Dehydration in children (PAP 7)
Notes by Isabel Vielba
Most common cause is gastrointestinal; others include CNS, Surgical, Endocrine and other volume deplete states such as Diabetes Insipidus, Renal failure, Burns.
Red flags in history taking:
- foreign travel
- food poisoning
- systemically unwell
- vomiting without diarrhoea
Clinical assessment is difficult. Gold standard is weight. Can look at RR, CRT, alert level. N.B. CRT is not reliable in DKA
- Mild <3%
- Moderate 3-9%
- Severe > 9%
- mild – oral rehydration and advice
- moderate – oral rehydration if possible, may need IV
- Severe – 20/kg fluid bolus if shocked
Fluid replacement = % dehydration x weight x 10 in mls over 24 hours
+ maintenance which is 100mls/kg/24 hours first 10kg
50mls/kg/24 hours 10-20kg
20mls/kg/24 hours 20+ kg
Use isotonic solution
The NICE guidance on Diarrhoea and Vomiting in children under 5 year old gives advice on assessment and treatment of dehydration
Up to 10% weight loss is physiological in breastfed babies, up to 7% in formula fed.
- poor oral intake
- illness – jaundice, sepsis, cardiac, or anatomical abnormalities e.g. tongue tie.
Investigate with Capillary gas, SBR, PCV and Na+.
- observe feed in ED
- exclude more serious causes