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Pediatric Dehydration

History: Triage
1. History from parents can help rule-out dehydration
2. Findings correlated with adequate hydration
  1. No decreased oral intake
  2. No decrease in urine output
  3. No history of Vomiting
3. References
  1. Porter (2003) Ann Emerg Med 41:196
Signs and symptoms: Minimal or subclinical Dehydration
1. Deficit: 1-2% (10-20 ml/kg)
2. Symptoms and signs
  1. Increased Thirst
  2. Mild Oliguria
Signs and symptoms: Mild Dehydration
1. Deficit
  1. Child: 3% deficit (30 ml/kg)
  2. Infant: 5% deficit (50 ml/kg)
2. Signs and Symptoms
  1. Dry lips
  2. Thick Saliva
  3. Decreased Tears
  4. Anterior Fontanelle flat
  5. Decreased Urine output
Signs and symptoms: Moderate Dehydration
1. Deficit
  1. Child: 6% deficit (60 ml/kg)
  2. Infant: 9% deficit (90 ml/kg)
2. Signs and symptoms
  1. Eyes sunken
  2. Tears absent
  3. Dry mucus membranes
  4. Sunken Fontanelle
  5. Pulse weak and rapid
  6. Skin turgur decreased
  7. Delayed capillary refill (>2 seconds)
  8. Skin slowly retracts (tenting)
  9. Listless and Irritable
  10. Urine characteristics
    1. Dark color
    2. Oliguria (Urine output <1-2 cc/kg/hour)
    3. Urine Specific Gravity = 1.030
  11. Blood Urea Nitrogen (BUN) increased
  12. Arterial pH <7.30
Signs and symptoms: Severe Dehydration
1. Deficit
  1. Child: 10% deficit (100 ml/kg)
  2. Infant: 15% deficit (150 ml/kg)
2. Signs and symptoms
  1. Limp and cold
  2. Lethargy or coma
  3. Acrocyanosis
  4. Thready pulse
  5. Grunting
  6. Deep and rapid Respiratory Rate
  7. Decreased Blood Pressure
  8. Skin retracts >2 sec
  9. Oliguria or Anuria
  10. Specific Gravity >1.035
  11. Capillary refill >4 seconds
  12. Blood Urea Nitrogen (BUN) markedly increased
  13. Arterial pH <7.10
Management
1. See Pediatric Dehydration Management

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.