Bolus: 20 ml/kg RL or NS for significant dehydration or volume deficit, and repeat if no significant clinical improvement

Maintenance Fluids: 1st 10 kg -100 ml/kg/24 hrs (or roughly 4 ml/kg/hr) + 2nd 10 kg - 50 ml/kg/24hrs (or roughly 2 ml/kg/hr) + wt > 20 kg -20 ml/kg/24hrs (or about 1 ml/kg/hr)

Dehydration and Deficits: Mild (<2-3 years old -5% or 50 ml/kg deficit, >2-3 years old -3% or 30 ml/kg deficit), Clinical -thirsty, ?dry mucous membranes, tears present, ?tachycardia, normal urine output (>1 ml/kg/hr), normal BP and respirations; Moderate (<2-3 years old -10% or 100 ml/kg deficit, >2-3 years old -6% or 60 ml/kg deficit), Clinical -thirsty, irritable, dry mucous membranes, no tears, delayed capillary refill (> 2 sec), decreased turgor, skin tenting, sunken eyeballs and anterior fontanel, oliguria, tachycardia, weak pulse, normal BP; Severe (<2-3 years old -15% or 150 mls/kg deficit, > 2-3 years old -9% or 90 ml/kg deficit), Clinical -shock, cold mottled skin, altered mental status, nonpalpable or very weak and thready pulse, significant oliguria or anuria, tachypnea, very sunken eyeballs and/or anterior fontanel, significant delayed capillary refill (>3-4 sec), no tears, very dry mucous membranes.

Management of Fluid Deficits: Isonatremic/Isotonic -Bolus with NS or LR. Replace [Deficit- Boluses] -50% over 1st 8 hours, then 50% over next 16 hours. Add maintenance. Use D5, 1/4NS or D5, 1/2NS. Replace K with adequate urine output. Hyponatremic/Hypotonic (Na < 130 mEq/I) -Bolus with NS or LR. Use D5 1/2NS with maintenance and deficits. Use 3% NaCI if Na < 115-120 mEq/l or symptomatic (i.e. seizures.). Consult specialist. Hypernatremic/Hypertonic (Na > 150 mEq/l) -Replace fluid deficit evenly during a 48-72 hour period. Bolus with NS prn. Add maintenance. Replace K with adequate urine output. Use D5 1/2 or D51/4 NS. Serum Na reduction should be < 10-14 mEq/l/day.

Blood Products: PRBCs -10 ml/kg ( Hct by 3%.); FFP: 10-15 ml/kg IV over 30-120 min; Platelets -6 units/m2 (1 unit/m2 pIts by 10,000/mm3); Cryoprecipitate -0.5 units/kg IV