In a pediatric shock patient with BgL greater than 250 mg/dL who is hypotensive, what is the recommended normal saline bolus dose (mL/kg)?

• A. 5 mL/kg
• B. 10 mL/kg
• C. 20 mL/kg
• D. 15 mL/kg

Answer: (B)

In this scenario the focus is fluid resuscitation for pediatric shock when hyperglycemia (>250 mg/dL) suggests a diabetic emergency such as DKA. In these patients, the initial isotonic fluid bolus is given more conservatively to restore perfusion while reducing the risk of cerebral edema from rapid osmotic shifts. A single 10 mL/kg bolus of normal saline is the recommended starting dose. If perfusion remains compromised after that, you can give additional boluses in small steps, up to a total of 40–60 mL/kg in the first hour, but the first dose is intentionally 10 mL/kg to balance rehydration with safety.