4/3/2016

PaediatricDehydrationAssessment

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Paediatric Dehydration Assessment

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OVERVIEW
Clinical assessment of dehydration can be difficult, especially in young infants, and rarely predicts the
exact degree of dehydration accurately.
The most useful individual signs for predicting 5% dehydration in children are an abnormal capillary
refill time, abnormal skin turgor and abnormal respiratory pattern. Combinations of examination signs
provide a much better method than any individual signs in assessing the degree of dehydration.
CLINICAL ASSESSMENT
Clinical assessment therefore comprises some of the following indicators of dehydration:
Loss of body weight:
Normal: no loss of body weight.

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EXAMS

APRIL 2, 2016

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PaediatricDehydrationAssessment

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Mild dehydration: 5-6% loss of body weight.

CCC

EXAMS

APRIL 2, 2016

Moderate: 7-10% loss of body weight.

Severe: over 10% loss of body weight.
Clinical features of mild-to-moderate dehydration; 2 or more of:
Restlessness or irritability.
Sunken eyes (also ask the parent).
Thirsty and drinks eagerly.
Clinical features of severe dehydration; 2 or more of:
Abnormally sleepy or lethargic.
Sunken eyes.
Drinking poorly or not at all.
Pinch test (skin turgor): the sign is unreliable in obese or severely malnourished children.
Normal: skin fold retracts immediately.
Mild or moderate dehydration: slow; skin fold visible for less than 2 seconds.
Severe dehydration: very slow; skin fold visible for longer than 2 seconds.
Other features of dehydration include dry mucous membranes, reduced tears and decreased urine
output.
Additional signs of severe dehydration include circulatory collapse (e.g. weak rapid pulse, cool or blue
extremities, hypotension), rapid breathing, sunken anterior fontanelle.
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About Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case
of knowledge dipsosis. Key areas of interest include: the ED-ICU interface,
toxicology, simulation and the free open-access meducation (FOAM)
revolution. @Twitter | + Chris Nickson | RAGE | INTENSIVE| SMACC | iTeachEM

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