Guidelines for perfusion in children with shock without severe malnutrition

The article was professionally consulted with Master, Doctor Ngo Thi Oanh - Pediatrician - Department of Pediatrics - Neonatology - Vinmec Ha Long International General Hospital.

Infusion of children is the method of shock treatment that should be done immediately in the emergency. However, to ensure safety, the infusion of fluids for children who are not malnourished must be carried out strictly according to the instructions of a specialist doctor.

Shock in a child is one of the emergency signs that requires immediate treatment. Children with shock will have the following signs:
Cold hands and feet Capillary filling time is long, greater than 3 seconds Fast and light pulse Low blood pressure Drowsiness When the child has the above signs of shock, it is necessary to seek medical attention. rapid transmission. Infusion for children is through an intravenous line to put into the child's body an amount of solution with a volume suitable for the child's weight. The solution can be water, electrolytes and nutrients. Infusion is a relatively simple technique, but it must be done correctly before, during and after infusion to avoid anaphylaxis.

Infusion for children with shock without severe malnutrition is performed as follows:
Establish an intravenous line. Infusion of Ringer's lactate solution or Normal saline at a dose of 20ml/kg, specifically: 2 months old children (weighing less than 4kg) - 50ml infusion; children 2 - under 4 months old (weight 4 - under 6kg) - 100ml infusion; children 4 - under 12 months old (weight 6 - under 10kg) - 150ml infusion; children 1 - under 3 years old (weight 10 - under 14kg) - 250ml infusion; Children 3 - under 5 years old (weight 14 - 19kg) - 350ml infusion.

Assessment after the first dose of infusion: if the condition does not improve, repeat the infusion as quickly as possible at a dose of 10-20ml/kg; If there are signs of bleeding, a blood transfusion of 20ml/kg is required. Assess after the second infusion, if the condition does not improve and the child shows signs of dehydration (eg, diarrhea or cholera), repeat Ringer's lactate solution or Normal saline at a dose of 20ml/kg; if condition does not improve, or septic shock is suspected, repeat infusion at 20ml/kg (note to consider adding adrenaline or dopamine); If the condition improves, the diagnosis should be reviewed. After IV infusion, if signs of shock improve (blood pressure increases above 10% or returns to normal, pulse becomes stronger, heart rate slows, capillary refill time is less than 2 seconds), Need to continue infusion of Ringer's lactate solution (Hartmann's) (or Normal saline) to manage dehydration in children after the shock phase, specifically: Newborns under 12 months old - 70ml/kg infusion over 5 hours; children from 12 months - age - 70ml/kg infusion in 2.5 hours.

Before giving fluids to the child, blood should be drawn to perform the necessary blood tests. If the child is in shock and is suspected to have malaria or anemia, care should be taken when administering rapid fluids, or giving blood instead of fluids if the child is severely anemic. Children need to be closely monitored throughout the infusion, and should be given at a slow rate. If any abnormality occurs, it should be treated immediately. When children are in shock, they need to be given fluids immediately and quickly to limit the risk of death. After the shock phase, it is necessary to continue giving fluids to the child to manage dehydration.
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