Fluid Management and Blood Component Therapy
Pediatrics patients who require aggressive fluid therapy:
- Pediatrics: 20 mL/Kg isotonic crystalloid (normal saline or Lactated Ringer’s) IV bolus; may repeat x 2-3 if necessary
- Further fluid therapy based on patient response.
Parkland Formula for burn patients:
Consider use of the Parkland formula for burn patients:
- 4 mL crystalloid x %BSA (2nd & 3rddegree) x Kg = mL of crystalloid to be given over the first 24 hours post-injury (in addition to maintenance fluids.)
- Give half of the amount in the first 8 hours and the remainder over the subsequent 16 hours.
- Lactated Ringer's solution is preferable to 0.9 NS, particularly in pediatric patients, to reduce the hyperchloremic acidosis.
- This formula is a guideline and ongoing resuscitation should be based on patient response (i.e. urine output, vitals, capillary refill, etc.)
Blood replacement therapy:
PRBCs may be given to patients with a condition and/or history suggesting:
- Significant ongoing blood loss
- Cyanotic heart disease and critically ill with hemoglobin < 10 g
- All other symptomatic patients with a hemoglobin < 7 g
- If additional crystalloid fluid beyond 2 L in trauma patients is required, consider blood replacement
- If patient is suffering from obvious massive blood loss, consider blood replacement even before the 2 L of crystalloid is infused.
Replacement therapy for PRBCs:
- Pediatrics: 10-15 mL/Kg over 1-3 hours.
- Replacement therapy must be immediately discontinued and reported if a transfusion reaction is suspected.
- In term maintenance fluid calculation:
24-hour fluid calculations formula:
0 - 10 kg = 100 ml/kg
10 - 20 kg = 50 ml/kg
>20 kg = 25 ml/kg
Total volume for 24 hours
Hourly fluid calculations formula (4-2-1 rule):
0 - 10 kg = 4 ml/kg/hr
10 - 20 kg = 2 ml/kg/hr
>20 kg = 1 ml/kg/hr
Hourly infusion rate
Using 24 hour calculations for a 22 kg child
1000 ml (for first 10 kg pt weight)
500 ml (for the second 10 kg pt weight)
50 ml (for the last 2 kg of pt weight)
1550 ml/24 hours or 64.5 ml/hour
Using 4-2-1 rule for 15 kg child
40 ml/hr (for first 10 kg)
10 ml/hr (for last 5 kg)
- Policy# HM 1.01P (IU Health Blood Administration Policy, Pediatric)