Volume of fluid required

The volume of fluid needed depends upon the following factors [19,22]:

Resuscitation fluid

• Shocked patients should receive 10ml/kg fluid bolus over 15 minutes. If required, further 10ml/kg boluses up to a maximum of 40ml/kg can be given, at which point inotropes should be considered.

• Non shocked patients should receive 10ml/kg fluid bolus over 30 minutes.

Example

What is the fluid requirement for a 20kg boy who has a pH of 7.15 who is not clinically shocked?

Answer

Fluid bolus= 10ml x 20kg = 200ml

Deficit percentage= 5%
Deficit volume= 5% x 20kg x 10 = 1000ml
Deficit volume minus bolus volume = 1000ml – 200ml = 800ml

Deficit replacement rate = 800ml ÷48 hours = 16.7ml/hour

Daily maintenance volume = 1500ml
Maintenance rate = 1500ml ÷ 24 = 62.5ml/hour

Fluid rate = deficit replacement rate + maintenance rate = 79.2ml/hour

The BSPED has an online DKA calculator [28] that enables you to create a personalised DKA protocol for your patient which includes fluid calculations.

Intravenous fluid volumes should be calculated carefully and documented in the patient’s notes.