What is the recommended fluid bolus for dehydration in pediatric viral gastroenteritis?

• A. 5 mL/kg hypotonic saline
• B. 20 mL/kg isotonic fluid
• C. 100 mL/kg hypotonic fluid
• D. No fluids; observe

Answer: (B)

Quickly restoring circulating volume with an isotonic fluid bolus is the key step when a child with dehydration from viral gastroenteritis shows signs of poor perfusion. The recommended amount is 20 mL per kilogram of body weight, given intravenously (normal saline or lactated Ringer’s) over a few minutes. Isotonic fluids stay in the intravascular space long enough to improve blood pressure and perfusion without causing dangerous shifts in osmolality. If shock signs persist after a bolus, repeat up to a total of 60 mL/kg with reassessment after each administration. Hypotonic fluids are avoided because they can worsen hyponatremia and cerebral edema, and giving no fluids would leave hypovolemia untreated. So, 20 mL/kg of isotonic fluid is the appropriate initial bolus.