Q2. a. In case of emergency resuscitation, the fluid bolus can be calculated depending on the body weight of the child and how much fluid deficit is present. The fluid bolus can be 20mL/Kg and can be repeated if necessary. So in the present case, if the deficit is taken as 2000 mL (as the child has been vomiting for two days), then as per calculations the fluid bolus would be 620 mL and the remaining deficit is 1380 mL.
b. The second and the third phases of the fluid resuscitation are maintenance phases. The second phase is the first eight hours. The fluid that is to be given to the patient can be calculated as half of remaining deficit plus one-third of the daily maintenance. So, in the present case, half of the remaining deficit is 690 and one-third of the daily deficit is taken from standard which is 333 mL and the total becomes 1023 mL. To calculate the rate at which this would be administered to the child it would be divided by the hours and that would be 128 mL per hour. The third phase is the next 16 hours where the dose and the rate can be calculated by the adding the half of the remaining deficit and two-thirds of the daily maintenance which in the present case would be 690 + 666 mL, that is, 1356 mL. For the rate this total is divided by the time that is 16 hours and the rate at which it should be administered to the child is 85 mL per hour.
c. Dehydration in pediatric patients can occur due to various reasons and it is better if the fluid resuscitation is provided to the children in a hospital care setting where all the necessary techniques and help are available. There are various guidelines and ways in which this is managed as well as the fluid that is administered to the children also vary so it is better that the fluid administration and maintenance is guided by the physiologic measures of the body like that of body weight and fluid deficit (Edelson et al., 2015).
Edelson, J. B., Orenstein, E. W., Zaoutis, L. B., & Copelovitch, L. (2015). Intravenous fluid management in the pediatric hospital setting: Is isotonic fluid the right approach for all patients?. Current Treatment Options in Pediatrics, 1(1), 90-99.
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