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How to give IV fluids rapidly for shock (child not severely malnourished)


Check that the child is not severely malnourished

  • Insert an intravenous line (and draw blood for emergency laboratory investigations).

  • Attach Ringer’s lactate or normal saline make sure the infusion is running well.

  • Infuse 20 ml/kg as rapidly as possible.

After improvement at any stage (pulse slows, faster capillary refill) continue
with specific management for the child’s condition.

Give this treatment only if the child has signs of shock and is lethargic or has lost consciousness:


  • Insert an IV line (and draw blood for emergency laboratory investigations)

  • Weigh the child (or estimate the weight) to calculate the volume of fluid to be given

  • Give IV fluid 15 ml/kg over 1 hour. Use one of the following solutions (in order of preference):

  1. Ringer’s lactate with 5% glucose (dextrose); or

  2. Half-normal saline with 5% glucose (dextrose); or

  3. Half-strength Darrow’s solution with 5% glucose (dextrose); or, if these are unavailable,

  4. Ringer’s lactate.

Measure the pulse and breathing rate at the start and every 5 10 minutes.


If there are signs of improvement (pulse and breathing rates fall):


  • Give repeat IV 15 ml/kg over 1 hour; then

  • Switch to oral or nasogastric rehydration with ReSoMal, 10 ml/kg/h up to 10 hours;

  • Initiate refeeding with starter F-75.


If the child fails to improve after the first 15 ml/kg IV, assume the child has septic shock:


  • Give maintenance IV fluid (4 ml/kg/h) while waiting for blood

  • When blood is available, transfuse fresh whole blood at 10 ml/kg slowly over 3 hours (use packed cells if in cardiac failure);



  • Initiate refeeding with starter F-75.


If the child deteriorates during the IV rehydration (breathing increases by 5 breaths/min or pulse by 25 beats/min), stop the infusion because IV fluid can worsen the child’s condition.

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Last updated 21.08.2020


  1. WHO. August 21.2020

  2. Tanzania Standard treatment guidline for pediatric, edition 2017

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