What should the initial fluid bolus be for a child in septic shock?

The initial fluid bolus for a child in septic shock is 20 mL/kg of isotonic crystalloid. This recommendation is based on current guidelines that emphasize the need for rapid fluid resuscitation in cases of septic shock to restore intravascular volume, improve tissue perfusion, and support hemodynamics.

Administering this amount allows for an adequate volume to counteract the hypovolemia often seen in septic patients without exceeding physiological limits, which could lead to fluid overload or complications such as pulmonary edema. Isotonic crystalloid solutions are preferred because they closely match the body's plasma osmolality and help correct any hypovolemia effectively by expanding the intravascular space.

Starting with a 20 mL/kg bolus provides an established balance between being aggressive enough to address shock yet conservative enough to minimize risks associated with fluid overload. Subsequent boluses may be needed based on the patient's response and ongoing assessment, but initiating treatment at this volume is crucial for effective early management of septic shock in pediatric patients.