Question from New York, USA:

My niece has type 1 diabetes and is prone to picking up common infections that her friends have, such as colds, stomach bugs, etc. My question relates to the management of dehydration in the diabetic child if she is unable to keep anything down because of recurrent vomiting. I find a lot of references to treating the ketoacidotic child, but none for regular dehydration, which in her case is hypoglycemic because of vomiting and insulin administration. Her endocrinologist has instructed her mother to bring her to the hospital where she is on staff if she needs intravenous hydration, but this is two hours away from her home, and they travel often. I would appreciate some general guidelines for mom to have (who is a nurse) so that if she needs to present to a local community hospital they will do the right thing. What general rules should emergency room doctors follow when managing the pediatric hypoglycemic dehydrated patient who requires intravenous fluid resuscitation? Would she get a 5-10cc/kg Normal Saline bolus or Lactate Ringer’s Solution bolus and then maintenance fluids with a dextrose containing solution?