In a child with severe dehydration and poor skin turgor, which action is the priority?

• A. Oral rehydration solution
• B. Withhold fluids
• C. An IV bolus of normal saline solution
• D. Administer antibiotics

Answer: (C)

Severe dehydration with signs of poor skin turgor signals volume depletion with compromised perfusion, so the priority is to rapidly restore circulating volume with an IV isotonic fluid bolus. This quickly expands intravascular volume and improves tissue perfusion, which is essential before attempting slower rehydration methods. A common initial dose is 20 mL/kg of normal saline given quickly (over about 5–10 minutes), and repeats may be needed up to about 60 mL/kg depending on response. Oral rehydration solutions are reserved for milder dehydration or for ongoing maintenance after perfusion is restored, not as the first step when perfusion is compromised. Withholding fluids would worsen hypovolemia, and antibiotics are not the immediate priority unless there is a separate infection requiring antimicrobial therapy.