PALS Provider Handbook By Dr. Karl Disque Pediatric Advanced Life Support

HYPOVOLEMIC SHOCK The primary means of responding to hypovolemic shock is to provide additional volume. For children, an isotonic crystalloid such as normal saline or Lactated Ringer’s is the preferred fluid for volume resuscitation. While volume repletion is somewhat straightforward in adults, great care must be taken when administering intravenous fluids to children and infants. Careful estimates should be made concerning the amount of volume lost (e.g. blood loss), the size of the person, and the degree of deficit. Current recommendations are to administer 20 mL/kg of fluid as a bolus over 5 to 10 minutes and repeat as needed. In hypovolemic (or hemorrhagic) shock, administer 3 mL of fluid for every 1 mL of estimated blood lost—a 3:1 ratio. If fluid boluses do not improve the signs of hypovolemic, hemorrhagic shock, consider the administration of packed red blood cells without delay. Albumin can also be considered for additional intravenous volume for shock, trauma, and burns as a plasma expander. If fluid boluses do not improve the signs of hypovolemic, hemorrhagic shock, re-evaluation of proper diagnosis and occult blood loss (e.g. into the GI tract) should be considered. The remaining interventions are aimed at restoring electrolyte imbalances (e.g. acid/base, glucose, etc.).