A 2-year-old with severe diarrhea has serum sodium of 162 mEq/L, indicating hypernatremic dehydration. The plan is to correct the sodium deficit over 48 hours. Which fluid is most appropriate for initial resuscitation in this child?
- A 0.45% half-normal saline as continuous infusion
- B 5% dextrose in water (D5W) bolus
- C 0.9% normal saline 20 mL/kg bolus ✓
- D Ringer's lactate 10 mL/kg bolus followed by 5% dextrose
Correct answer: C. 0.9% normal saline 20 mL/kg bolus
Explanation
In hypernatremic dehydration with hemodynamic compromise, isotonic saline (0.9% NaCl) 10–20 mL/kg is used for initial emergency resuscitation to restore perfusion without lowering sodium too rapidly. After stabilization, the free water deficit is replaced slowly over 48 hours using hypotonic fluids (0.45% NaCl or 0.2% NaCl in 5% dextrose) to avoid cerebral edema from rapid sodium correction. The target rate of sodium correction is <0.5 mEq/L/hour to prevent seizures.
Reference: Ghai Essential Pediatrics, 10th ed.
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