Health

Dehydration in Children : Causes, Types, Symptoms, & Treatment

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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