Written by Dr.Md.Redwanul Huq (Masum)
Monday, 16 January 2012 13:04


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
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
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’):

  1.  Existing fluid deficit should to be corrected in 4 hours by ORS
  2. Treatment should be done in the ORT corner or in an observation room in the hospital & no admission in the hospital is usually required
  3. Amount of ORS required is – 75 ml / Kg
  4. To continue breast feeding / other normal feeding during the rehydration phase
  5. 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:


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.


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.

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