Pediatric emergency medicine trisk 0526 0526
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place, do not need radiographic confirmation of placement, and the patient does
not need to remain awake while receiving the rehydration solution. A small
feeding tube is better tolerated for fluid administration than a larger NG tube.
Since NG tubes are considered a very noxious intervention, practitioners and
parents may choose parenteral rehydration over NG.
FIGURE 22.2 Oral rehydration therapy.
Parenteral Rehydration
Approximately 20% of patients will be unable to tolerate oral syringe
administration of ORT because of persistent vomiting, high stool outputs, or
inability to cooperate. If the patient is unable to tolerate ORT or is severely
dehydrated, then administration of 20-mL/kg boluses of isotonic saline or lactated
Ringer solution intravenously would be appropriate. The number of boluses
required depends on the patient’s physiologic response to the fluid that has been
administered. Once the initial resuscitation phase is completed, the patient will
need to be reassessed to see if maintenance fluids are necessary for ongoing
losses or continued inability to tolerate ORT. For ages 28 days to 18 years, the
recommended maintenance fluid is D5NS with 20 mEq/L of potassium chloride.
