In pediatric nausea/vomiting, what is the recommended Normal Saline bolus?

• A. Normal Saline: 20 ml/kg
• B. Normal Saline: 10 ml/kg
• C. Normal Saline: 5 ml/kg
• D. Normal Saline: 30 ml/kg

Answer: (A)

In pediatric nausea/vomiting with dehydration, the priority is to rapidly restore circulating blood volume using an isotonic crystalloid bolus. Isotonic saline is used because its osmolality matches blood plasma, so it expands intravascular volume without causing harmful shifts into or out of cells. The bolus is given as a weight-based dose, allowing the amount to be tailored to the child’s size and repeated if signs of poor perfusion persist after the initial dose. This approach quickly improves perfusion, which you can monitor through heart rate, capillary refill, mental status, and urine output. Smaller initial amounts may not correct shock promptly, while much larger single doses increase the risk of fluid overload, especially in kids with underlying heart or kidney problems. If IV access is challenging, intraosseous access is a valid alternative, and you can reassess after the first bolus to decide on additional dosing.