Initial IV fluid

5% D/NS (5%D/0.45%saline in younger children)

@ 6 ml/kg/hr

Follow up haematocrit at least 6 hourly / hourly vital signs / urine output

IMPROVEMENT NO IMPROVEMENT
Hct.  Hct.  Pulse 
Stable pulse & BP Pulse pressure < 20 mmHg
Urine output  Urine output 

Reduce iv rate to 5 ml/kg/hr VITAL SIGNS WORSEN *Increase iv rate to 10 ml/kg/hr

OR  HAEMATOCRIT

IMPROVEMENT IMPROVEMENT NO IMPROVEMENT

*Increase iv rate to 15 ml/kg/hr

Reduce iv rate to 3 ml/kg/hr
Monitor PCV and vital signs hourly

FURTHER UNSTABLE VITAL

IMPROVEMENT SIGNS
Urine output 
Signs of shock

Stop iv infusion after 24-48 hr Central venous access

Urinary catheter
Rapid fluid bolus
(see Figure 3)
VITAL SIGNS & Hct.
STABLE
Adequate diuresis
HAEMATOCRIT  HAEMATOCRIT 
(or distress)

IV colloid infusion Blood transfusion

IMPROVEMENT
Figure 2 : Volume replacement flow-chart in DHF with >20% increase in haematocrit 17
(Hct = Haematocrit, D/NS = Dextrose-saline solution)
* Exercise caution when administering iv fluids to children weighing > 30 kg

Adapted from Ref 12 : Nimmanitya S, 1997 & WHO95632