Normal Saline Fluid Dosing for a 6-Year-Old
For a 6-year-old child requiring normal saline resuscitation, administer 20 mL/kg boluses rapidly, which equals approximately 400-500 mL per bolus for an average 20-25 kg child, repeating as needed until hemodynamic stability is achieved. 1
Clinical Context and Weight Estimation
- A typical 6-year-old weighs approximately 20-25 kg, though individual assessment is essential 2
- The specific indication (shock, dehydration, anaphylaxis, maintenance) determines the dosing approach and rate 3, 1
Resuscitation Dosing (Acute Situations)
For Shock, Severe Dehydration, or Anaphylaxis
- Administer 20 mL/kg boluses of normal saline rapidly - this is the standard pediatric resuscitation dose 3, 1
- For a 20 kg child: 400 mL per bolus; for a 25 kg child: 500 mL per bolus 1
- Repeat boluses as needed until pulse, perfusion, blood pressure, and mental status normalize 3, 1, 4
- The American Academy of Pediatrics recommends children receive up to 30 mL/kg in the first hour for initial resuscitation 3, 1
- Initial rates of 5-10 mL/kg in the first 5 minutes are appropriate for emergency resuscitation 1, 4
Special Considerations for Anaphylaxis
- In anaphylaxis with hypotension, 1-2 L may be needed for adults, but pediatric dosing follows the 20 mL/kg bolus approach 3
- Five of eight hypotensive adults required 1 L boluses in the first few minutes, with one requiring 3 L total - extrapolating to pediatrics reinforces the need for multiple boluses 3
- Large volumes are often required due to increased vascular permeability, which can transfer 50% of intravascular fluid into extravascular space within 10 minutes 1
Maintenance Fluid Dosing (Non-Acute Situations)
Calculating Maintenance Rate Using 4:2:1 Formula
- For the first 10 kg: 4 mL/kg/hr 2
- For the second 10 kg: 2 mL/kg/hr 2
- For remaining weight: 1 mL/kg/hr 2
Example for a 20 kg Child:
- First 10 kg: 10 kg × 4 mL/kg/hr = 40 mL/hr
- Second 10 kg: 10 kg × 2 mL/kg/hr = 20 mL/hr
- Total maintenance rate: 60 mL/hr or 1,440 mL per 24 hours 2
Example for a 25 kg Child:
- First 10 kg: 40 mL/hr
- Second 10 kg: 20 mL/hr
- Remaining 5 kg: 5 kg × 1 mL/kg/hr = 5 mL/hr
- Total maintenance rate: 65 mL/hr or 1,560 mL per 24 hours 2
Critical Monitoring Parameters
- Establish continuous vital sign monitoring during rapid fluid administration to identify complications 1
- Monitor for signs of volume overload, particularly in patients with underlying cardiac or renal disease 3, 1
- Assess for hypotension using age-appropriate definitions: for children >1 to 10 years, hypotension is systolic BP <70 + (2 × age in years) mm Hg 3
- For a 6-year-old, hypotension is systolic BP <82 mm Hg 3
Common Pitfalls to Avoid
- Do not delay resuscitation while calculating exact weight - use estimated weight and administer 20 mL/kg boluses promptly 3, 1
- Do not use maintenance rates for resuscitation - acute situations require rapid boluses, not slow infusions 3, 1
- Do not assume one bolus is sufficient - most children in shock require multiple boluses to achieve hemodynamic stability 3, 1
- Be aware that normal saline is preferred over hypotonic solutions for resuscitation to avoid hyponatremia 1, 5