In pediatric non-fatal drowning with hypotension and clear lung sounds, what is the recommended Normal Saline bolus?

• A. 10 mL/kg
• B. 30 mL/kg
• C. 20 mL/kg
• D. 5 mL/kg

Answer: (C)

In pediatric drowning with hypotension but clear lungs, treat as hypovolemic shock from fluid loss by rapidly expanding intravascular volume with a normal saline bolus. The standard initial dose is 20 mL/kg, given quickly to restore perfusion. If hypotension or poor perfusion persists after that bolus, another 20 mL/kg can be given, up to a total of about 60 mL/kg, while monitoring for signs of fluid overload. Clear lung sounds suggest there isn’t fluid overload yet, so a 20 mL/kg bolus is the best balance between correcting hypovolemia and avoiding unnecessary fluid excess. Smaller doses may not improve perfusion promptly, while larger upfront doses aren’t needed unless the shock persists after the initial resuscitation.