How is dehydration treated in a mild to moderate pediatric patient in the EMS setting?

• A. Oral rehydration if the child can tolerate oral intake; otherwise IV or IO isotonic fluids, approximately 20 mL/kg bolus, then reassess.
• B. Immediate 60 mL/kg bolus of hypotonic fluids.
• C. No fluids; observation only.
• D. Only IV fluids without a bolus.

Answer: (A)

The main idea is to replace fluids in a way that quickly restores perfusion while choosing the safest route. If the child can tolerate oral intake, start oral rehydration therapy with a suitable solution and offer small, frequent sips to replace losses. If they cannot keep fluids down or show signs of dehydration with possible hypoperfusion, begin IV or IO access and give isotonic crystalloids, typically a 20 mL/kg bolus, then reassess for improvement in heart rate, cap refill, skin turgor, and mental status. Repeat boluses as needed guided by reassessment, but avoid hypotonic fluids for initial resuscitation. Dehydration isn’t adequately treated by observation alone, and giving fluids without a bolus when there’s significant dehydration can fail to restore perfusion promptly.