What fluid resuscitation strategy is commonly used for pediatric arrest due to hypovolemia?

• A. Give isotonic crystalloid boluses (e.g., 20 mL/kg) and reassess.
• B. Give a single 5 mL/kg bolus of saline.
• C. Administer only colloids.
• D. Avoid fluids altogether.

Answer: (A)

In pediatric hypovolemic arrest, the priority is to restore the circulating blood volume to improve preload and cardiac output. Isotonic crystalloids are preferred because they rapidly expand the intravascular space without causing large shifts between compartments. The standard approach is to give a rapid 20 mL/kg IV or IO bolus of an isotonic solution (like normal saline or lactated Ringer’s) and reassess the child’s perfusion after each bolus. If there’s still poor perfusion, you can repeat the bolus up to a total of about 60 mL/kg while continuing to monitor for signs of improvement or overload. Underdosing with a small bolus won’t correct the deficit, and relying on colloids alone isn’t the recommended first step in this scenario, while withholding fluids would miss the immediate need to restore volume.