What is the standard initial IV fluid bolus dose for a child in hypovolemic shock?

• A. 5 mL/kg isotonic crystalloid
• B. 10 mL/kg hypotonic fluid
• C. 20 mL/kg isotonic crystalloid; repeat up to 60 mL/kg as needed
• D. 100 mL/kg isotonic crystalloid

Answer: (C)

In pediatric hypovolemic shock, the priority is to rapidly restore intravascular volume with isotonic fluids to improve preload and tissue perfusion. The standard initial bolus is 20 mL/kg of isotonic crystalloid (such as normal saline or lactated Ringer’s). If perfusion remains compromised after that dose, you can repeat boluses, up to a total of 60 mL/kg, reassessing after each one and monitoring for signs of fluid overload. This approach provides quick intravascular expansion without shifting water into cells or causing risky electrolyte changes. Using hypotonic fluids is avoided in shock because they can worsen cellular swelling and hyponatremia. Giving too small a amount would fail to correct the shock, while giving too large a single dose or exceeding 60 mL/kg early increases the risk of edema and heart failure.