Dehydration in Children : Definition, Etiology, Assessment, Signs, Symptoms, Effects, Reaction, Management, & Prevention
Definition
- Dehydration happens due to fluid loss in body (e.g. due to diarrhea).
Assessment
Parameter | No dehydration | Some dehydration | Severe dehydration |
General condition | Conscious, Alert | Irritable | Lethargic or Comatose |
Eyes | Normal | Sunken | Very sunken |
Tears | Present | Absent | Absent |
Oral mucosa | Wet | Dry | Dry |
Thirst | Not thirsty, drinks normally | Thirst, drinks eagerly | Unable to drink |
Skin pinch test | Wrinkles go back quickly | Wrinkles go back slowly | Wrinkles go back very slowly |
Note: Signs of dehydration in neonates: Depressed anterior fontanelle.
Management
A. Plan A
No dehydration
⇓
ORT (Oral Rehydration Therapy)
⇓
ORS or Home based fluids (e.g. Coconut water, Dal water, Rice water)
Amount
- If child < 2 year : 50-100 ml/loose stool
- If child 2-10 year : 100-200 ml/loose stool
- If child > 10 year : As much as wants
What is not ORT?
- Tea, Coffee, Milk
- Juice
- Carbonated beverages
- Pure dextrose solutions
What are the causes of failure of ORT?
- Incorrect preparation
- Incorrect administration of ORT
- Persistent vomiting (> 3 times/hour)
- Glucose malabsorption
- High stool purge rate (> 5 ml/kg/hr)
- Paralytic ileus
B. Plan B
Some dehydration
⇓
WHO based ORS (Low osmolarity ORS)
Amount: 75 ml/kg over 4 hour followed by 10-20 ml/kg/loose stool
WHO based ORS
- Total osmolality: 245 mOsm/l
Constituent | Amount (g/l) | Osmole/Ion | mmole/l |
NaCl | 2.6 | Sodium | 75 |
Chloride | 65 | ||
Glucose, anhydrous | 13.5 | Glucose, anhydrous | 75 |
KCl | 1.5 | Potassium | 20 |
Trisodium citrate, dihydrate | 2.9 | Citrate | 10 |
C. Plan C
Severe dehydration
⇓
IV fluids
- Best: Ringer’s lactate (RL)
- Alternate: Normal saline (NS)
Total amount to be given: 100 ml/kg
Age | 1st 30 ml/kg | 1st 70 ml/kg |
Child < 12 months | Over 1 hour | Over 5 hour |
Child > 12 months | Over 30 minute | Over 2.5 hour |
Note: During all the three plan, never stop feeding.
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