Clinical Shock

Resuscitation phase

  • Ensure patient airway, give high flow oxygen
  • Obtain urgent IV access
    • Measure baseline U&Es, blood glucose and venous blood gas
  • Give a fluid bolus of 20 ml/kg 0.9% saline
  • If remains shocked after first bolus
    • Give a second bolus
    • Consider other causes for shock
  • If remains shocked after second bolus
    • Give a further bolus
    • Consider discussion with paediatric intensive care team

Maintenance phase

  • Once symptoms and signs of shock have resolved
  • Calculate daily maintenance requirement
  • Use 10% estimate for deficit calculation
  • Consider adding potassium to fluids once serum level is known
  • Monitor clinical and laboratory response to fluid therapy, adjust subsequent fluids as appropriate
  • Discuss with paediatric team

Worked example

A 24 kg child responded to a 20 ml/kg fluid bolus and is no longer shocked. What is his initial hourly IV fluid requirement using the standard regime? What type of fluid would you prescribe?

Answer

Estimated deficit 10% for this category

Deficit = 10 X 24kg X 10 = 2400 ml

Daily maintenance = (100 ml/kg x 10 kg) + (50 ml/kg x 10 kg) + (20 ml/kg x 4 kg) = 1580 ml

Hourly requirement = (2400 + 1580) / 24 = 165 ml/hour if replacing over 24hrs

Consider adding potassium once serum levels are known