Dehydration In Children

Dehydration is loss of body water, usually accompanied by electrolyte loss. Acute gastroenteritis is the most common cause in children. Infants deteriorate faster because of higher baseline fluid requirements and limited physiological reserve.

Classification into no, some or severe dehydration determines treatment.

Important signs include:

• Thirst
• Reduced urine output
• Dry mucous membranes
• Sunken eyes
• Reduced tears
• Tachycardia
• Restlessness or irritability
• Delayed skin pinch
• Lethargy in severe disease

Shock is suggested by altered consciousness, cold extremities, weak pulses and prolonged capillary refill.

Hypernatraemic dehydration can be deceptive because intravascular volume and skin turgor may appear relatively preserved despite major water deficit.

Primarily clinical.

Assess:

• Weight if a reliable recent baseline exists
• Mental state
• Pulse and perfusion
• Urine output
• Eyes and mucosae
• Skin recoil
• Ability to drink

Check electrolytes, urea, creatinine and glucose in severe dehydration, prolonged illness, altered consciousness, suspected dysnatraemia or when IV fluids are required.

• No dehydration: ORS after each loose stool, continue breastfeeding and normal feeding.

• Some dehydration: ORS 75 mL/kg over 4 hours, given in frequent small amounts. Use nasogastric administration if oral intake is inadequate but the gut remains usable.

• Reassess after 4 hours and reclassify rather than automatically continuing the same regimen.

• Replace ongoing losses with additional ORS.

• IV therapy is required for shock, severe dehydration with inability to tolerate enteral rehydration, or deterioration despite appropriate ORS.