A 6-month-old infant with acute gastroenteritis is assessed: sunken eyes, absent tears, dry mouth, skin turgor reduced with 3-second return, HR 164/min, BP 68/42 mmHg, and weak pulse. She is not tolerating oral fluids. Which is the MOST appropriate initial fluid management?

• A IV Ringer's lactate 20 mL/kg over 30 minutes; reassess ✓
• B Oral rehydration therapy (ORS) 50 mL/kg over 3 hours
• C IV 0.9% NaCl 100 mL/kg over 4 hours
• D Hypotonic IV fluid (0.45% NaCl in 5% dextrose) at maintenance rate

Explanation

This infant has severe dehydration (>10%) with signs of impending shock: weak pulse, tachycardia, low BP, and markedly reduced skin turgor. WHO and IAP guidelines indicate that severe dehydration with shock requires immediate IV resuscitation with an isotonic crystalloid (normal saline or Ringer's lactate) at 20 mL/kg over 30–60 minutes, repeated as needed until hemodynamic stability is achieved. ORS is indicated for mild-to-moderate dehydration and cannot be used in a child with impaired oral intake and shock. Running 100 mL/kg over 4 hours is a dehydration replacement regimen for moderate dehydration without shock. Hypotonic fluid is contraindicated in shock management.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.