In pediatric beta blocker overdose, what is the initial fluid bolus for hypotension?

• A. Normal Saline 20 ml/kg (For Hypotension)
• B. Normal Saline 10 ml/kg
• C. Lactated Ringer's 20 ml/kg
• D. Dextrose in water 10 ml/kg

Answer: (A)

In a child with beta blocker overdose who is hypotensive, the first step is to rapidly restore intravascular volume with an isotonic crystalloid bolus to improve preload and perfusion. The standard initial dose is 20 ml/kg of normal saline given quickly (over a few minutes). This dose is chosen because it effectively increases circulating volume and supports blood pressure in shock states, and it’s the typical starting bolus in pediatric resuscitation protocols.

A smaller bolus, such as 10 ml/kg, is often not enough to raise blood pressure promptly in established hypotension and may require repetition, delaying adequate perfusion. Dextrose-containing fluids are not appropriate for immediate resuscitation because they don’t reliably correct volume status and can introduce glycemic variability. Lactated Ringer’s could be used as an alternative isotonic fluid, but the option presented as normal saline 20 ml/kg aligns with common initial resuscitation practice and is the preferred initial choice in this scenario.