Pediatric Dehydration

1. 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
      4. Normal tear production
   3. References
      1. Porter (2003) Ann Emerg Med 41:196-205
2. 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
3. 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
4. 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 is prolonged (Skin slowly retracts or tents)
      7. Delayed Capillary Refill (>2 seconds)
      8. Listless and Irritable
      9. Urine characteristics
         1. Dark color
         2. Oliguria (Urine output <1-2 cc/kg/hour)
         3. Urine Specific Gravity = 1.030 (low Test Sensitivity and Specificity)
      10. Blood Urea Nitrogen (BUN) increased (low Test Sensitivity and Specificity)
      11. Metabolic Acidosis
          1. Arterial pH <7.30
          2. Serum bicarbonate <17 meq/L (failure to respond to ORS is associated with serum bicarbonate <13 meq/L)
5. 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. Severe Metabolic Acidosis
          1. Arterial pH <7.10
6. Management
   1. See Pediatric Dehydration Management