Pediatric patient fluid requirement

Even if a medication is available in multiple formulations and dosage forms, the prescriber must consider the absorption and distribution differences between adult and pediatric patients. Blood supply at injection or infusion site, available blood supply for unit muscle mass, and skeletal muscle mass relative to body mass vary with patient age and size, causing drug absorption to vary, as well. A rapid intravenous bolus in a pediatric patient might result in acute toxicity a slow intravenous infusion, often required in neonates, can cause erratic, unreliable drug delivery in an older child. In addition, the volume of fluid tolerated for intravenous delivery varies significantly with the age and size of the patient. The blood supply and blood flow to and from the injection site are of prime importance since a gradual decrease in blood supply per unit muscle mass is seen with maturation. In addition, the skeletal muscle mass relative to... 

Other issues that must be considered with blood product administration include monitoring for transfusion-related reactions and attention to appropriate warming, particularly when large volumes are given to pediatric patients, because hypothermia is associated with increased fluid requirements and mortality." ... 

Observational studies In a 10-year prospective study of the effects of the timing of the introduction of amiodarone after corrective surgery for congenital heart defects, 71 of 2651 patients (2885 procedures, 2106 cardiopulmonary bypass procedures) received amiodarone for newly detected postoperative atrial tachydysrhythmias (n = 70) or ventricular tachydysrhythmias (n = 7) as early treatment (i.e. within 60 minutes from detection n = 29) or late treatment (i.e. after 60 minutes from detection n = 42) [21 ]. There were significant benefits of early treatment for time to rate and rhythm control, reduction in the dose needed to obtain rate control, and reduction of pediatric cardiac intensive care stay. No adverse events in either group required additional catecholamine therapy, additional fluids, or resuscitation. 

---