Dehydration in Children (PAP7)

Dehydration in children (PAP 7)

Paediatric Acute Presentations 7
Paediatric Acute Presentations 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

Classified as

  • Mild <3%
  • Moderate 3-9%
  • Severe > 9%

See LITFL Paediatric Dehydration Assessment 


  • 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.

Common causes:

  • 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
  • educate/reassure
  • exclude more serious causes




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