An unresponsive 4-month-old female has had diarrhea for 3 days and shows signs of dehydration. What is the recommended immediate treatment?

In the case of an unresponsive 4-month-old with diarrhea and signs of dehydration, the immediate treatment that should be prioritized is the administration of a fluid bolus, specifically a normal saline bolus. This approach addresses the child's urgent need for volume replacement due to dehydration.

The recommended dosage of 20 mL/kg of normal saline is appropriate for rehydration and helps restore intravascular volume. In a child who is unresponsive, the likelihood of oral rehydration being effective is diminished due to the potential for decreased swallowing reflex and the risk of aspiration. Thus, intravenous fluids are essential for swift correction of dehydration.

In contrast, other options such as administering glucose orally or offering clear fluids every hour are not suitable given the severity of the situation; oral rehydration may not be tolerated, and any delay in rehydration can exacerbate the child’s condition. Monitoring vital signs for 24 hours does not address the immediate needs of this critically dehydrated patient. Prioritizing fluid resuscitation is vital to stabilize the patient’s condition.