What is the appropriate intravenous (IV) fluid for a 2-year-old child weighing 12.5 kilograms with hyperpyrexia (high-grade fever)?

From the Guidelines

For a 12.5 kg child of 2 years with high-grade fever requiring IV fluids, I recommend maintenance fluids using D5 1/4NS or D5 1/2NS at a rate of 45 mL/hour, as calculated by the Holliday-Segar method, and closely monitoring the child for signs of dehydration or fluid overload, as suggested by the most recent guidelines 1. The calculation is based on 100 mL/kg for the first 10 kg (1000 mL) plus 50 mL/kg for the next 2.5 kg (125 mL), totaling 1125 mL per day or approximately 45-47 mL/hour.

• It is essential to monitor the child closely for signs of dehydration and adjust fluids accordingly, considering the increased metabolic demands and insensible losses due to the fever.
• If the child shows signs of dehydration, a bolus of 20 mL/kg (250 mL) of normal saline over 1 hour can be provided before starting maintenance fluids, as per general pediatric guidelines.
• Regular assessment of vital signs, urine output, and electrolytes is crucial, and the underlying cause of fever should be treated with appropriate antipyretics like acetaminophen (15 mg/kg/dose) or ibuprofen (10 mg/kg/dose) while investigating the source of infection, as recommended by pediatric care standards.
• The use of isotonic fluids, such as D5 1/4NS or D5 1/2NS, is preferred to reduce the risk of hyponatremia, as suggested by the guidelines 1.
• Dextrose is included in maintenance fluids to prevent hypoglycemia, while sodium is necessary for maintaining electrolyte balance during this illness.
• It is also important to consider the total daily amount of maintenance fluid therapy, including all IV fluids, blood products, and medications, to prevent fluid creep and reduce fluid intake, as recommended by the guidelines 1.

From the Research

IV Fluid for a 12.5 kg Child with High Grade Fever

• The child's weight is 12.5 kg, and the age is 2 years, but the provided studies do not directly address the specific question of IV fluid administration for a child of this age and weight with high-grade fever.
• However, the studies provide information on the use of different IV fluids, such as Normal Saline (NS), Ringer Lactate (RL), and Dextrose-Supplemented Saline, in children with acute diarrhea and severe dehydration 2, 3, 4.
• One study compared the effects of RL and NS on serum sodium levels in children with acute diarrhea and severe dehydration, and found that both fluids were equivalent in terms of change in serum sodium from baseline 2.
• Another study found that maintenance intravenous therapies using NS, Dextrose-Supplemented Saline, or RL had different effects on metabolic balance in children with acute gastroenteritis 3.
• A study comparing RL and NS for rapid intravenous rehydration in children with acute diarrhea and severe dehydration found no significant difference in improvement in pH over baseline between the two groups 4.
• Other studies discussed the use of IV fluids in different contexts, such as sepsis-induced hypotension 5 and hemorrhagic shock 6, but these may not be directly relevant to the question of IV fluid administration for a child with high-grade fever.

Considerations for IV Fluid Administration

• The choice of IV fluid may depend on various factors, including the child's underlying condition, electrolyte balance, and acid-base status.
• It is essential to consider the potential effects of different IV fluids on the child's metabolic balance and acid-base status 3.
• The studies suggest that a personalized approach to fluid therapy, taking into account the child's individual needs and clinical variables, may be advisable 3.