Dehydration (peds): Difference between revisions

Latest revision as of 17:07, 17 January 2026

This page is for pediatric patients. For adult patients, see: dehydration

Background

1kg body wt = to 1 liter fluid

Clinical Features

Sunken fontanelle in a 1-month old.

Decreased urine output
Sunken fontanelle
Most reliable: ^[1]
- Abnormal capillary refill
- Abnormal respiratory pattern
- Decreased skin turgor

Differential Diagnosis

Evaluation

Management

Ondansteron for vomiting
Mild to moderate dehydration: start with trial of oral rehydration therapy or half strength apple juice^[2]^[3]
- Part of ACEP Choosing wisely
- Provide ORS solution (e.g. Pedialyte) at 50 to 100 mL/kg over 2-4 hours in small doses q5min
- If the child vomits, wait 15 minutes then try again
- Provide additional ORS to replace ongoing GI losses
Consider Fluid Repletion (IVF) only if severely dehydrated, not tolerating oral intake or failed oral rehydration therapy

External Links

Pediatric Emergency Playbook Podcast: Subcutaneous Rehydration

References

↑ Steiner, M. J. (2004) ‘Is This Child Dehydrated?’, JAMA, 291(22), p. 2746. doi: 10.1001/jama.291.22.2746
↑ Freedman SB, Willan AR, Boutis K, Schuh S. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial. JAMA. 2016 May 10;315(18):1966-74. doi: 10.1001/jama.2016.5352. PMID: 27131100. https://pubmed.ncbi.nlm.nih.gov/27131100/
↑ SGEM#158: Tempted by the Fruit of Another – Dilute Apple Juice for Pediatric Dehydration https://www.thesgem.com/2016/06/sgem158-tempted-by-the-fruit-of-another-dilute-apple-juice-for-pediatric-dehydration/

Authors:

[1] Steiner, M. J. (2004) ‘Is This Child Dehydrated?’, JAMA, 291(22), p. 2746. doi: 10.1001/jama.291.22.2746

[2] Freedman SB, Willan AR, Boutis K, Schuh S. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial. JAMA. 2016 May 10;315(18):1966-74. doi: 10.1001/jama.2016.5352. PMID: 27131100. https://pubmed.ncbi.nlm.nih.gov/27131100/

[3] SGEM#158: Tempted by the Fruit of Another – Dilute Apple Juice for Pediatric Dehydration https://www.thesgem.com/2016/06/sgem158-tempted-by-the-fruit-of-another-dilute-apple-juice-for-pediatric-dehydration/

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
-==Fluid Requirements==
+{{PediatricPage|dehydration}}
-*4-2-1 Rule (insensible losses only)
+==Background==
-**For 0-10kg: 4 mL/kg/hr
+kg body wt = to 1 liter fluid
-**For 10-20kg: + 2 mL/kg/hr
-**For >20kg: + 1 mL/kg/hr
-*Sodium
-**3 mEq/kg/d
-*Potassium
-**2 mEq/kg/d
-==Treatment==
+==Clinical Features==
-kg body wt = to 1 liter flluid
+[[File:Human anterior fontanelle 1 month dscn1449.jpg|thumb|Sunken fontanelle in a 1-month old.]]
+*Decreased urine output
+*Sunken fontanelle
+*Most reliable: <ref>Steiner, M. J. (2004) ‘Is This Child Dehydrated?’, JAMA, 291(22), p. 2746. doi: 10.1001/jama.291.22.2746</ref>
+**Abnormal capillary refill
+**Abnormal respiratory pattern
+**Decreased skin turgor
-Oral rehydration soln should contain 60- 90 meq of Na and 2% dextrose. Can use pedialyte, rehydralyte or infalyte.
+==Differential Diagnosis==
-Home made solns:
+==Evaluation==
-- 1 litre water
+==Management==
+*[[Ondansteron]] for [[vomiting]]
+*Mild to moderate dehydration: start with trial of [[oral rehydration therapy]] or half strength apple juice<ref>Freedman SB, Willan AR, Boutis K, Schuh S. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial. JAMA. 2016 May 10;315(18):1966-74. doi: 10.1001/jama.2016.5352. PMID: 27131100. https://pubmed.ncbi.nlm.nih.gov/27131100/</ref><ref>SGEM#158: Tempted by the Fruit of Another – Dilute Apple Juice for Pediatric Dehydration https://www.thesgem.com/2016/06/sgem158-tempted-by-the-fruit-of-another-dilute-apple-juice-for-pediatric-dehydration/</ref>
+**Part of [[Choosing wisely ACEP|ACEP Choosing wisely]]
+**Provide ORS solution (e.g. Pedialyte) at 50 to 100 mL/kg over 2-4 hours in small doses q5min
+**If the child vomits, wait 15 minutes then try again
+**Provide additional ORS to replace ongoing GI losses
+*Consider [[Fluid Repletion (IVF)]] only if severely dehydrated, not tolerating oral intake or failed oral rehydration therapy
-- 8 teaspoons sugar
+==See Also==
+*[[Fluid Repletion (IVF)]]
+*[[Acute gastroenteritis (peds)]]
+*[[Nausea and vomiting (peds)]]
+*[[Diarrhea (peds)]]
-- 1 tsp salt
+==External Links==
+*[http://pemplaybook.org/podcast/subcutaneous-rehydration/ Pediatric Emergency Playbook Podcast: Subcutaneous Rehydration]
-- can add banana or orange juice for potassium
+==References==
+<references/>
+[[Category:Pediatrics]]
-- give Xcc q 5min
-- if vomit, wait 10 min and do again
-- try to achieve 50cc/kg over 3- 4 hr for mild- mod dehydration
-- if diarrheal stool, add 10cc/kg extra
-- for mod to severe dehydration, do 100cc/kg over 3- 4hrs
-Can do ngt if refuses to take po's- 150 cc/ hr. If not vomiting can infuse faster at 25cc/kg/hr.
-If fail, do IVF at 30- 40 cc/kg at minimum- replaces 3- 4% body wt
-==Source==
-/06 MISTRY
-[[Category:Peds]]