| Written by Dr.Md.Redwanul Huq (Masum) |
| Monday, 16 January 2012 13:04 |
Definition:
Dehydration is a condition in which there is lack of water in the body. Dehydration in children may result serious consequences and therefore should be managed quickly and perfectly.
Classification (Types) of dehydration:
Dehydration is of following three types-
1. No dehydration
2. Some dehydration
3. Severe dehydration.
Assessment of dehydration:
| Traits | No dehydration | Some dehydration | Severe dehydration | ||
| Look | |||||
| 1. *Appearance | Well alert | * Restless , irritable | * Lethargic, unconscious or floppy | ||
| 2. Eyes | Normal | Sunken | Very sunken & dry | ||
| 3. Tears | Present | Absent | Absent | ||
| 4. Mouth & tongue | Moist | Dry | Very dry | ||
| 5. * Thirst | Drinks normally , not thirsty | * Drink eagerly, Thirsty. | * Drinks poorly or not able to drink | ||
| Feel | |||||
| 6. * Skin pinch | Goes back quickly | * Goes back slowly | * Goes back very slowly | ||
Key signs{ * } are three – Appearance, thirst & skin pinch.
Some or severe dehydration – two or more signs including at least one key { * } sign.
Treatment of Dehydration:
Treatment plan A (For ‘No dehydration’): Home treatment.
1. More fluid than usual – Plane water, dub-water, salt sugar solution, salt molasses solution, chira water etc.
2. Amount of Oral Rehydration Solution (ORS) to be given:
| Age | Amount of ORS after each stool |
| Less than 2 years | 50 -100 ml (10 – 20 tsf) |
| 2 – 9 years | 100 – 200 ml (20 – 40 tsf) |
| 10 years or more | As much as the child wants |
3. More food for 2 weeks (after acute attack), for 4 weeks (after chronic attack)
4. Referral knowledge to the mother: To take the child to the health facility centre if diarrhea does not get better in 3 days or develop any of the following signs/symptoms-
a) Sunken eye
b) Eat or drink poorly
c) Increased frequency or duration
d) Passage of blood through stool
e) Noticeable thirst
f) Recurrent vomiting
g) Fever.
Treatment plan – B (For ‘Some dehydration’):
- Existing fluid deficit should to be corrected in 4 hours by ORS
- Treatment should be done in the ORT corner or in an observation room in the hospital & no admission in the hospital is usually required
- Amount of ORS required is – 75 ml / Kg
- To continue breast feeding / other normal feeding during the rehydration phase
- To monitor the patient one hourly and re-assess the child after 4 hours & then select plan A, B or C to continue treatment. If again plan B – to give the child food, milk, juice also.
Treatment plan – C (For ‘Severe dehydration’):
1. The child should be admitted in the hospital.
2. The existing fluid deficit (more than 10 % of body wt.) to be corrected by normal saline / cholera saline / Ringer’s lactate solution in 6 hours in infants and in 3 hour in older children. For intravenous treatment:
| Age | At first 30 ml/Kg | Then 70 ml/Kg |
| Infant (below 1 year) | In 1 hour | In 5 hours |
| Older (1 year or more) | In 30 minutes | In 2.5 hour |
3. To re-assess every 1 -2 hours and finally after 6 hrs (in case of infant) or 3 hrs (in case of older children) and then to choice appropriate plan (A/B/C) to continue treatment guidelines. If hydration is not improving, IV fluid should be given more rapidly.
Features and management of shock in children due to dehydration:
Signs:
1. Weakness or low level of consciousness
2. Peripheral pulses – feeble or absent
3. Tachycardia – pulse rate is more than 120 beats per minute
4. Capillary refill time – prolonged, more than 3 seconds.
Treatment:
1. Quick venous access, either an intravenous or intraosseous line
2. Bolus infusion of 20 ml/kg of Ringers lactate solution / Normal saline/ Cholera saline.
3. Continuation of treatment of dehydration – plan C.
