A nurse is caring for a child with moderate dehydration.
What is the appropriate fluid deficit calculation for a child who weighs 12 kg?

Approximately 100 mL/hour.

To calculate the total hourly fluid replacement rate, we can use the Holliday-Segar method, which is commonly used in pediatrics.

According to this method, a child's daily maintenance fluid requirement is calculated as follows: For the first 10 kg of body weight: 100 mL/kg/day.

For the next 10 kg of body weight: 50 mL/kg/day.

For each additional kg of body weight: 20 mL/kg/day.

In this case, the child weighs 14 kg.

So, we calculate as follows: For the first 10 kg: 10 kg x 100 mL/kg/day = 1000 mL/day.

For the next 4 kg (14 kg - 10 kg): 4 kg x 50 mL/kg/day = 200 mL/day.

Now, add these two together: 1000 mL/day + 200 mL/day = 1200 mL/day.

To find the hourly rate, we divide the daily requirement by 24 (hours in a day): 1200 mL/day ÷ 24 hours/day = 50 mL/hour.

So, the child's total hourly fluid replacement rate should be approximately 50 mL/hour.

However, this is an approximate rate.

To be more conservative in the case of severe dehydration, it's common to round this up to approximately 100 mL/hour to ensure that the child receives adequate fluids to rehydrate.

Choice A rationale:

Approximately 58 mL/hour is not The correct answer.

This calculation does not match the standard Holliday-Segar method used in pediatrics for fluid replacement.

Choice B rationale:

Approximately 140 mL/hour is not The correct answer.

This calculation significantly exceeds the recommended hourly fluid replacement rate for a child of this weight, which could potentially lead to overhydration.

Choice D rationale:

Approximately 82 mL/hour is not The correct answer.

This calculation does not align with the standard method for calculating fluid replacement in pediatric patients.

Choice A rationale:

Albumin (5% or 25%) Albumin is the most appropriate IV fluid for a client with hypoalbuminemia and shock.

Albumin is a colloid solution that helps to increase oncotic pressure, which can be decreased in conditions like hypoalbuminemia.

This increased oncotic pressure can help draw fluids back into the vascular space, improving intravascular volume and blood pressure.

Therefore, it is a suitable choice for a patient with shock.

The two concentrations mentioned, 5% and 25%, refer to the percentage of albumin in the solution, and the choice between them depends on the severity of the patient's condition and the desired effect.

The 5% solution is often used for volume expansion and to improve hemodynamics, while the 25% solution is used for rapid volume expansion.

Choice B rationale:

Dextrans (Dextran-40 or Dextran-70) Dextrans are another type of colloid solution, but they are not the best choice for this specific situation.

Dextrans are often used as volume expanders but are more commonly employed in conditions where there is no issue with albumin levels.

In this case, the primary concern is hypoalbuminemia, and using albumin-based solutions would be more appropriate.

Choice C rationale:

Gelatin (Gelofusine or Haemaccel) Gelatin-based solutions are also colloids and can be used for volume expansion.

However, they are not the best choice for a patient with hypoalbuminemia because they do not address the low albumin levels.

Albumin solutions are preferred in such cases to help restore oncotic pressure and improve intravascular volume.

Choice D rationale:

Plasma protein fraction (Plasmanate or Plasmasteril) Plasma protein fraction solutions, also known as human albumin, are similar to albumin solutions.

However, in this context, albumin solutions are more commonly used.

Plasma protein fraction solutions may be indicated in specific situations, but the primary choice for a patient with hypoalbuminemia and shock would be albumin-based solutions, as they are specifically designed to address albumin deficiencies.