Plan C timing depends on age
IMCI Plan C treats severe dehydration with intravenous fluid when the nurse can start it at once. The total volume is 100 mL/kg of Ringer's lactate (or normal saline if Ringer's lactate is not available), given in two phases. For infants under 12 months, 30 mL/kg is given in 1 hour, then 70 mL/kg in 5 hours. For children 12 months up to 5 years, the same volumes are given faster: 30 mL/kg in 30 minutes, then 70 mL/kg in 2½ hours. This infant is 11 months old, so the slower infant timing applies.
Working out the rate
The infant weighs 8 kg. The first phase was 30 × 8 = 240 mL over 1 hour and has just been completed. The second phase is 70 × 8 = 560 mL over 5 hours. The rate is 560 ÷ 5 = 112 mL per hour. The first phase is repeated only if the radial pulse is still very weak or not detectable after it; here the pulse is easily felt, so the nurse proceeds directly to the second phase.
| Age | First phase: 30 mL/kg | Second phase: 70 mL/kg |
|---|
| Under 12 months | 1 hour | 5 hours |
| 12 months up to 5 years | 30 minutes | 2½ hours |
| This infant (8 kg) | 240 mL in 1 hour (done) | 560 mL in 5 hours = 112 mL/hour |
How the distractors were built
224 mL per hour uses the timing for children 12 months and older (560 mL over 2½ hours), an age error that makes the fluid run too fast for an infant. 133 mL per hour spreads the whole 800 mL evenly over 6 hours, ignoring the two-phase design that gives a faster initial bolus. 93 mL per hour divides the second-phase volume by the total 6 hours instead of its own 5 hours. Watch out! The infant is 11 months old, not 12; the age line is drawn at 12 months, so check the age before choosing the timing.
Monitoring during Plan C
Reassess the infant every 15 to 30 minutes, and start oral rehydration solution at about 5 mL/kg per hour as soon as the infant can drink. After 6 hours for an infant, the nurse reclassifies the dehydration and chooses Plan A, B, or C accordingly. If hydration is not improving, the drip rate is increased. Throughout, the mother is encouraged to continue breastfeeding once the infant can drink, and the infant is observed for at least 6 hours after rehydration to make sure the mother can maintain hydration with ORS.