patient is in shock, give bolus fluid (IVF NS)
      • Neonate: 10ml/kg over 20 minutes
      • Child: 20 ml/kg over 20 mintues
      • Repeat as necessary
    • After resuscitation, use Plan C (USE IVF Ringer
      Lactate)

      • <12 months
        • 30ml/kg in 1 hour
        • 70ml/kg in 5 hours
      • >12 months
        • 30ml/kg in 30 minutes
        • 70ml/kg in 2 and ½ hour

Types of commonly available IV fluid

  • Hypotonic
    • 0.45% Normal Saline (1/2 NS)
    • 5% Dextrose in Water (D5)
    • Isolyte – P
  • Isotonic
    • Lactated Ringer’s (LR)/ Ringer Lactate/ Hartman
    • 0.9% Normal Saline (NS)
    • Dextrose Normal Saline (DNS)
  • Hypertonic
    • 10% Dextrose (D10)
    • 25% Dextrose (D25)
    • 3% Normal Saline (3% NS)

 

Blood Transfusion in Pediatric

  • Types of blood: Whole blood, Packed Red Blood Cell (PRBC), Fresh Frozen Plasma (FFP), Fresh Blood, Platelet Concentrates (PC)
  • Indication:
    • Low hemoglobin (Whole blood, Fresh blood,
      PRBC)

      • < 5 gm/dL
      • 5-7 gm/dL (Transfusion based on clinical judgement)
      • >7 gm/dL (may consider if hemodynamically unstable)
    • Bleeding or Low platelet (PC, FFP)
  • Dose: 0.15 ml/kg over 6- 4 hours + Inj Lasix (Furosemide) 0.5mg/kg in between

IV Fluid Preparation

  • 10% EP
    • Requirement:
      • IVF DNS 500ml (1)
      • IVF 10% Dextrose 500ml (1)
      • Syringe 50ml (1) + 10ml (1)
      • Inj KCL (1 amp)
    • Procedure:
      Take out 100ml fluid from 10% Dextrose
      Add 100ml DNS to 10% Dextrose
      Add 5ml KCL i.e. 10 meq to 10% Dextrose
  • 5% EP
    • Requirement:
      Inj D5 500ml (1)
      Inj DNS 500ml (1)
      Inj KCL (1)
    • Procedure:
      Take out 100ml fluid from 5% Dextrose
      Add 100ml DNS to 5% Dextrose
      Add 5ml KCL i.e. 10 meq to 10% Dextrose
  • ½ NS
    • Requirement:
      Normal Saline 250 ml (1)
      SWFI 250 ml (1)
      Syringe as required
    • Procedure:
      Mix equal volume of NS and SWFI
      For example: To make 500ml of ½ NS, mix
      250ml of NS and 250 ml of SWFI
  • 1/5th NS
    • Requirement:
      Normal Saline 100 ml (1)
      SWFI 400ml (1)
      Syringe as required
    • Procedure:
      Take distilled water of 500ml and remove
      100ml. Then, add 100ml NS to 400ml distilled
      water.
  • 2/5th NS in 10% Dextrose
    • Requirement:
      Normal Saline
      Inj 10% Dextrose
      Syringe 20ml
    • Procedure:
      Remove 200ml of 10% Dextrose from 500ml
      and add 200ml of NS in it.
  • ½ DNS
    • Requirement:
      Inj DNS 500ml (1)
      Inj 5% Dextrose 500ml (1)
      Inj 10% Dextrose 500ml (1)
    • Procedure:
      Take out 250ml of Inj DNS and add in 250 ml of
      5% dextrose or 10% dextrose
  • 10% ½ DNS
    • Requirement:
      Inj ½ DNS (1)
      50% Dextrose (50ml) – 2 amp
    • Procedure:
      Remove 50ml ½ DNS and add 50ml of 50%
      Dextrose (2 ampoule)
  • 1/4th DNS
    • Requirement:
      Inj DNS 500ml (1)
      Inj 5% Dextrose 500ml (1)
      Inj 10% Dextrose 500ml (1)
    • Procedure:
      Take out 125ml of 5% or 10% Dextrose from
      500ml then add 125ml of DNS in the remaining
      dextrose ( 125ml DNS + 375ml 5% or 10%
      Dextrose)

Note: Use 5% dextrose in fluid for Neonate and 10% dextrose for older child.

  • 1/3rd DNS
    • Requirement:
      Inj DNS 500ml (1)
      Inj 5% Dextrose 500ml (1)
      Inj 10% Dextrose 500ml (1)
    • Procedure:
      Take out 166 ml of 5% or 10% Dextrose from
      500mlthen add 166 ml of DNS in the
      remaining dextrose ( 166ml DNS + 334ml 5% or 10% Dextrose)
  • 1/5th DNS
    • Requirement:
      Inj DNS 500ml (1)
      Inj 5% Dextrose 500ml (1)
      Inj 10% Dextrose 500ml (1)
    • Procedure:
      Take out 100 ml of 5% or 10% Dextrose from
      500ml then add 100ml of DNS in the
      remaining dextrose ( 100ml DNS + 400ml 5% or 10% Dextrose)
  • 2/3rd DNS
    • Requirement:
      Inj DNS 500ml (1)
      Inj 5% Dextrose 500ml (1)
      Inj 10% Dextrose 500ml (1)
    • Procedure:
      Take out 333ml of 5% or 10% Dextrose from
      500ml then add 333ml of DNS in the remaining dextrose ( 333ml DNS + 167ml 5% or 10% Dextrose

 

Medicine Preparation

  • Inj Morphine
    • 1 ampoule = 1ml= 10mg
    • Mix 1ml Morphine in 9ml NS or SWFI i.e. 10ml=10mg
    • Dose: 0.1 mg/kg/dose
  • Inj Fentanyl
    • 1 ampoule = 2ml= 100mcg (i.e. 1ml= 50mcg)
    • Mix 2ml Fentanyl in 8ml NS i.e. 10ml=100mcg
    • Dose:
      1-2 mcg/kg/hr (Infusion)
      1-4 mcg/kg/dose (Sedation)
  • Inj Vancomycin
    • 1 Vial (Powder) = 500mg
    • Dissolve 1 vial Vancomycin in 10ml distilled water i.e. 10ml= 500mg
    • Dose: 60-100 mg/kg/day
      Note: It should be further dissolved in 20ml NS. After dissolving, the vial should be stored in refrigerator at 5 dgree celcius.
  • Inj Imipenem
    • 1 Vial (Powder) = 500mg
    • Dissolve 1 vial Vancomycin in 4ml distilled water i.e. 4ml= 4mg
    • Dose: 100-200 mg/kg/day BD
    • Note: It should be further dissolved in 10ml NS. After dissolving, the vial should be stored in refrigerator at 5 dgree celcius.
  • Inj Vecuronium
    • 1 Vial (Powder) = 4mg
    • Dissolve 1 vial Vecuronium in 4ml SWFI i.e. 4ml = 4mg or 1ml=1mg
    • Dose: 0.1-0.2 mg/kg/day BD
  • Inj Clindamycin
    • 1 ampoul= 2ml= 300mg/600mg
    • Mix 2ml Morphine in 9ml NS i.e.10ml=300mg/600mg
    • Dose: 10mg/kg/dose
      Note: Further dissolve it in 10ml NS and give it
      over 30 minutes
  • Inj Aminophyline
    • 1 ampoule = 10ml= 250mg i.e. 1ml= 25mg
    • Mix 1ml Aminophyline in 9ml NS i.e. 10ml=25mg
    • Dose:Loading: 5mg/kg/dose
      Maintainance: 1-2 mg/kg/dose (TDS)
    • Note: Loading dose should be dissolved in 10ml
      NS. After 24 hours of loading dose, maintainance
      dose should be given.
  • Inj Caffeine
    • 2ml= 25mg
    • Mix 2ml Caffeine in 3 ml NS i.e 5ml= 25mg
    • Note: Loading dose should be dissolved in 10ml
      NS and maintainaince dose should be given after
      24 hours of loading dose
  • Inj Dobutamine
    • 1 ampoule = 5ml= 250mg i.e 1ml= 50mg
    • Preparation: (B.W x 6) mg mixed in …ml NS or 5%
      Dextrose as per prescription
  • Inj Dopamine
    • 1 ampoule = 5ml= 200mg i.e 1ml= 40mg
    • Preparation: (B.W x 6) mg mixed in …ml NS or 5% Dextrose as per prescription
  • Inj Phenytoin
    • 1 ampoule = 2ml= 100mg i.e 1ml = 50mg
    • Mix 2ml Phenytoin in 3ml NS i.e. 5ml=100mg
    • Dose:
      Loading : 15-20mg/kg
      Maintaenance: 5-8 mg/kg/day
      Note: Further dissolve it in 10ml NS and give over
      30 minutes.
  • Inj Levetiracetam
    • 1 Vial (Powder) = 500mg
    • Dissolve 1 vial Levetiracetam in 5ml distilled water i.e. 5ml= 500mg
    • Dose:
      • Loading: 20mg/kg/day
      • Maintainance: 5-10mg/kg/day BD
        Note: Further dissolve in 10ml Ns and give it
        within 30 minutes.
  • Inj Ranitidine
    • 1 ampoule = 2ml= 50mg
    • Mix 3ml NS in 2ml Ranitidine i.e 5ml = 50mg
      Dose: 1mg/kg/day
  • Tab Phenobarbitone
    • 1 tab= 30mg
    • Dissolve 1 tab Phenobarbitone in 5ml NS/ Milki.e. 5ml= 30mg
  • Inj Atropine
    • 1amp=1m = 0.6mg
    • Dissolve 1amp in 5ml of distilled water i.e 6ml =0.6mg or 1ml= 0.1mg
  • Inj Adrenaline
    • 1 Ampoule= 1ml= 1.8mg
    • Dilute 1ml Adrenaline in 9ml Distilled water i.e 10ml =1.8mg
      Dose: 0.1ml/kg/dose
      For Nebulization: 0.25-0.5ml dilute in 3 ml NS