The most useful individual signs for predicting 5%. The resuscitation phase should reduce moderate or severe dehydration to a deficit of about 8% body weight. Signs of severe diarrhea include 10 stoolsday, 5 days, bloody stools, and dehydration. Oral fluid therapy is recommended by the american academy of pediatrics and the who and should be used for children with mild to moderate dehydration who are accepting fluids orally unless prohibited by. If you dont replace lost fluids, you will get dehydrated. Dehydration in children msd manual professional edition. Diagnosis and management of dehydration in children amy canavan, md, virginia commonwealth university school of medicine, falls church, virginia billy s.
Clinically, it is useful to divide fluid therapy into repletion therapy and maintenance therapy. The importance of close monitoring of a dehydrated child can. Hypernatremia is typically defined as a serum or plasma sodium greater than 150 meql. Infants and young children are particularly susceptible. Dehydration is defined as the condition that results from excessive loss of body water 1. The management of mild, moderate and severe dehydration, which is the third step in the initial treatment of severe acute malnutrition, takes place in the hospital. Call the doctor if you notice these signs or if your childs diarrhea lasts more than 24 hours. Oral rehydration therapy protocol in pediatric dehydration, dehydration management in children with oral replacement, pediatric diarrhea fluid replacement. Although these children lack distinct signs of dehydration, they should be given more fluid than usual to prevent dehydration from developing. Dehydration is a common complication of illness observed in pediatric patients presenting to the emergency department ed.
Alternatively, the preillness weight can be calculated as follows. C 37, 11 ort is the preferred treatment for mild to moderate dehydration in children. Pediatric dehydration is frequently the result of increased output from gastroenteritis, characterized by vomiting, diarrhea, or both cellucci, 2019. This page includes the following topics and synonyms. Mild to moderate dehydration is characterized by thirst, restless or irritable behaviour, normal to slightly sunken eyes and a sunken fontanelle in infants.
Rapid oral rehydration therapy ort over 34 hours remains the cornerstone treatment of. The most useful individual signs for predicting 5% dehydration in children are an abnormal capillary refill time, abnormal skin turgor and abnormal respiratory pattern. When the body has less water than it needs to function optimally. Dehydration is one of the common presentations to the general practice or emergency departments eds in children having acute gastroenteritis age. Department of health and human services, atlanta, ga 30333. Dehydration is one of the leading causes of pediatric morbidity and mortality throughout the world. Assessing the severity of dehydration remains a challenge among physicians, and the dehydration scales currently available are inaccurate. This assessment helps guide decision making about therapy and patient disposition. Dehydration in children discharge care what you need. Clinical professor of pediatrics, university of california at san francisco and stanford university school of medicine, san francisco, ca after completing this article, readers should be able to. Pediatric saskatchewan registered nurses association. Faculty of medical science school of nursing kurdistan iraqdehydration in pediatrics prepared by students. Recognize the different clinical and laboratory abnormalities in isonatremic, hyponatremic, and hypernatremic dehydration. Pediatric dehydration assessment at triage koreamed synapse.
Parent education vomiting and diarrhea orlando pediatrics, llc. Diarrheal disease and dehydration account for 14% to 30% of worldwide deaths among. Start the oral rehydration protocol see above calculate 24 hour maintenance requirements. Jul 01, 2015 dehydration is one of the leading causes of pediatric morbidity and mortality throughout the world. Table 1 shows the classification of diarrhea without dehydration or blood in stools, according to the imci strategy. Dehydration is condition caused by the loss of too much fluid from the body. Diagnosis and management of dehydration in children american. When we talk of 5% dehydration, it means that the child has lost an amount of fluid equal to 5% of the body weight. Classification of children with persistent diarrhea has the child had diarrhea for 14 days or more. Dehydration american academy of pediatrics textbook of. Treatment of hypovolemia dehydration in children uptodate. Many illnesses often lead to dehydration in young children. This complex pathophysiological state was oversimplified as dehydration and the severity of body fluid losses categorized according to percentage of body weight loss.
Click here to start downloading to download the previous edition 20th edition, 2016, click here. The terms volume depletion or hypovolemia a condition in which extracellular fluid is lost and dehydration a condition in which pure water loss occurs are used interchangeably. Hypernatremic dehydration hd is dehydration associated with an elevated serum sodium concentration that is generally defined as a level of 150 meql or higher. Parent education vomiting and diarrhea orlando pediatrics. The most common causes of dehydration in children are vomiting and diarrhea. Clinical assessment of dehydration can be difficult, especially in young infants, and rarely predicts the exact degree of dehydration accurately. Features of dehydration decide if child is mildly, moderately or severely dehydrated once you have determined the degree of dehydration based on clinical features, use the appropriate degree of dehydration in table 4, fluid resuscitation to determine rate of fluid administration and special considerations during rehydration. Nov 12, 2018 dehydration is a common complication of illness observed in pediatric patients presenting to the emergency department ed. Anyone may become dehydrated, but the condition is especially dangerous for young children and older adults.
Although oral rehydration is underutilized in the united states, most children with dehydration can be successfully rehydrated via the oral route. Although pediatric hypernatremia is an uncommon electrolyte abnormality, there can be significant neurologic. Evaluation and management of dehydration in children. Unc department of pediatrics division of pediatric emergency medicine oral hydration therapy instructions dear parentscaregivers. Oral fluid therapy is effective, safe, convenient, and inexpensive compared with iv therapy. Another way to assess the degree of dehydration in children with acute dehydration is change in body weight. Pediatric oral rehydration therapy pathway in the emergency. Care guide for dehydration in children discharge care. Nelson textbook of pediatrics 21st edition pediacalls.
All children with diarrhea should be assessed to determine the duration of diarrhea, if there is blood in the stools, and if dehydration is present. Oral rehydration therapy protocol in pediatric dehydration. Fluid management and dehydration national pediatric nighttime curriculum written by dr. Byerley, md, mph clinical scenarios case 1 a 20monthold girl is brought to the emergency department ed after 2. Fluid resuscitationtreatment of dehydration for dehydration,shock,blood lossisotonic normal saline or lactated ringers give 20mlkg as bolus. A decrease of 2% or more can result in physical, visual, or cognitive changes. It happens when you are losing more fluids than you are taking in, and your body does not have enough fluids to work properly. Dehydration is such a common concern in pediatrics that clinicians in primary care offices, eds, and hospital settings all assess volume status as part of their evaluation. Dehydration versus volume depletion the terms dehydration and volume depletion are commonly used interchangeably but they refer to different physiologic conditions resulting from.
Diarrhea and dehydration the american academy of pediatrics. If dehydration is moderate, 20 mlkg 2% body weight is given iv over 20 to 30 minutes. Below is the download link of nelson textbook of pediatrics, 2 volume set edition. Dehydration denotes lack of plasma free water, and in the strict. Children are particularly susceptible to dehydration.
See oral rehydration therapy protocol in pediatric dehydration mild to moderate dehydration. So, a 10 kg child who is 5% dehydrated will weigh 9. To evaluate the reliability and validity of a previously derived clinical dehydration scale cds in a cohort of children with gastroenteritis and evidence of dehydration. However, this method depends on knowing a precise, recent preillness weight. Pdf understanding clinical dehydration and its treatment. If dehydration is severe, 3 boluses of 20 mlkg 6% body weight may be required. Early recognition and early intervention are important to reduce risk of progression to hypovolemic shock and endorgan failure. Oct 07, 2015 recognize the different clinical and laboratory abnormalities in isonatremic, hyponatremic, and hypernatremic dehydration. Do not give over the counter medications for diarrhea unless prescribed by your doctor 2. Sep 19, 2019 dehydration occurs when you use or lose more fluid than you take in, and your body doesnt have enough water and other fluids to carry out its normal functions. Dehydration in infancy and childhood american academy of. Early recognition and early intervention are important to reduce risk. The mmwr series of publications is published by the epidemiology program office, centers for disease control and prevention cdc, u. Pediatric dehydration management, dehydration management in children, intravenous therapy protocol in pediatric dehydration.
Hypernatremia is a serum sodium concentration 150 meql 150 mmoll, usually caused by dehydration. In severe acute malnutrition, dehydration is caused by untreated diarrhoeal disease which leads to the loss of water. Clinical examination methods for diagnosing dehydration. Fluid management and dehydration texas tech university. What are childrens symptoms of dehydration in children.
Definition of diarrhea diarrhea is the passage of loose or watery stools at. Diarrheal disease and dehydration account for 14% to 30% of worldwide deaths among infants and toddlers. Nov 12, 2018 the severity of dehydration is typically measured as the acute weight loss presumably fluid as a percentage of preillness weight. It can occur any time your child is losing more fluidthrough vomiting, diarrhea, or other causesthan he or. In children, the most common abnormality requiring fluid therapy is. Pdf purpose dehydration is a paediatric medical emergency but there is no single standard parameter to evaluate it at the emergency. The correct assessment of dehydration is the basis for proper management of acute diarrhea in children. C 17, 18, 19 a single dose of ondansetron zofran may facilitate ort in children with dehydration. This module will first discuss diarrheal diseases and their management, and dehydration and its treatments. Features of dehydration decide if child is mildly, moderately or severely dehydrated once you have determined the degree of dehydration based on clinical features, use the appropriate degree of. Apr 16, 2019 clinical assessment of dehydration can be difficult, especially in young infants, and rarely predicts the exact degree of dehydration accurately. If dehydration is moderate, 20 mlkg 2% body weight is given iv over 20 to 30 minutes, reducing a 10% deficit to 8%. The mmwr series of publications is published by the epidemiology program office, centers for disease control and prevention. Diarrhea is the passage of loose or watery stools at least 3 times in a 24 hour period.
Clinical professor of pediatrics, university of california at san francisco and stanford university school of medicine, san francisco, ca after completing this. Pediatric dehydration is a common problem in emergency departments and wide practice variation in treatment exists. Fluid therapy maintains the normal volume and composition of body fluids and, if needed, corrects any existing abnormalities. Who initial treatment of dehydration for severe acute. Pediatric dehydration is a common problem in emergency departments and. This was a prospective pilot cohort study of children who presented to two paediatric. Factors associated with unrestrained young passengers in motor vehicle crashes. March 01, 2019, 143 3 american academy of pediatrics. C 1417 use of an appropriate ort solution corrects and helps prevent electrolyte disturbances caused by gastroenteritis in children.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Dehydration can be treated with oral, nasogastric, subcutaneous, or intravenous fluids. Occurs when the bodys output is greater than intake. Participants were 226 children older than 3 months who presented to a tertiary care emergency department and required intravenous rehydration. Hypernatremia is seen in a variety of clinical states in infancy, but this article is concerned with its occurrence in the clinical. Children should be assessed for degree of dehydration based on physical examination findings. However, the preillness weight is often not available in the ed setting and clinicians have to rely on the patients history and physical examination findings to assess the severity of dehydration. Oral rehydration therapy protocol in pediatric dehydration, dehydration management in children with oral replacement, pediatric diarrhea fluid. See maintenance fluid requirements in children hollidaysegar formula. Diagnosis and management of dehydration in children. Pediatric annals hypernatremic dehydration in exclusively breastfed neonates is associated with a free water deficit secondary to inadequate fluid intake. Although these children lack distinct signs of dehydration, they should be given more fluid than usual to prevent dehydration from. Reliability was assessed at treatment initiation, by. What are critical treatments for children with diarrhoea and dehydration.
Oral fluid therapy is recommended by the american academy of pediatrics and the who and should be used for. Some people lose their sense of thirst as they age, so they dont drink enough fluids. Study 22 terms pediatric dehydration case study flashcards. Fluid and electrolyte therapy is an essential component of the care of hospitalized children, and a thorough understanding of the changing requirements of growing children is fundamental in appreciating the many important pharmacokinetic changes that occur from birth to adulthood. Dehydration results from decreased intake, increased output renal, gastrointestinal or insensible losses, a shift of fluid eg, ascites, effusions, or capillary leak of fluid eg, burns and sepsis.