Pediatric Dehydration Graded Fluid Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Dehydration severity grading
   How severe is the dehydration? (By weight loss/clinical signs: mild (infant <5% / child <3%), moderate (infant 6–10% / child 4–6%), severe (infant >10% / child ≥7%, with circulatory compromise: lethargy, capillary refill >3 s, thready tachycardia, oliguria, hypotension). Determine the presence of shock first.)
   • Mild-moderate (no shock) → Mild-moderate → oral rehydration
   • Severe / shock → Severe / shock → IV resuscitation
2. [End] Mild-moderate → oral rehydration
   Oral rehydration salts (ORS, preferred): about 50–100 mL/kg over 2–4 h in divided doses, small frequent sips every 5 min (starting at 5 mL), ondansetron for vomiting; also replace ongoing losses. Oral is better than IV (fewer complications, higher satisfaction), <5% of children need IV. Switch to IV if oral fails or vomiting persists. (Note: After correction, counsel parents on home rehydration and when to seek care.)
3. [End] Severe / shock → IV resuscitation
   IV (or intraosseous) isotonic resuscitation: 0.9% sodium chloride (or lactated Ringer) 20 mL/kg rapidly over 15–20 min, may repeat after reassessing perfusion and vital signs (total up to 60 mL/kg); no improvement after >60 mL/kg warrants checking for sepsis/hemorrhage/cardiogenic cause. WHO Plan C: 100 mL/kg (over 3 h if ≥1 year, 6 h if <1 year). Once circulation is stable, replace the cumulative deficit + maintenance (Holliday-Segar 100/50/20 mL/kg/day), add potassium 20 mmol/L once urine output returns. (Note: Beware overly rapid sodium correction (especially hyper/hyponatremia); large boluses in fever or suspected sepsis need caution (FEAST trial).)

Source guidelines & references

• WHO diarrhea dehydration management (Plan A/B/C) / AAP-WHO oral rehydration therapy
• Pediatric Dehydration. StatPearls / Merck Manual (Professional)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways