Dehydration (peds)

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

Background

1kg body wt = to 1 liter fluid

Clinical Features

  • 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/