Appendix 5. Volumes of RL and ORS for rehydration

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    These tables are designed to:
    – Simplify the prescription of standard rehydration protocols on admission, according to the degree of dehydration and age or weight if weight is known;
    – Facilitate implementation and monitoring of the protocol, by describing standard treatment procedures for severe dehydration or hypovolaemic shock (IV route, Plan C) and some dehydration (oral route, Plan B). 

     

    5.1 Severe dehydration in children 5 years and over and adults (RL, Plan C)
    5.2 Severe dehydration in children under 5 years (RL, Plan C)
    5.3 Severe dehydration in children under 5 years with severe malnutrition (RL, Plan C)
    5.4 Some dehydration in children and adults (ORS, Plan B)

     

    This appendix gives an overview of what the patient should receive, how, and over what length of time it should be delivered for correctly administered, effective rehydration.
    These tables should not be seen as an extremely rigid framework, they are to be used as a guide, following as closely as possible the protocol as administered in ideal conditions. 

     

    The quantities of RL and ORS are rounded off (to the nearest lower or higher whole number) to facilitate practical administration, as the quantity of liquids lost is always an estimation (approximately 10% for severe dehydration and 7.5% for some dehydration). 

     

    RL is administered through:
    – a standard infusion set (1 ml = 20 drops) in children 5 years and over and adults;
    – a “precision” paediatric infusion set (1 ml = 60 drops; 150 ml chamber; dead volume: approximately 15 ml) in children under 5 years. 

     

    The flow rates are given in ml/minute or ml/hour as they are too high to be given in drops/minute.
    During rapid fluid replacement time (“bolus”), the infusion set clamp should be opened without trying to count the number of drops. The bolus is administered in the presence of a nurse or doctor that closely monitors the patient and the volume being delivered. The infusion rate is then lowered to administer the rest of the RL, monitoring the volume delivered and to be delivered over 3 hours (4 hours maximum), except for specific cases requiring slower rehydration (such as severe malnutrition).
    Once rehydration has been completed, the catheter is not removed. Further treatment depends on the patient’s clinical evolution and capacity to drink ORS. 

    5.1 Severe dehydration in children 5 years and over and adults (RL, Plan C)

    RL is administered through a standard infusion set (1 ml = 20 drops). 

     

    Age 
    Weight 

    Total volume
    of RL 

    30 ml/kg (a) Citation a. Bolus may be repeated once if necessary. RL (bolus) 
    in ± 30 minutes 

    70 ml/kg RL 
    in ± 3 hours 

    5 to < 6 years 
    19-20 kg 

    2000 ml 

    600 ml in 30 minutes 
    (approx. 20 ml/minute) 

    1400 ml in 3 hours 
    400 ml in 1h + 1000 ml in 2h 

    6 to < 7 years 
    21-23 kg 

    2200 ml 

    700 ml in 30 minutes 
    (approx. 25 ml/minute) 

    1500 ml in 3 hours 
    1000 ml in 2h + 500 ml in 1h 

    7 to < 8 years 
    24-26 kg 

    2500 ml 

    800 ml in 30 minutes 
    (approx. 25 ml/minute) 

    1700 ml in 3 hours 
    1000 ml in 2h + 700 ml in 1h 

    8 to < 9 years 
    27-29 kg 

    2800 ml 

    800 ml in 30 minutes 
    (approx. 25 ml/minute) 

    2000 ml in 3 hours 
    1000 ml in 1h30 x 2 

    9 to < 10 years 
    30-31 kg 

    3000 ml 

    1000 ml in 30 minutes 
    (approx. 35 ml/minute) 

    2000 ml in 3 hours 
    1000 ml in 1h30 x 2 

    10 to < 11 years 
    32-34 kg 

    3300 ml 

    1000 ml in 30 minutes 
    (approx. 35 ml/minute) 

    2300 ml in 3 hours 
    1000 ml in 1h + 1000 ml in 1h 
    + 300 ml in 1h 

    11 to < 12 years 
    35-38 kg 

    3500 ml 

    1000 ml in 30 minutes 
    (approx. 35 ml/minute) 

    2500 ml in 3 hours 
    1000 ml in 1h + 1000 ml in 1h 
    + 500 ml in 1h 

    12 to < 13 years 
    39-43 kg 

    4000 ml 

    1200 ml in 30 minutes 
    1000 ml in 20 minutes (50 ml/min) 
    + 200 ml in 10 minutes (20 ml/min) 

    2800 ml in 3 hours 
    800 ml in 1h + 1000 ml in 1h 
    + 1000 ml in 1h 

    13 to < 14 years 
    44-49 kg 

    4500 ml 

    1500 ml in 30 minutes 
    1000 ml in 20 minutes 
    + 500 ml in 10 minutes 

    3000 ml in 3 hours 
    1000 ml in 1h x 3 

    14 to < 15 years 
    50-54 kg 

    5000 ml 

    1500 ml in 30 minutes 
    1000 ml in 20 minutes 
    + 500 ml in 10 minutes 

    3500 ml in 3 hours 30 
    500 ml in 30 minutes 
    + 1000 ml in 1h x 3 

    ≥ 15 years 
    ≥ 55 kg 

    6000 ml 

    2000 ml in 30 minutes 
    1000 ml in 15 minutes x 2 

    4000 ml in 4 hours 
    1000 ml in 1h x 4 

    5.2 Severe dehydration in children under 5 years (RL, Plan C)

    RL is administered through a “precision” paediatric infusion set (1 ml = 60 drops; 150 ml chamber).

     

    Weight 
    Age 

    Total volume 
    of RL 

    20 ml/kg (b) Citation b.  In total, up to 3 boluses if necessary.  RL (bolus) 
    in ± 15 minutes 

    70 ml/kg RL 
    in ± 3 hours 

    3 to < 4 kg 
    0-1 month 

    270 ml 

    60 ml in 15 minutes 

    210 ml in 3 hours 
    70 ml in 1h x 3 

    4 to < 5 kg 
    1-2 months 

    350 ml 

    80 ml in 15 minutes 

    270 ml in 3 hours 
    90 ml in 1h x 3 

    5 to < 6 kg 
    2-3 months 

    450 ml 

    100 ml in 15 minutes 

    350 ml in 3 hours 
    120 ml in 1h x 3 

    6 to < 7 kg 
    3-4 months 

    550 ml 

    120 ml in 15 minutes 

    430 ml in 3 hours 
    145 ml in 1h x 3 

    7 to < 8 kg 
    4-7 months 

    650 ml 

    150 ml in 15 minutes 

    500 ml in 4 hours 
    125 ml in 1h x 4 

    8 to < 9 kg 
    7-10 months 

    750 ml 

    150 ml in 15 minutes 

    600 ml in 4 hours 
    150 ml in 1h x 4 

    9 to < 10 kg 
    10-12 months 

    800 ml 

    200 ml in 20 minutes 
    100 ml in 10 minutes x 2 

    600 ml in 4 hours 
    150 ml in 1h x 4 

    10 to < 13 kg 
    1-2 years 

    1000 ml 

    250 ml in 20 minutes 
    125 ml in 10 minutes x 2 

    750 ml in 3 hours 
    150 ml in 40 minutes x 5 

    13 to < 15 kg 
    2-3 years 

    1200 ml 

    300 ml in 20 minutes 
    150 ml in 10 minutes x 2 

    900 ml in 3 hours 
    150 ml in 30 minutes x 6 

    15 to < 17 kg 
    3-4 years 

    1500 ml 

    300 ml in 20 minutes 
    150 ml in 10 minutes x 2 

    1200 ml in 3 hours 
    150 ml in 20 minutes x 8 

    17 to < 19 kg 
    4 to < 5 years 

    1700 ml 

    400 ml in 15 minutes 
    130 ml in 5 minutes x 3 

    1300 ml in 3 hours 
    150 ml in 20 minutes x 9 

    5.3 Severe dehydration in children under 5 years with severe malnutrition (RL, Plan C)

    RL is administered through a “precision” paediatric infusion set (1 ml = 60 drops; 150 ml chamber).

     

    Weight 

    Total volume 
    of RL 

    20 ml/kg (c) Citation c. In total, up to 3 boluses if necessary. RL (bolus) 
    in 30 minutes 

    70 ml/kg RL 
    in 6 hours 

    3 to < 4 kg 

    270 ml 

    60 ml in 30 minutes 

    210 ml in 6 hours 
    35 ml in 1h x 6 

    4 to < 5 kg 

    350 ml 

    80 ml in 30 minutes 

    270 ml in 6 hours 
    45 ml in 1h x 6 

    5 to < 6 kg 

    450 ml 

    100 ml in 30 minutes 

    350 ml in 6 hours 
    60 ml in 1h x 6 

    6 to < 7 kg 

    550 ml 

    120 ml in 30 minutes 

    430 ml in 6 hours 
    70 ml in 1h x 6 

    7 to < 8 kg 

    650 ml 

    150 ml in 30 minutes 

    500 ml in 6 hours 
    85 ml in 1h x 6 

    8 to < 9 kg 

    750 ml 

    150 ml in 30 minutes 

    600 ml in 6 hours 
    100 ml in 1h x 6 

    9 to < 10 kg 

    800 ml 

    200 ml in 30 minutes 
    100 ml in 15 minutes x 2 

    600 ml in 6 hours 
    100 ml in 1h x 6 

    10 to < 11 kg 

    900 ml 

    200 ml in 30 minutes 
    100 ml in 15 minutes x 2 

    700 ml in 6 hours 
    120 ml in 1h x 6 

    11 to < 12 kg 

    1000 ml 

    220 ml in 30 minutes 
    110 ml in 15 minutes x 2 

    780 ml in 6 hours 
    130 ml in 1h x 6 

    12 to < 13 kg 

    1100 ml 

    240 ml in 30 minutes 
    120 ml in 15 minutes x 2 

    860 ml in 6 hours 
    140 ml in 1h x 6 

    13 to < 14 kg 

    1250 ml 

    250 ml in 30 minutes 
    125 ml in 15 minutes x 2 

    1000 ml in 6 hours 

    14 to < 15 kg 

    1300 ml 

    300 ml in 30 minutes 
    150 ml in 15 minutes x 2 

    1000 ml in 6 hours 

    5.4 Some dehydration in children and adults (ORS, Plan B)

    Weight 

    Age 

    Total volume
    of ORS 

    Volume of ORS per hour 

    3 to < 4 kg 

    0 to < 1 month 

    230 ml 

    60 ml per hour for 4 hours 

    4 to < 5 kg 

    1 to < 2 months 

    300 ml 

    75 ml per hour for 4 hours 

    5 to < 6 kg 

    2 to < 3 months 

    400 ml 

    100 ml per hour for 4 hours 

    6 to < 7 kg 

    3 to < 4 months 

    480 ml 

    120 ml per hour for 4 hours 

    7 to < 8 kg 

    4 to < 7 months 

    550 ml 

    140 ml per hour for 4 hours 

    8 to < 9 kg 

    7 to < 10 months 

    600 ml 

    150 ml per hour for 4 hours 

    9 to < 10 kg 

    10 to < 12 months 

    700 ml 

    180 ml per hour for 4 hours 

    10 to < 13 kg 

    1 to < 2 years 

    800 ml 

    200 ml per hour for 4 hours 

    13 to < 15 kg 

    2 to < 3 years 

    1000 ml 

    250 ml per hour for 4 hours 

    15 to < 17 kg 

    3 to < 4 years 

    1200 ml 

    300 ml per hour for 4 hours 

    17 to < 19 kg 

    4 to < 5 years 

    1400 ml 

    350 ml per hour for 4 hours 

    19 to < 21 kg 

    5 to < 6 years 

    1600 ml 

    400 ml per hour for 4 hours 

    21 to < 24 kg 

    6 to < 7 years 

    1600 ml 

    400 ml per hour for 4 hours 

    24 to < 27 kg 

    7 to < 8 years 

    1800 ml 

    450 ml per hour for 4 hours 

    27 to < 30 kg 

    8 to < 9 years 

    2000 ml 

    500 ml per hour for 4 hours 

    30 to < 32 kg 

    9 to < 10 years 

    2200 ml 

    550 ml per hour for 4 hours 

    32 to < 35 kg 

    10 to < 11 years 

    2400 ml 

    600 ml per hour for 4 hours 

    35 to < 39 kg 

    11 to < 12 years 

    2800 ml 

    700 ml per hour for 4 hours 

    39 to < 44 kg 

    12 to < 13 years 

    3200 ml 

    800 ml per hour for 4 hours 

    44 to < 50 kg 

    13 to < 14 years 

    3600 ml 

    900 ml per hour for 4 hours 

    ≥ 50 kg 

    ≥ 14 years 

    4000 ml 

    1000 ml per hour for 4 hours 

    ≥ 75 kg    6000 ml  1500 ml per hour for 4 hours

     

     
    If the patient wants to drink more than prescribed, give more ORS. 

     

     

    • (a)Bolus may be repeated once if necessary.
    • (b) In total, up to 3 boluses if necessary.
    • (c)In total, up to 3 boluses if necessary.