Guidelines for perfusion in children with shock and severe malnutrition

The article was professionally consulted with Master, Doctor Truong Thanh Tam - Pediatrician at the Department of Pediatrics - Neonatology - Vinmec Danang International General Hospital.

Infusion of malnourished children in shock should be done immediately and quickly because shock is an emergency sign. During the infusion process to treat shock in children, it is necessary to closely monitor the child to promptly handle possible dangerous complications.

In children, especially young children, shock is a serious emergency that requires immediate treatment. Malnourished children in shock will have signs such as:
Cold hands and feet Time to fill pulse more than 3 seconds Fast and light pulse Low blood pressure Lethargy, or coma To treat shock in children, especially In severely malnourished children, intravenous infusion is a treatment method that should be performed with the correct technique, quickly, with a dose and rate of infusion suitable for the child's weight and age.

Establish an intravenous line. Take blood to perform emergency tests. Calculate the amount of infusion based on the weight of the child (it can be estimated or weighed.

Choose an infusion containing Ringer's lactate with 5% glucose (dextrose); Half-strength Darrow's solution with 5% glucose (dextrose); 0.45% NaCl in 5% glucose (dextrose). Intravenous infusion at a dose of 15ml/kg in 1 hour, specifically: the child's weight is 4kg - 60ml/hour infusion; 6kg - 90ml/hour; 8kg - 120ml/hour; 10kg - 150ml/hour; 12kg - 180ml/hour; 14kg - 210ml/hour; 16kg - 240ml/hour; 18kg - 270ml/hour. When starting infusion for malnourished children with shock every 5 - 10 minutes during the infusion process, it is necessary to monitor and count the child's pulse, bounce, breathing rate. If shock improves (with signs of a stronger pulse, slowed, or slower breathing) and the child has no evidence of pulmonary edema, repeat intravenous infusion of 15 mL/kg over 1 hour. After that, rehydrate the child with oral solution (or nasogastric tube) ReSoMal at a dose of 10ml/kg/hour for 10 hours. Feed the baby again with the F-75 formula. If after infusing the malnourished child with 2 doses of intravenous fluids, the shock does not improve, maintain the infusion at a dose of 4ml/kg/hour while waiting for blood transfusion. When there is blood solution for transfusion, transfuse fresh whole blood at a slow rate, at a dose of 10ml/kg in 3 hours (if the child has heart failure, use erythrocytes). Then, start feeding the baby again with formula F-75 and intravenous antibiotics. If treating shock in children with intravenous fluids makes the condition worse (with signs such as breathing rate increased 5 times/minute, pulse rate faster than 15 times/minute, hepatomegaly, moist rales in the lungs, distended neck veins, auscultate auscultation with gallop), the infusion should be discontinued because the child may develop acute pulmonary edema.
Malnourished children in shock need immediate and prompt emergency care. During the infusion process, the child needs to be closely monitored to promptly handle possible events.

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