Children are particularly vulnerable to developing dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration because they have higher insensible water loss and more elevated metabolic rates than adults. In addition, children's inability to communicate their needs compounds with large losses of fluids (e.g., diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea, vomiting Vomiting The forcible expulsion of the contents of the stomach through the mouth. Hypokalemia), putting them at even higher risk. Dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration is defined as a decrease in total body water Total body water Body Fluid Compartments, and can be characterized as mild, moderate, or severe. Fluid replacement treatment is based on severity. Clinicians must be prepared to administer optimal rehydration Rehydration Dengue Virus therapy in addition to the other required measures for the causal illness. When treated promptly, dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration starts to resolve clinically within the first few hours.
Last updated: 8 Jan, 2021
Dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration ( hypovolemia Hypovolemia Sepsis in Children) is a decrease in total body water Total body water Body Fluid Compartments, both intracellular and extracellular.
Dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration in children worldwide is primarily caused by diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea:
In most cases, a good history and physical exam are sufficient to diagnose dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration and its etiology. Laboratory testing is reserved for severe cases and to monitor rehydration Rehydration Dengue Virus.
Mild | Moderate | Severe | |
---|---|---|---|
Weight loss Weight loss Decrease in existing body weight. Bariatric Surgery | < 5% in infants, < 3% in older children | 5%–10% in infants, 3%–9% in older children | < 10% in infants, < 9% in older children |
Dry mucosas (first sign) | – | +/-, looks dry | +, looks parched |
Skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions turgor (last sign) | + | +/- | -, tenting |
Anterior fontanelle Anterior Fontanelle Physical Examination of the Newborn depression | – | + | +/++ |
Mental status | Normal | Fatigued/irritable | Apathy Apathy Lack of emotion or emotional expression; a disorder of motivation that persists over time. Wernicke Encephalopathy and Korsakoff Syndrome/ lethargy Lethargy A general state of sluggishness, listless, or uninterested, with being tired, and having difficulty concentrating and doing simple tasks. It may be related to depression or drug addiction. Hyponatremia |
Enophthalmos Enophthalmos Recession of the eyeball into the orbit. Marfan Syndrome | – | + | + |
Breathing | Normal | Deep, may be tachypneic | Deep and tachypneic |
Heart rate Heart rate The number of times the heart ventricles contract per unit of time, usually per minute. Cardiac Physiology | Normal | Increased | Very high |
Hypotension Hypotension Hypotension is defined as low blood pressure, specifically < 90/60 mm Hg, and is most commonly a physiologic response. Hypotension may be mild, serious, or life threatening, depending on the cause. Hypotension | – | + | + |
Distal perfusion | Normal | Feels cold, 3–4 seconds | Acrocyanotic, > 4 seconds |
Urinary output | Decreased | Oliguria Oliguria Decreased urine output that is below the normal range. Oliguria can be defined as urine output of less than or equal to 0. 5 or 1 ml/kg/hr depending on the age. Renal Potassium Regulation | Oliguria Oliguria Decreased urine output that is below the normal range. Oliguria can be defined as urine output of less than or equal to 0. 5 or 1 ml/kg/hr depending on the age. Renal Potassium Regulation/ anuria Anuria Absence of urine formation. It is usually associated with complete bilateral ureteral (ureter) obstruction, complete lower urinary tract obstruction, or unilateral ureteral obstruction when a solitary kidney is present. Acute Kidney Injury |
Components of the CHEM-7:
Na:
sodium
Sodium
A member of the alkali group of metals. It has the atomic symbol na, atomic number 11, and atomic weight 23.
Hyponatremia
Cl:
chloride
Chloride
Inorganic compounds derived from hydrochloric acid that contain the Cl- ion.
Electrolytes
BUN: blood
urea
Urea
A compound formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids.
Urea Cycle
nitrogen
Nitrogen
An element with the atomic symbol n, atomic number 7, and atomic weight [14. 00643; 14. 00728]. Nitrogen exists as a diatomic gas and makes up about 78% of the earth’s atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells.
Urea Cycle
K:
potassium
Potassium
An element in the alkali group of metals with an atomic symbol k, atomic number 19, and atomic weight 39. 10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte that plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance.
Hyperkalemia
HCO3:
bicarbonate
Bicarbonate
Inorganic salts that contain the -HCO3 radical. They are an important factor in determining the ph of the blood and the concentration of bicarbonate ions is regulated by the kidney. Levels in the blood are an index of the alkali reserve or buffering capacity.
Electrolytes
Cr: creatinine
CHEM-7 with normal values
Image by Lecturio.Example of a CHEM-7 for a child with mild dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration: Notice the slight rise of the BUN and the decreased glucose Glucose A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. Lactose Intolerance.
Image by Lecturio.Example of a CHEM-7 for a child with moderate dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration: Notice the increased sodium Sodium A member of the alkali group of metals. It has the atomic symbol na, atomic number 11, and atomic weight 23. Hyponatremia (145), chloride Chloride Inorganic compounds derived from hydrochloric acid that contain the Cl- ion. Electrolytes (112) and BUN (16), while bicarbonate Bicarbonate Inorganic salts that contain the -HCO3 radical. They are an important factor in determining the ph of the blood and the concentration of bicarbonate ions is regulated by the kidney. Levels in the blood are an index of the alkali reserve or buffering capacity. Electrolytes (13) and glucose Glucose A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. Lactose Intolerance (58) have decreased sharply. It’s becoming acidotic.
Image by Lecturio.Example of a CHEM-7 for a child with severe dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration: Notice the increased sodium Sodium A member of the alkali group of metals. It has the atomic symbol na, atomic number 11, and atomic weight 23. Hyponatremia (180), chloride Chloride Inorganic compounds derived from hydrochloric acid that contain the Cl- ion. Electrolytes (142), BUN (40), and creatinine (2.3), while bicarbonate Bicarbonate Inorganic salts that contain the -HCO3 radical. They are an important factor in determining the ph of the blood and the concentration of bicarbonate ions is regulated by the kidney. Levels in the blood are an index of the alkali reserve or buffering capacity. Electrolytes (8) and glucose Glucose A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. Lactose Intolerance (48) have decreased sharply. It’s becoming acidotic.
Image by Lecturio.Severe dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration can cause hypoperfusion of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification and vital organs and is considered a medical emergency to be addressed rapidly.
A child who weighs 25 kg with severe dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration:
Approach to evaluation and treatment with oral replacement fluid (ORF) or intravenous (IV) fluids of children with dehydration Dehydration The condition that results from excessive loss of water from a living organism. Volume Depletion and Dehydration based on severity of symptoms
Image by Lecturio.Daily requirements = maintenance fluids + growth fluids: