Trauma bolus 20cc/kg X 2 then 10cc/kg blood

Maintenance fluid = 0.9% NS with 20K + D5

• 4-2-1 rule: 4 cc/hr for first 10 kg, 2 cc/hr for 11-20 kg, 1 cc/hr for each additional kg over 20 kg

Maintenance fluid for all pediatric patients = D5 NS +/- potassium

• 2018 guideline for patients age 28 days to 18 yo
• Avoid potassium in infants and toddlers until making urine
• All children need glucose in maintenance fluid

If Severe dehydration (mottled, lethargy, decreased cap refill) → start with 20cc/kg of NS

Oral rehydration therapy is the preferred treatment for children with mild to moderate hypovolemia or after severe dehydration and resuscitated

The use of hypotonic or hypertonic crystalloid solutions for the purpose of emergent volume resuscitation is never recommended in pediatric patients – except pyloric stenosis

Infants with moderate or severe dehydration 2/2 to pyloric stenosis: D5 0.45%NS + 20K (1.5 to 2 times maintenance rate)

• If there is ANY renal dysfunction (rise in Cr or low UOP) DO NOT GIVE potassium until patient has UOP
• Alkalosis must be fixed prior to going to OR because it increases risk of post op apnea

Neonate and infant UOP should be 2-3 cc/kg/hr