Dehydration

Abdalla Mutwakil GamalHouse Officer

Department of PediatricsIbrahim Malik Teaching Hospital

Khartoum, Sudan

10/5/2017

Contents

• Definition

• Epidemiology

• Causes

• Assessment

• Management

Definition

• dehydration is a deficit of total body water, with an accompanying disruption of metabolic processes.

• - ECF: 1/3

• - ICF: 2/3

Epidemiology

• In USA:

– 3 million visit

– 10% of admissions (220,000)

– 2 episodes per year

– $2 billion

Prepared by Delfin S. Go. Unless otherwise indicated, text and charts based on Global Monitoring Report 2010: The MDGs after the Crisis, published by the World Bank in 2010. The report is available at www.worldbank.org/gmr2010

Causes

• Related to intake

• Related to loss

• Translocations

• The Most common cause for dehydration is …………….

Assessment

• 1995.

• By United Nations Children's Fund and the World Health Organization in 1995.

• Systemic.

• Treatment and prevention.

IMCI training video Exercise G How to assess a child for diarrhoea

• https://www.youtube.com/watch?v=Y1HBGjVRHXk

Mild Moderate Severe

Weight Loss 3-5% 6-9% >10%

Blood pressure Normal Orthostatic Shock

Pulse Normal Increase Tachycardic

Behavior Normal Irritable Lethargic

Membranes Moist Dry Parched

Tears Present Decrease Absent

Cap. Refill 2 seconds 2-4 seconds >4 seconds

Urine SG >1.020 >1.030 Oliguria

Management of dehydration:

1) Resuscitation (if shocked).

2) If severe dehydration but no shock.

3) If some dehydration/moderate dehydration

4) Child with hypernatremic dehydration

5) How to calculate the maintainace?

1. Resuscitation (if shocked)

• PR, BP.

• ABC.

• 20 ml/kg NS or RL.

• Reasses.

• Repeat till PR, BP and mental state are normal.

2 - If severe dehydration but no shock.

• child with severe dehydration and no shock 100ml/kg ringers lactate or glucose 5%+1/2 saline.

• If the child is <1yr 30ml/kg over 1hr then 70ml/kg over 5 hr.

• If >1yr 30 ml/kg over ½ hr then 70 ml/kg over 2 ½ hrs.

• Give Zinc after rehydration.

3 – If some dehydration (mild or moderate dehydration)

• ORS 75 ml/kg over 4 hrs., unless there is severe vomiting or patient is unable to drink give i.v fluids glucose 5% with ½ saline or Ringer's lactate.

• Give Zinc after rehydration ORS (7 – 10 ml/kg) or homemade fluid after motion Give Zinc.

4 - Child with hypernatremicdehydration:• Start slow rehydration, give fluids over

48hours:

– Day 1: 1/2deficit + maintenance for the first 24 hrs.

– Day 2: 1/2deficit + maintenance for the second 24 hrs.

• Usual replacement fluid is D5 1/5 NS or D5 ½ NS.

• If Na>180 mmol/l, may need dialysis.

5 – How to calculate the maintainace?

• According to patient weight:

– 0-10 kg: 100 kcal/kg

– 10-20 kg: 50 kcal/kg

– > 20kg: 20 kcal/kg