A child weighing 33 lbs presents with fever, malaise, and a capillary refill of 4 seconds. What should you administer?

In the given scenario, the child is exhibiting signs of dehydration and possibly shock, as evidenced by the prolonged capillary refill time of 4 seconds in conjunction with fever and malaise. When considering fluid resuscitation in pediatric patients, it's crucial to follow guidelines that account for their weight and clinical presentation.

For a child who weighs 33 lbs (approximately 15 kg), the recommendation for initial bolus fluid administration typically is around 20 mL/kg of isotonic crystalloid solution. Therefore, calculating this amount for the child results in approximately 300 mL (20 mL/kg x 15 kg = 300 mL). Administering this volume helps to rapidly restore intravascular volume and improve perfusion, which is vital given the observed signs.

Choosing this option is appropriate based on guidelines for fluid resuscitation in pediatric patients, ensuring that the child receives a sufficient volume to address potential hypovolemia without overloading their system, which could happen with larger volumes like 500 mL or 1 L. Additionally, administering D5W would not be suitable in this situation as it does not contain the necessary electrolytes or volume required for rapid resuscitation in a potentially dehydrated child.