What is the reference for a 5cc/kg/hr maintenance fluid rate in a 6-year-old child with mild to moderate dehydration due to acute gastroenteritis?

The 5 cc/kg/hr Maintenance Fluid Rate: No Standard Reference Exists

There is no established reference for a 5 cc/kg/hr maintenance fluid rate in pediatric acute gastroenteritis management. This rate does not appear in current evidence-based guidelines or standard pediatric fluid management protocols.

What the Guidelines Actually Recommend

For Mild to Moderate Dehydration (Your Clinical Scenario)

The 2017 IDSA guidelines and CDC recommendations specify oral rehydration solution (ORS) as first-line therapy, not continuous IV maintenance rates 1:

• Rehydration phase: Administer 50-100 mL/kg of ORS over 2-4 hours for mild to moderate dehydration 1, 2
• Ongoing loss replacement: Give 10 mL/kg of ORS for each diarrheal stool 2, 3
• Vomiting losses: Replace with 2 mL/kg of ORS per episode 2, 3

When IV Fluids Are Actually Indicated

IV fluids are reserved for specific situations, not routine mild-moderate dehydration 1:

• Severe dehydration (≥10% deficit): 20 mL/kg boluses of isotonic crystalloid (lactated Ringer's or normal saline) until pulse, perfusion, and mental status normalize 1, 2
• ORS failure: If unable to drink or persistent vomiting despite antiemetics 1
• Altered mental status or shock 1

If IV Maintenance Is Required

When patients cannot tolerate oral intake and require IV maintenance fluids, the guidelines specify 1:

• 5% dextrose in 0.25 normal saline with 20 mEq/L potassium chloride administered intravenously 1
• This is given as replacement therapy, not at a specific "5 cc/kg/hr" rate 1

Standard IV Rehydration Rates in the Literature

Research studies examining rapid IV rehydration protocols use 4, 5, 6:

• 20 mL/kg/hour for 1-4 hours as the standard IV rehydration rate 4, 5
• 30 mL/kg over 3 hours (equivalent to 10 mL/kg/hr) in some protocols 6
• 60 mL/kg/hour in rapid rehydration protocols, though this shows no superiority over standard rates 5

Critical Clinical Pitfall

A continuous 5 cc/kg/hr rate is far too slow for active rehydration and does not match any evidence-based protocol 4, 5. This rate would provide only 120 mL over 24 hours for a 20 kg child—grossly inadequate for correcting dehydration or replacing ongoing losses 2, 3.

The Correct Approach for Your 6-Year-Old Patient

For a 6-year-old with mild to moderate dehydration from acute gastroenteritis 1, 2:

1. First-line: ORS 50-100 mL/kg over 2-4 hours 1, 2
2. Ongoing losses: 10 mL/kg ORS per diarrheal stool 2, 3
3. If vomiting prevents ORS: Consider ondansetron to improve tolerance 2
4. If ORS fails: Nasogastric ORS at 15 mL/kg/hour 3
5. Only if above fail: IV isotonic crystalloid at 20 mL/kg/hour for 1-4 hours, then transition back to ORS 4, 5

The "5 cc/kg/hr" rate you're asking about has no basis in current pediatric gastroenteritis management guidelines and should not be used.