A 2-year-old with acute watery diarrhoea is lethargic, unable to drink, has sunken eyes and very slow skin pinch. Under IMNCI Plan C, which IV fluid is preferred for rapid rehydration of this child?

• A 5% dextrose in 0.45% saline
• B Half-strength Darrows with dextrose
• C 5% dextrose in water
• D Ringer lactate solution ✓

Explanation

Lethargy with inability to drink defines severe dehydration requiring Plan C: IV Ringer lactate 100 mL/kg, given faster in the first hour for older children and over 3 hours for those under 12 months. Ringer lactate is preferred because its composition most closely replaces the sodium and potassium lost in diarrhoeal stool. Dextrose-containing hypotonic fluids redistribute into cells and fail to restore intravascular volume, worsening cerebral edema risk.

Reference: Pocket Book of Hospital Care for Children, WHO, 2nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.