What is the typical initial fluid bolus for suspected pediatric hypovolemic shock in prehospital care?

• A. 10 mL/kg of hypotonic solution
• B. 20 mL/kg of isotonic crystalloid (normal saline or lactated Ringer’s), reassess after each bolus
• C. 50 mL/kg of isotonic crystalloid
• D. 5 mL/kg of saline without reassessment

Answer: (B)

In pediatric hypovolemic shock, the goal is to restore intravascular volume with an isotonic solution that expands the circulating volume without causing dangerous shifts in osmolality. The standard initial move is to give 20 mL/kg of isotonic crystalloid (normal saline or lactated Ringer’s) over about 5–10 minutes, then reassess the child after the bolus. This amount is large enough to improve perfusion in a dehydrated child but small enough to limit the risk of fluid overload. Reassessment after each bolus guides whether more fluids are needed and helps avoid over-resuscitation. Isotonic solutions are preferred because they stay in the intravascular space better than hypotonic fluids, reducing the risk of worsening edema or electrolyte disturbances. Larger initial volumes (like 50 mL/kg) can increase the risk of fluid overload, while very small boluses (such as 5 or 10 mL/kg) may not rapidly correct hypoperfusion.