Appendix 5. Volumes of RL and ORS for rehydration
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 | Total volume | 30 ml/kg* RL (bolus) | 70 ml/kg RL |
---|---|---|---|
5 to < 6 years | 2000 ml | 600 ml in 30 minutes | 1400 ml in 3 hours |
6 to < 7 years | 2200 ml | 700 ml in 30 minutes | 1500 ml in 3 hours |
7 to < 8 years | 2500 ml | 800 ml in 30 minutes | 1700 ml in 3 hours |
8 to < 9 years | 2800 ml | 800 ml in 30 minutes | 2000 ml in 3 hours |
9 to < 10 years | 3000 ml | 1000 ml in 30 minutes | 2000 ml in 3 hours |
10 to < 11 years | 3300 ml | 1000 ml in 30 minutes | 2300 ml in 3 hours |
11 to < 12 years | 3500 ml | 1000 ml in 30 minutes | 2500 ml in 3 hours |
12 to < 13 years | 4000 ml | 1200 ml in 30 minutes | 2800 ml in 3 hours |
13 to < 14 years | 4500 ml | 1500 ml in 30 minutes | 3000 ml in 3 hours |
14 to < 15 years | 5000 ml | 1500 ml in 30 minutes | 3500 ml in 3 hours 30 |
≥ 15 years | 6000 ml | 2000 ml in 30 minutes | 4000 ml in 4 hours |
* Bolus may be repeated once if necessary.
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 | Total volume | 20 ml/kg* RL (bolus) | 70 ml/kg RL |
---|---|---|---|
3 to < 4 kg | 270 ml | 60 ml in 15 minutes | 210 ml in 3 hours |
4 to < 5 kg | 350 ml | 80 ml in 15 minutes | 270 ml in 3 hours |
5 to < 6 kg | 450 ml | 100 ml in 15 minutes | 350 ml in 3 hours |
6 to < 7 kg | 550 ml | 120 ml in 15 minutes | 430 ml in 3 hours |
7 to < 8 kg | 650 ml | 150 ml in 15 minutes | 500 ml in 4 hours |
8 to < 9 kg | 750 ml | 150 ml in 15 minutes | 600 ml in 4 hours |
9 to < 10 kg | 800 ml | 200 ml in 20 minutes | 600 ml in 4 hours |
10 to < 13 kg | 1000 ml | 250 ml in 20 minutes | 750 ml in 3 hours |
13 to < 15 kg | 1200 ml | 300 ml in 20 minutes | 900 ml in 3 hours |
15 to < 17 kg | 1500 ml | 300 ml in 20 minutes | 1200 ml in 3 hours |
17 to < 19 kg | 1700 ml | 400 ml in 15 minutes | 1300 ml in 3 hours |
* In total, up to 3 boluses if necessary.
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 | 20 ml/kg* RL (bolus) | 70 ml/kg RL |
---|---|---|---|
3 to < 4 kg | 270 ml | 60 ml in 30 minutes | 210 ml in 6 hours |
4 to < 5 kg | 350 ml | 80 ml in 30 minutes | 270 ml in 6 hours |
5 to < 6 kg | 450 ml | 100 ml in 30 minutes | 350 ml in 6 hours |
6 to < 7 kg | 550 ml | 120 ml in 30 minutes | 430 ml in 6 hours |
7 to < 8 kg | 650 ml | 150 ml in 30 minutes | 500 ml in 6 hours |
8 to < 9 kg | 750 ml | 150 ml in 30 minutes | 600 ml in 6 hours |
9 to < 10 kg | 800 ml | 200 ml in 30 minutes | 600 ml in 6 hours |
10 to < 11 kg | 900 ml | 200 ml in 30 minutes | 700 ml in 6 hours |
11 to < 12 kg | 1000 ml | 220 ml in 30 minutes | 780 ml in 6 hours |
12 to < 13 kg | 1100 ml | 240 ml in 30 minutes | 860 ml in 6 hours |
13 to < 14 kg | 1250 ml | 250 ml in 30 minutes | 1000 ml in 6 hours |
14 to < 15 kg | 1300 ml | 300 ml in 30 minutes | 1000 ml in 6 hours |
* In total, up to 3 boluses if necessary.
5.4 Some dehydration in children and adults (ORS, Plan B)
Weight | Age | Total volume | 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.