7 months child with 5kg weight with severe dehydration, amount of Ringer lactate to be given in first hour is?
First, the core concept here is fluid resuscitation for severe dehydration in pediatrics. The key point is the initial fluid bolus rate. I remember that in pediatric patients, especially with severe dehydration, the initial treatment involves rapid fluid administration to restore perfusion. The standard approach is to give 20 mL/kg of isotonic solution like Ringer lactate or normal saline in the first hour.
So the child weighs 5 kg. Calculating 20 mL/kg would be 20 * 5 = 100 mL. Therefore, the correct answer should be 100 mL. But I need to check if there are any exceptions or other factors. The question mentions Ringer lactate specifically, which is appropriate here because it's isotonic and contains lactate, which is metabolized to bicarbonate, helping with acidosis. Normal saline is also isotonic but might contribute to hyperchloremic acidosis if used in large volumes. So Ringer lactate is preferred in many cases.
Now, let's look at the incorrect options. If the options included 50 mL (which is 10 mL/kg) or 150 mL (30 mL/kg), those would be wrong. The 50 mL would be for mild dehydration or not enough for severe cases, while 150 mL might be a distractor but the correct bolus is 20 mL/kg. Another possible wrong option might be 250 mL, which is 50 mL/kg, which is too much and could lead to fluid overload.
Clinical pearls: The key is remembering the 20 mL/kg for initial bolus in severe dehydration. Also, after the initial bolus, maintenance fluids and replacement of ongoing losses are considered. But the first hour is critical for resuscitation. Another point is that Ringer lactate is preferred over normal saline in some guidelines because of the lactate buffer, though both are acceptable in emergencies.
Wait, the question is about the first hour. So the 20 mL/kg is given over the first hour. If the options had different time frames, that might matter, but here it's specifically first hour. So the calculation is straightforward. The correct answer must be 100 mL. Let me confirm with standard guidelines. WHO and AAP recommend 20 mL/kg for initial bolus in severe dehydration. Yes, that's consistent. So the answer is 100 mL.
**Core Concept**
This question tests the initial fluid resuscitation protocol for **severe dehydration** in pediatric patients. The key principle is administering **isotonic fluids (e.g., Ringer lactate)** at a rate of **20 mL/kg in the first hour** to rapidly restore intravascular volume and perfusion.
**Why the Correct Answer is Right**
For a 5 kg child, 20 mL/kg × 5 kg = **100 mL of Ringer lactate** to be given as a bolus over 1 hour. Ringer lactate is preferred due to its balanced electrolyte content and