Fluid Management and Blood Component Therapy

Guidelines:

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 Equals: 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 Equals: Hourly infusion rate
Example: 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) Equals: 1550 ml/24 hours or 64.5 ml/hour		Example: Using 4-2-1 rule for 15 kg child 40 ml/hr (for first 10 kg)   + 10 ml/hr (for last 5 kg) Equals: 50 ml/hr

Citations/References:

1. Policy# HM 1.01P (IU Health Blood Administration Policy, Pediatric)