Parasites such as Giardia and Cryptosporidium account for less than 5 percent of cases. Dehydration causes a decrease in total body water in both the intracellular and extracellular fluid volumes. Volume depletion closely correlates with the signs and symptoms of dehydration.

The total body water TBW in humans is distributed in two major compartments. The total body water is higher in infants and children as compared to adults. As indicated earlier, dehydration is total water depletion with respect to sodium, and volume depletion is the decrease in the circulation volume.

Volume depletion is seen in acute blood loss and burns, whereas distributive volume depletion is seen in sepsis and anaphylaxis. In much of the literature, the distinction between dehydration and volume depletion is a blur.

Metabolic acidosis is seen in infants and children with dehydration, the pathophysiology of which is multifactorial. excess bicarbonate loss in the diarrhea stool or in the Urine is certain types of renal tubular acidosis.

Ketosis secondary to the glycogen depletion seen in starvation which sets in infants and children much earlier when compared to adults. Hydrogen ion retention by the kidney from decreased renal perfusion and decreased glomerular filtration rate. Children with pyloric stenosis have very unique electrolyte abnormalities from the excessive emesis of gastric contents.

This is seen mostly in older children. They lose chloride, sodium, and potassium in addition to volume resulting in hypochloremic, hypokalemic metabolic alkalosis.

The kidney excretes base in the form of HCO 3 ion to maintain acid-base balance of loss of hydrogen ion in the emesis in the form of hydrogen chloride. It is interesting to note that the kidney also excretes hydrogen ions to save sodium and water, which could be the reason for aciduria.

A recently published article has shown that many children with pyloric stenosis may not have metabolic alkalosis. Various signs and symptoms can be present depending on the patient's degree of dehydration. The table below can assist with categorizing the patient's degree of dehydration.

An infant has to lose more body weight than an older child to get to the same level of dehydration. Mental status Normal Listless, irritable Altered mental.

Heart rate Normal Increased Increased. Pulses Normal Decreased Thready. Capillary refill Normal Prolonged Prolonged. Blood pressure Normal Normal Decreased. Respirations Normal Tachypnea Tachypnea.

Eyes Normal Slightly sunken Fewer tears. Fontanelle Normal Sunken Sunken. Urine output Normal Decreased Oliguric.

Dehydration could be associated with hypo or hyper, or isonatremia. Most cases of dehydration are hyponatremic. In selected cases, electrolyte abnormalities may exist. This includes derangements in sodium levels and acidosis characterized by low bicarbonate levels or elevated lactate levels.

For patients with vomiting who have not been able to tolerate oral fluids, hypoglycemia may be present. Evaluation of urine specific gravity and the presence of ketones can assist in the evaluation of dehydration.

Children who were given free water when they have ongoing diarrhea disease can present with hyponatremic dehydration, excess of free water concurrent to excess sodium, and bicarbonate loss in diarrhea.

This is also seen in the syndrome of inappropriate secretion of antidiuretic hormone SIADH. In these cases, the children appear to be more dehydrated and could also present with hyponatremic seizure activity. Similarly, infants who are fed oral rehydration solution prepared from excess salt or who lost excess free water, as in diabetes insipidus, could have hypernatraemic dehydration.

End-tidal carbon dioxide measurements have been studied in an attempt to assess degrees of dehydration greater than five percent in children. This non-invasive approach has promise, but as of now has not proven to be an effective tool in determining the degree of dehydration in children.

Priorities in the management of dehydration include early recognition of symptoms, identifying the degree of dehydration, stabilization, and rehydration strategies. Symptoms include vomiting, diarrhea, fever, decreased oral intake, inability to keep up with ongoing losses, decreased urine output, progressing to lethargy, and hypovolemic shock.

The American Academy of Pediatrics recommends oral rehydration for patients with mild dehydration. Breastfed infants should continue to nurse. Fluids with high sugar content may worsen diarrhea and should be avoided.

Children can be fed age-appropriate foods frequently but in small amounts. The Morbidity and Mortality Weekly Report recommends administering 50 mL to mL of oral rehydration solutions per kilogram per body weight for two to four hours to replace the estimated fluid deficit, with additional oral rehydration solution administered to replace ongoing losses.

Patients who are severely dehydrated can present with altered mental status, lethargy, tachycardia, hypotension, signs of poor perfusion, weak thread pulses, and delayed capillary refill.

Multiple boluses may be needed for children in hypovolemic shock. Additional priorities include obtaining a point-of-care glucose test, electrolytes, and urinalysis assessing for elevated specific gravity and ketones.

Hypoglycemia should be assessed at the point of care testing via glucometer and venous blood gas with electrolytes or serum chemistries. It should be treated with intravenous glucose. The dose is 0. The use of D50 is usually reserved for adolescent or adult-sized patients using a large bore intravenous line.

An assessment of the degree of dehydration will determine the fluid replacement. Using tables that can predict the degree of dehydration is helpful. If a previous "well weight" is available, that can be subtracted from the patient's "sick weight" to calculate total weight loss.

One kilogram of weight loss equates to one liter of fluid lost. The rate of replacement is based on the severity of the dehydration. This could be repeated 3 times with reassessment in between the boluses.

Ringer lactate is superior to normal saline in hemorrhagic shock requiring rapid resuscitation with isotonic fluids. In these children, the replacement with normal saline and Ringer's lactate did show similar clinical improvement.

Rapid infusion can cause cardiac insufficiency, congestive heart failure, and pulmonary edema. The rapid correction in patients with diabetic ketoacidosis can cause cerebral edema in adolescents and children.

The rate of replacement fluids is calculated after taking into account the maintenance, replacement, and deficit requirement of the patient. The sodium requirements of the children in the hospital are higher than that of the adults. The children have high metabolic needs and have higher insensible loss as they have a higher body surface area.

They also have higher respiratory and heart rates, requiring the use of an intravenous solution containing high sodium like D5NS. The deficit is determined by the degree of dehydration, as outlined earlier.

The remaining half of the deficit and two-thirds of the daily maintenance therapy is given during the third phase of the therapy, which spans the following 16 hours. For patients where intravenous access can not be achieved or maintained, other methods can be employed.

They include continuous nasogastric hydration and subcutaneous hydration. Hypodermoclysis refers to hydrating the subcutaneous space with fluid that can be absorbed systemically. Hypodermoclysis is best reserved for the stable child or infant with mild to moderate dehydration who either fails a trial of fluids by mouth or who needs some degree of rehydration to facilitate gaining intravenous access after a slow subcutaneous fluid bolus has been given.

The placement of topical anesthetic cream, such as EMLA, cover with an occlusive dressing and wait for 15 to 20 minutes. Insert a gauge butterfly needle or gauge angiocatheterInject units of hyaluronidase SC if available. Fluid therapy should include maintenance fluids plus replacement of the existing fluid deficit.

Deficit calculation can be determined in several ways. If the patient's weight before the illness is known, it can be subtracted from the current weight.

Each kilogram lost would be equivalent to one liter of fluid lost. If the prior weight is not known, multiply the weight in kilograms by the dehydration percent.

Divide the total by 24 to determine the hourly rate. In hyponatremic dehydration, half of the deficit can be replaced over eight hours, with the remaining half the following sixteen hours. Rapid correction of hypernatremia may result in cerebral edema as a result of intracellular swelling.

Osmotic demyelination syndrome, also known as central pontine myelinolytic, can occur as a result of rapid correction of hyponatremia. Symptoms include a headache, confusion, altered consciousness, and gait disturbance, which may lead to respiratory arrest.

Diarrheal diseases and resulting severe dehydration are the leading cause of infant mortality worldwide, especially in children less than 5 years of age. To improve the outcome and decrease the morbidity and mortality from diarrhea diseases, especially rotaviral disease which is the leading cause of death in children, cooperation between various different agencies and countries is needed.

World health organization, while working with member countries and other agencies, promotes national policies and investments to have access to safe drinking water, to improve sanitation, to research diarrhea prevention such as vaccination, to implement preventive measures like source water treatments, safe storage and to help train the health care workers who could go into communities to bring the change at the local level.

Disclosure: Roy Vega declares no relevant financial relationships with ineligible companies. Disclosure: Usha Avva declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. Turn recording back on.

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Author Information and Affiliations Authors Roy M. Affiliations 1 Bronx Lebanon Hospital Center. Continuing Education Activity The World Health Organization defines dehydration as a condition that results from excessive loss of body water.

Introduction The World Health Organization defines dehydration as a condition that results from excessive loss of body water. Kids should drink often during hot weather. Those who play sports or are very physically active should drink extra liquids beforehand, and then take regular drink breaks about every 20 minutes during the activity.

KidsHealth Parents What to Do About Dehydration. en español: Qué hacer en caso de deshidratación. Medically reviewed by: Melanie L. Pitone, MD. Primary Care Pediatrics at Nemours Children's Health. Listen Play Stop Volume mp3 Settings Close Player. Larger text size Large text size Regular text size.

Signs of dehydration include: a dry or sticky mouth few or no tears when crying eyes that look sunken in babies, the soft spot fontanelle on top of the head looks sunken peeing less or fewer wet diapers than usual crankiness drowsiness or dizziness How Do I Treat Dehydration?

If your child has signs of dehydration, call your doctor. The best liquid for dehydrated kids is an oral rehydration solution, like Pedialyte® and Enfalyte® and many stores also have a store brand.

It has the right amounts of water, sugar, and salt to help with dehydration. You can buy it without a prescription at drugstores or supermarkets. Other liquids can help with dehydration. If you breastfeed your child, you can keep doing so.

If your child is feeding less than usual, also give the rehydration fluids. Don't give babies plain water instead of oral rehydration solution. It doesn't have the right nutrients for babies with dehydration. Older children also can have electrolyte ice pops.

They have too much sugar and can make some symptoms worse. A small medicine cup , medicine syringe, or spoon or to give the fluids with. A clock or timer such as on your phone. A way to keep track of what your child drinks. Tracking on a piece of paper or a note on your phone will work fine.