Severe Dehydration In Children

Severe dehydration represents major fluid depletion causing marked physiological compromise and may progress to hypovolaemic shock, acute kidney injury, severe electrolyte disturbance and death.

Severe malnutrition changes fluid management substantially and should be recognized before standard rapid rehydration is used.

Severe dehydration is suggested by:

• Lethargy or reduced consciousness
• Inability to drink adequately
• Markedly sunken eyes
• Very slow skin pinch
• Tachycardia
• Oliguria or anuria

Shock adds:

• Cold extremities
• Weak or absent peripheral pulses
• Capillary refill longer than 3 seconds
• Altered consciousness

Assess airway, breathing and circulation immediately.

Check:

• Glucose
• Electrolytes
• Urea and creatinine
• Acid base status where severely unwell

Identify severe malnutrition and severe anaemia before giving rapid fluid boluses.

For severe dehydration without severe malnutrition:

• Give Ringer's lactate 100 mL/kg total.

• First 30 mL/kg: over 30 minutes if at least 12 months old, or 60 minutes if younger than 12 months.

• Then 70 mL/kg: over 2.5 hours if at least 12 months old, or 5 hours if younger than 12 months.

• Give ORS approximately 5 mL/kg/hour as soon as the child can drink or by nasogastric tube.

If true hypovolaemic shock is present:

• Ringer's lactate 20 mL/kg IV or IO over approximately 15 minutes, then immediately reassess. A second bolus may be required before continuing deficit replacement.

Do not apply this rapid regimen to severe acute malnutrition.