Replacement fluid therapy represents the third crucial pillar in comprehensive fluid management for children, complementing fluid resuscitation and maintenance strategies. IV fluids replacement aims to replenish preexisting deficits (fluids lost before treatment) and address ongoing losses, such as gastrointestinal issues due to vomiting and diarrhea, by administering the appropriate solutions to correct fluid, electrolyte, and acid-base disorders.

The five crucial steps to planning optimal and effective replacement fluid therapy in children are as follows:

The first step in replacement fluid management is to assess the severity of dehydration, which helps to decide both the urgency of intervention and the volume of fluid necessary for effective rehydration.

Determining the extent of dehydration involves three assessment steps: Asking specific questions, looking at visible signs, and physical examinations, as summarized in Table 49.1.

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