Pediatric Dehydration

Pediatric Dehydration is responsible for 200,000 hospitalizations and 300 deaths in the U.S. per year

History from parents can help rule-out Dehydration
Findings correlated with adequate hydration
1. No decreased oral intake
2. No decrease in Urine Output
3. No history of Vomiting
4. Normal tear production
References
1. Porter (2003) Ann Emerg Med 41:196-205 [PubMed]

Markers of Dehydration have low accuracy as single measures, but useful in combination
1. Hoxha (2015) Med Arch 69(1): 10–2 [PubMed]

Increased Respiratory Rate (rapid deep breathing)
1. May be a sign of Metabolic Acidosis
Abnormal skin turgur
1. Pinch skin at umbilical level of lateral abdominal wall
2. Skin Tenting with a >2 second delay in return to normal suggests Dehydration
Capillary Refill
1. Perform in a warm room
2. Press on Sternum or pad of foot in infants
3. Press on finger tuft in children (held at heart level)
4. Capillary Refill Time over 2 seconds suggests Dehydration
Serum bicarbonate
1. Serum bicarbonate >15-17 mEq/L decreases the likelihood of Clinically Significant Dehydration
2. Serum bicarbonate <13 mEq/L increases the likelihood that Oral Rehydration Solution will fail
3. Teach (1997) Clin Pediatr 36(7): 395-400 [PubMed]

Deficit <5% loss
1. Child: 3% deficit (30 ml/kg)
2. Infant: 5% deficit (50 ml/kg)
Signs and Symptoms
1. Dry lips
2. Thick Saliva
3. Decreased Tears
4. Anterior Fontanelle flat
5. Decreased Urine Output

Deficit 5-9% loss
1. Child: 6% deficit (60 ml/kg)
2. Infant: 9% deficit (90 ml/kg)
Signs and symptoms
1. Eyes sunken
2. Tears absent
3. Dry mucus membranes
4. Sunken Fontanelle
5. Pulse weak and rapid (Tachycardia)
6. Tachypnea
  1. Compensatory Tachypnea for Metabolic Acidosis without respiratory distress
7. Skin turgur is prolonged (Skin slowly retracts or tents for 2 sec)
8. Delayed Capillary Refill (2-4 seconds)
9. Listless and Irritable
10. Urine characteristics
  1. Dark color
  2. Oliguria (Urine Output <1-2 cc/kg/hour)
  3. Urine Specific Gravity = 1.030 (low Test Sensitivity and Specificity)
11. Blood Urea Nitrogen (BUN) increased (low Test Sensitivity and Specificity)
12. Metabolic Acidosis
  1. Arterial pH <7.30
  2. Serum bicarbonate <17 meq/L (failure to respond to ORS is associated with serum bicarbonate <13 meq/L)

Deficit >10% loss
1. Child: >10% deficit (100 ml/kg)
2. Infant: 15% deficit (150 ml/kg)
Signs and symptoms
1. Limp and cold
2. Lethargy or coma
3. Toxic appearance
4. Sunken eyes
5. Very dry mucous membranes
6. Acrocyanosis
7. Thready and rapid pulse (severe Tachycardia)
8. Grunting
9. Deep and rapid Respiratory Rate
  1. Compensatory Tachypnea for Metabolic Acidosis without respiratory distress
10. Decreased Blood Pressure
  1. Children compensate and maintain Blood Pressure with Sinus Tachycardia and vascular constriction
  2. Hypotension is an ominous late marker of severe Dehydration in Children and heralds cardiovascular collapse
11. Skin turgur is very prolonged (Skin slowly retracts or tents for >4 sec)
12. Skin retracts >2 sec
13. Oliguria or Anuria
14. Specific Gravity >1.035
15. Capillary Refill >4 seconds
16. Blood Urea Nitrogen (BUN) markedly increased
17. Severe Metabolic Acidosis
  1. Arterial pH <7.10