In this lecture, we’re going to discuss
fluid replacement therapy in children.
This seems like a strange topic to discuss,
but it turns out that fluid
replacement therapy in children
is a bit more complicated
than in adults.
So dehydration is extremely
common in children
and one of the most important
risks for a child’s health.
We see this all the time.
It occurs commonly in patients with upper
respiratory infections like colds.
Simply they don’t want to drink.
Children with lower respiratory infections
like bronchiolitis or pneumonia.
It’s common in children with vomiting
from gastroenteritis for example
or diarrhea, the same.
It’s also common in
simply febrile illnesses.
Recall, a child has a much higher body
surface area per weight than an adult does.
And so insensible losses through
sweating and breathing fast
are much more significant.
So when we see an infant or
a child with dehydration,
we want to make an assessment of
exactly how dehydrated they are.
Let’s imagine three children.
A child who’s minimally, moderately, and
another who is severely dehydrated.
In our minimally dehydrated child, which
is about less than 3% dehydration,
we really expect this child
to be mostly normal.
Mental status, heart rate, mucous
membranes, capillary refill,
skin turgor, extremities,
all of this is normal.
The first thing that becomes abnormal
is a decrease in urine output.
Parents will report dry diapers
or you may note decreased urine output
if the patient is hospitalized.
What’s key to understand is that
the kidneys holding on to fluids
is the very first thing to go when
a patient is minimally dehydrated.
In moderate dehydration, we
see more systemic symptoms.
In particular, you’ll note a child
has fatigue or irritability
that may be from the illness.
Their heart rate may be
increased as a way of
decreased blood volume.
What’s key is dry mucous membranes.
We see this and it’s a great way of assessing
quickly whether a child is hydrated.
Also they may have fever
tears present when crying.
Capillary refill may be mildly delayed
around three to four seconds.
The skin turgor is still normal.
They may now have cool extremities
as they’re having vasoconstriction
to redirect the little blood they have
where it needs to go and remember
that urine output is still decreased.
As we proceed to the patient
with severe dehydration,
which is more than
these patients have apathy, lethargy,
they do not have a normal mental status.
Heart rate will be very high.
They will have parched mucous membranes,
very prolonged capillary refill and
this is when you may see that tenting
that you mostly read about in books
or see in developing countries.
Most children don’t get that
sick in the United States.
Children may have
That’s from vasoconstriction of blood
vessels going out to the skin.
And again, they will have almost no urine
output, very decreased urine output.