Dehydration (peds)

This page is for pediatric patients. For adult patients, see: dehydration

Background

1kg body wt = to 1 liter fluid

Clinical Features

Sunken fontanelle in a 1-month old.
  • Decreased urine output
  • Sunken fontanelle
  • Most reliable: [1]
    • Abnormal capillary refill
    • Abnormal respiratory pattern
    • Decreased skin turgor

Differential Diagnosis

Evaluation

Management

  • Ondansteron for vomiting
  • Mild to moderate dehydration: start with trial of oral rehydration therapy or half strength apple juice[2][3]
    • Part of ACEP Choosing wisely
    • Provide ORS solution (e.g. Pedialyte) at 50 to 100 mL/kg over 2-4 hours in small doses q5min
    • If the child vomits, wait 15 minutes then try again
    • Provide additional ORS to replace ongoing GI losses
  • Consider Fluid Repletion (IVF) only if severely dehydrated, not tolerating oral intake or failed oral rehydration therapy

See Also

External Links

References

  1. ↑ Steiner, M. J. (2004) ‘Is This Child Dehydrated?’, JAMA, 291(22), p. 2746. doi: 10.1001/jama.291.22.2746
  2. ↑ Freedman SB, Willan AR, Boutis K, Schuh S. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial. JAMA. 2016 May 10;315(18):1966-74. doi: 10.1001/jama.2016.5352. PMID: 27131100. https://pubmed.ncbi.nlm.nih.gov/27131100/
  3. ↑ SGEM#158: Tempted by the Fruit of Another – Dilute Apple Juice for Pediatric Dehydration https://www.thesgem.com/2016/06/sgem158-tempted-by-the-fruit-of-another-dilute-apple-juice-for-pediatric-dehydration/
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