Dehydration (peds): Difference between revisions
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{{Peds top}} [[dehydration]] | |||
==Background== | ==Background== | ||
1kg body wt = to 1 liter fluid | 1kg body wt = to 1 liter fluid | ||
==Clinical | ==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 | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
== | ==Evaluation== | ||
== | ==Management== | ||
*[[Ondansteron]] | *[[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== | ==See Also== | ||
*[[Fluid Repletion (IVF)]] | *[[Fluid Repletion (IVF)]] | ||
*[[Acute gastroenteritis (peds)]] | |||
*[[Nausea and vomiting (peds)]] | |||
*[[Diarrhea (peds)]] | |||
==External Links== | |||
*[http://pemplaybook.org/podcast/subcutaneous-rehydration/ Pediatric Emergency Playbook Podcast: Subcutaneous Rehydration] | |||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Pediatrics]] | ||
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
- 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
- ↑ 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/