A 4-year-old, 16 kg child with severe dehydration due to diarrhea requires IV fluid resuscitation. After initial 20 mL/kg NS bolus, his deficit is estimated at 8% (about 1280 mL). Using the Holliday-Segar method, his daily maintenance is 1100 mL. How should the remaining deficit be replaced over 24 hours?
- A Give the full remaining deficit (1280 mL) plus maintenance over 24 hours as a single rate
- B Give remaining deficit over 48 hours plus maintenance for non-hypernatremic dehydration
- C Give half the deficit in the first 8 hours, the remainder over the next 16 hours, plus maintenance throughout ✓
- D Oral rehydration therapy only, no further IV
Correct answer: C. Give half the deficit in the first 8 hours, the remainder over the next 16 hours, plus maintenance throughout
Explanation
For isonatremic and hyponatremic dehydration in children, the standard approach after initial resuscitation boluses is to replace half of the calculated remaining fluid deficit in the first 8 hours and the other half over the subsequent 16 hours, with maintenance added throughout. For hypernatremic dehydration, the correction is slowed to 48 hours (max 10–12 mEq/L per 24 hours sodium drop) to prevent cerebral edema. Oral rehydration is preferred for mild-moderate but not severe dehydration requiring IV.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.