A 4-year-old with viral gastroenteritis has depressed fontanelle, dry mucous membranes, skin pinch retracts slowly (>2 sec), and sunken eyes. He is irritable but responds to voice. He is classified as having severe dehydration. What is the WHO-recommended initial treatment?

• A ORS 75 mL/kg over 4 hours
• B IV 0.9% saline 20 mL/kg bolus followed by ORS
• C Nasogastric ORS at 20 mL/kg/hour
• D IV Ringer's lactate 100 mL/kg over 3 hours (Plan C) ✓

Explanation

WHO Plan C for severe dehydration in children older than 12 months recommends IV Ringer's lactate (or normal saline if RL unavailable) 100 mL/kg given as follows: 30 mL/kg over 30 minutes, then 70 mL/kg over 2.5 hours. After initial IV rehydration, ORS is started as soon as the child can drink. Plan A is for no dehydration, Plan B (ORS 75 mL/kg over 4 hours) is for some dehydration. This child's clinical signs indicate severe dehydration requiring IV therapy.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.