Makindo Medical Notes

Dehydration is a common and potentially life-threatening condition in children, especially in cases of gastroenteritis, fever, or inadequate fluid intake. Prompt assessment, diagnosis, and management are critical in preventing complications such as shock, electrolyte imbalances, and organ failure. This note will provide an overview of the key aspects of dehydration in children.

Assessment of Dehydration

Assessment of dehydration in children is primarily clinical and based on the degree of fluid loss. Dehydration can be classified as mild, moderate, or severe based on clinical signs and symptoms.

History

• Recent Illness: Ask about vomiting, diarrhoea, fever, and reduced fluid intake.
• Urine Output: Reduced urine output or fewer wet nappies may indicate dehydration.
• Duration: The longer the symptoms (e.g., diarrhoea), the higher the risk of dehydration.

Clinical Signs of Dehydration

Sign	Mild Dehydration (5% loss)	Moderate Dehydration (6-9% loss)	Severe Dehydration (>10% loss)
General Appearance	Alert, may be thirsty	Irritable, tired, thirsty	Lethargic, drowsy, or unconscious
Skin Turgor	Normal	Slightly delayed skin pinch	Very delayed (>2 seconds)
Mucous Membranes	Moist	Dry	Very dry
Capillary Refill	Normal (<2 seconds)	Slightly delayed	Prolonged (>2 seconds)
Eyes	Normal	Slightly sunken	Sunken
Urine Output	Normal	Reduced	Minimal to absent
Pulse	Normal	Rapid	Weak, rapid

Diagnosis of Dehydration

Diagnosis is primarily based on clinical assessment. However, laboratory investigations may be required in severe cases or if the child has underlying medical conditions.

Clinical Diagnosis

• Physical Examination: Assess for signs of dehydration such as dry mucous membranes, sunken eyes, delayed capillary refill, poor skin turgor, and lethargy.
• History: A focused history on recent vomiting, diarrhoea, fever, or fluid loss can help estimate the severity of dehydration.

Laboratory Investigations (If Required)

• Serum Electrolytes: To detect hyponatraemia, hypernatraemia, or hypokalaemia.
• Blood Urea Nitrogen (BUN) and Creatinine: To assess renal function and hydration status.
• Acid-Base Status: Venous blood gas analysis can identify metabolic acidosis, which is often present in moderate to severe dehydration.
• Urinalysis: May show concentrated urine or ketones in cases of dehydration.

Management

The primary goal of management is to restore fluid and electrolyte balance. The management depends on the severity of dehydration and the child's overall condition.

• Mild to Moderate Dehydration
  • Oral Rehydration Therapy (ORT): The first-line treatment for mild to moderate dehydration is oral rehydration solution (ORS).
    • Give small, frequent sips of ORS (e.g., Dioralyte) to replace lost fluids and electrolytes.
    • Dosage: 50-75 mL/kg over 4 hours in mild dehydration, and 75-100 mL/kg in moderate dehydration.
    • Continue breastfeeding or formula feeding in infants.
  • Diet: Once rehydrated, gradually reintroduce the child's regular diet, avoiding sugary drinks or juices that may worsen diarrhoea.
• Severe Dehydration
  • Intravenous (IV) Fluid Resuscitation:
    • For severe dehydration, IV fluids are required to restore circulatory volume rapidly.
    • Start with an IV bolus of 20 mL/kg isotonic saline (0.9% NaCl), and repeat as necessary based on clinical response.
    • Once stabilized, replace deficits and ongoing losses with maintenance IV fluids (e.g., 0.45% NaCl with 5% dextrose).
  • Electrolyte Monitoring: Regularly monitor electrolytes, blood gases, and renal function in children with severe dehydration.
• Ongoing Monitoring
  • Monitor hydration status with regular clinical reassessments (e.g., capillary refill, skin turgor, urine output).
  • Ensure adequate fluid intake is maintained after initial rehydration.

Prevention of Dehydration

Prevention is key in reducing the incidence and severity of dehydration in children. Parents and caregivers should be educated on the importance of maintaining adequate hydration during illness, especially with diarrhoea and vomiting.

• Encourage regular fluid intake, especially in hot weather or during illness.
• Use ORS early in cases of gastroenteritis or during periods of vomiting/diarrhoea.
• Continue breastfeeding or formula feeding even during illness to ensure adequate hydration in infants.

Conclusion

Dehydration in children is a common condition that can progress rapidly, particularly in younger children. Early recognition, accurate assessment of the severity, and appropriate rehydration are essential to prevent complications. Oral rehydration therapy remains the cornerstone of treatment for mild to moderate dehydration, while intravenous fluid therapy is necessary for severe cases.