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 10ml/kg 0.9% saline
• If remains shocked after first bolus
  • Give a second bolus of 10ml/kg
  • 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 24kg child responded to a 10ml/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