What is the recommended fluid bolus for treating pediatric hypovolemic shock?

• A. 5 mL/kg isotonic
• B. 20 mL/kg isotonic
• C. 40 mL/kg isotonic
• D. 100 mL/kg isotonic

Answer: (B)

In pediatric hypovolemic shock, the goal is rapid restoration of intravascular volume using isotonic crystalloids. The recommended initial bolus is 20 mL per kilogram, given quickly (about 5–10 minutes) and then reassessed right away. This dose is enough to improve perfusion without risking the complications that come with overly large or overly rapid fluid administration in a single swoop. After the bolus, check for improvement in blood pressure, capillary refill, mental status, and urine output, and be prepared to repeat boluses up to roughly 60 mL/kg in the first hour if shock persists, using additional boluses as needed and guided by the patient’s response. Isotonic fluids used include normal saline or lactated Ringer’s. The smaller 5 mL/kg dose is generally insufficient for resuscitation, while much larger single doses or very high totals increase the risk of fluid overload.