Dehydration (peds): Difference between revisions

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==Treatment==
{{Peds top}} [[dehydration]]
==Background==
1kg body wt = to 1 liter fluid


==Clinical Features==
[[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


1kg body wt = to 1 liter flluid
==Differential Diagnosis==


==Evaluation==


Oral rehydration soln should contain 60- 90 meq of Na and 2% dextrose. Can use pedialyte, rehydralyte or infalyte.
==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


==See Also==
*[[Fluid Repletion (IVF)]]
*[[Acute gastroenteritis (peds)]]
*[[Nausea and vomiting (peds)]]
*[[Diarrhea (peds)]]


Home made solns:
==External Links==
*[http://pemplaybook.org/podcast/subcutaneous-rehydration/ Pediatric Emergency Playbook Podcast: Subcutaneous Rehydration]


- 1 litre water
==References==
<references/>


- 8 teaspoons sugar
[[Category:Pediatrics]]
 
- 1 tsp salt
 
- can add banana or orange juice for potassium
 
 
- 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
 
 
Lactobacillus from yogurt may decrease diarrhea by one day.
 
 
ABX
 
- avoid in entrohemorrhagic e coli
 
- may increase carrie state in non typhoid salmonella
 
- unless severe or comorbidity or <3 months old, do not tx salmonella, yersinia, aeromonas, campylobacter or c diff.
 
- tx shigella or vibrio
 
- Continue to breast feed
 
- Lactose intolerance rare but if intolerant will have acidic stool with>0.5% reducing substances
 
- BRAT ok as is complex carbs and lean meat, fruits, veg.
 
- BRAT has low energy and protein
 
 
==Source==
 
 
6/06 MISTRY
 
 
 
 
[[Category:Peds]]

Latest revision as of 22:24, 1 February 2023

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

See Also

External Links

References

  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/
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