What is the recommended fluid bolus for a pediatric patient with nausea/vomiting and hypovolemia?

• A. NS or LR 20 mL/kg IV/IO; may repeat up to 60 mL/kg
• B. NS 5 mL/kg
• C. LR 10 mL/kg
• D. Dextrose 5% 20 mL/kg

Answer: (A)

When a child is hypovolemic from vomiting, the goal is to rapidly restore intravascular volume with isotonic crystalloids. The recommended approach is to give 20 mL/kg of normal saline or lactated Ringer's solution via IV or IO, and you may repeat this up to a total of 60 mL/kg if signs of shock persist after reassessment. Isotonic fluids stay in the intravascular space and quickly improve perfusion, which is crucial in pediatric patients who can deteriorate fast with dehydration.

Smaller boluses (like 5 or 10 mL/kg) don’t reliably restore perfusion in hypovolemia, and dextrose-containing fluids are not used for initial volume resuscitation unless there are other indications (such as hypoglycemia). After each bolus, reassess vitals, perfusion, mental status, capillary refill, and urine output to determine if more fluid is needed up to the total 60 mL/kg limit, or if further evaluation is required.