Dehydration (pediatrics) Quiz: Ace Your Exams

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A 16-month-old boy presents to the emergency department for evaluation of nausea, vomiting, and diarrhea for the past seven days. The parents were highly concerned today when the infant was difficult to arouse and refused to eat or drink. The patient was born prematurely at 36 weeks but has otherwise been healthy. An older sibling at home has similar symptoms. Temperature is 37.5°C (99.5°F), pulse is 165/min, respirations are 39/min, blood pressure is 69/46 mm Hg, and oxygen saturation is 99% on room air. Physical exam reveals an ill-appearing infant who is difficult to arouse. Cardiopulmonary exam reveals bounding pulses and delayed capillary refill. Mucous membranes appear dry. Intravenous (IV) access is difficult to obtain, and an intraosseous (IO) line is placed. Which of the following correctly describes the best next step in management?

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20 mL/kg intraosseous normal saline

20 mL/kg intraosseous 5% dextrose in water (D5W)

Oral rehydration therapy

5 mL/kg intraosseous 3% saline

20 mL/kg intraosseous albumin