What is the pediatric fluid bolus dose?

• A. 20 mL/kg per bolus for up to three boluses (max 60 mL/kg total)
• B. 10 mL/kg
• C. 5 mL/kg for one bolus
• D. 30 mL/kg

Answer: (A)

The main concept is the standard initial fluid resuscitation approach for pediatric shock: give 20 mL/kg of isotonic crystalloid as a bolus and reassess quickly. This dose is chosen because it reliably expands intravascular volume to improve preload and cardiac output without waiting too long to correct hypoperfusion. If perfusion remains inadequate after that first bolus, you may repeat another bolus, up to two more times, for a total of 60 mL/kg. The idea is to restore circulation promptly while keeping a safety ceiling to reduce the risk of fluid overload and pulmonary edema in fragile pediatric patients.

Smaller doses like 10 mL/kg or 5 mL/kg are slower to correct hypovolemia and may delay improvement in perfusion. A single 30 mL/kg bolus carries a higher risk of fluid overload and potential complications, especially if the child has capillary leak or heart issues. Remember to reassess after each bolus and be prepared to adjust management based on the child’s response, including considering vasopressors or inotropes if shock persists.