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Dehydration in Children - Pediatrics - MSD Manual Professional Edition

Infants and young children are particularly susceptible to diarrheal disease and dehydration. In addition to total body water losses, electrolyte abnormalities may exist. Pathophysiology . to the original author(s) and the source, a link is provided to the Creative Commons license, and any changes made are indicated . Depending on the type of pathophysiologic process, water and salts (primarily are simultaneously involved in a reciprocal relationship with bicarbonate ions. diarrhea resulting in dehydration is a leading cause of death in parts of the world from Finberg L, Kravath RE, Hellerstein S. Water and Electrolytes in Pediatrics. In the midst of conflicting literature on fluid and electrolytes therapy, it would appear that The article reviews the pathophysiology of water and sodium metabolism and, In fact, death among volume depleted children with diarrheal disease is the . an excess of water in relation to sodium in extracellular fluid ( ECF) (35).

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

Although oral rehydration therapy is adequate to correct mild to moderate isonatraemic dehydration, parenteral fluid therapy is safer for the child with severe dehydration and those with changes in serum sodium. The importance of a keen and regular clinical and laboratory monitoring of a child being rehydrated is emphasized. The article would be valuable to clinicians in less-developed countries, who must use pre-mixed fluids, and who often cannot get some suitable rehydrating solutions.

Poor tissue perfusion, acidosis, end-organ damage to the kidneys, liver, and brain, and death are consequences of a poorly managed hypovolaemic child 1 — 4. In fact, death among volume depleted children with diarrheal disease is the second leading cause of death among the under-five children word wide 5.

Dehydration

Although the basic principles on fluid and electrolytes therapy have been investigated for decades, the topic remains a challenge, as consensus on clinical management protocol is difficult to reach, and more adverse events are reported from fluid administration than for any other drug 67. While the maintenance fluid therapy promoted by Holliday and Segar in has stood the test of time 8 ; recent systematic reviews and meta-analyses have highlighted the risk of hyponatraemia, and hyponatraemic encephalopathy in some children treated with hypotonic fluids that have been used for decades as maintenance therapy 9 — The compositions of these hypotonic fluids have emanated originally from the Holliday and Segar estimations 8.

Apart from unavailability of some desired fluids e. For example, the comprehensive treatise by K. Powers recommendations are incorrect and could pose serious complications if followed. While hypotonic fluids use is associated with a high incidence of hyponatraemia that could result in fatal hyponatraemic encephalopathy; children on high-potassium solutions are also at risk of dangerous hyperkalemia Furthermore, Kiguli et al.

Insensible losses evaporative free water losses from the skin and respiratory tract account for about one third of total maintenance water slightly more in infants and less in adolescents and adults.

Maintenance Fluid Calculation for Children Volume rarely must be exactly determined but generally should aim to provide an amount of water that does not require the kidney to significantly concentrate or dilute the urine. More complex calculations eg, those using body surface area are rarely required. Maintenance fluid volumes can be given as a separate simultaneous infusion, so that the infusion rate for replacing deficits and ongoing losses can be set and adjusted independently of the maintenance infusion rate.

The traditional approach to calculating the composition of maintenance fluids was also based on the Holliday-Segar formula.

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According to that formula, patients require Sodium: This calculation indicates that maintenance fluid should consist of 0. Other electrolytes eg, magnesium, calcium are not routinely added. However, recent literature suggests that hospitalized dehydrated children receiving 0. Iatrogenic hyponatremia may be a greater problem for more seriously ill children and those who are hospitalized after surgery.

Due to this possibility of iatrogenic hyponatremia, many centers are now using a more isotonic fluid such as 0.

Pediatric Dehydration: Through Case Study Questions

This change also has the benefit of allowing use of the same fluid to replace ongoing losses and supply maintenance needs, which simplifies management. Bacterial pathogens cause less than 20 percent of cases. Parasites such as Giardia and Cryptosporidium account for less than 5 percent of cases.

Pathophysiology Dehydration causes a decrease in total body water in both the intracellular and extracellular fluid volumes.

Dehydration, Pediatric - StatPearls - NCBI Bookshelf

Volume depletion closely correlates with the signs and symptoms of dehydration. History and Physical Various sign and symptoms can be present depending on the patient's degree of dehydration. The table below can assist with categorizing the patient's degree of dehydration. In selected cases, electrolyte abnormalities may exist. This includes derangements in sodium levels, acidosis characterized by low bicarbonate levels or elevated lactate levels. For patients with vomiting, who have not been able to tolerate oral fluids hypoglycemia may be present.

Evaluation of urine specific gravity and presence of ketones can assist in the evaluation of dehydration. End-tidal carbon dioxide measurements have been studied in an attempt to assess degrees of dehydration greater than five percent in children.

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

This non-invasive approach has promise, but as of now has not proven to be an effective tool is determining the degree of dehydration in children. Symptoms include vomiting, diarrhea, fever, decreased oral intake, inability to keep up with ongoing losses, decreased urine output, progressing to lethargy, and hypovolemic shock.

Mild Dehydration The American Academy of Pediatrics recommends oral rehydration for patients with mild dehydration. Breastfed infants should continue to nurse. Fluids with high sugar content may worsen diarrhea and should be avoided.