For pediatric patients over 5 years with hemorrhagic shock, what is the recommended normal saline bolus per kilogram?

• A. 5 ml/kg
• B. 20 ml/kg
• C. 100 ml/kg
• D. 200 ml/kg

Answer: (B)

For pediatric hemorrhagic shock, the initial approach is to rapidly restore circulating volume with an isotonic crystalloid. The recommended bolus is 20 mL/kg of normal saline (0.9% NaCl) given quickly (about 5–10 minutes). This amount is large enough to improve perfusion and vital signs without overloading the system, and it aligns with standard pediatric resuscitation guidelines. If there is insufficient improvement after that bolus, a second dose can be given, with the total potentially reaching around 60 mL/kg while continuously monitoring for signs of overload. Smaller amounts, like 5 mL/kg, are usually inadequate to impact perfusion, while very large single doses (100 or 200 mL/kg) risk volume overload and serious complications. In hemorrhagic cases, address ongoing bleeding and consider blood products as guided by clinical status and reserves.