How should suspected hypovolemia be addressed in pediatric resuscitation?

• A. Withhold fluids until ROSC
• B. Use hypertonic saline bolus
• C. Administer isotonic crystalloids 10-20 mL/kg bolus, reassess after each bolus and repeat if needed
• D. Administer diuretics to reduce edema

Answer: (C)

Prompt restoration of circulating volume with isotonic crystalloids is the initial move in suspected pediatric hypovolemia during resuscitation. The goal is to quickly expand the intravascular space to improve tissue perfusion. Give isotonic crystalloids as a bolus of about 10-20 mL/kg (commonly 20 mL/kg) and reassess after each bolus for signs of improved perfusion, such as better capillary refill, stronger pulses, improved mental status, and urine output. If perfusion is still poor after the first bolus, repeat the bolus, up to roughly 60 mL/kg total, while monitoring for fluid overload like respiratory distress or edema. Withholding fluids until spontaneous circulation returns would miss an opportunity to correct the shock, and diuretics would worsen hypovolemia. Hypertonic saline is not the standard first-line fluid for routine pediatric hypovolemic resuscitation and carries additional risks.