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Pediatric Dehydration Differential Diagnoses

  • Author: Alex Koyfman, MD; Chief Editor: Timothy E Corden, MD  more...
 
Updated: Oct 04, 2015
 
 
 
Contributor Information and Disclosures
Author

Alex Koyfman, MD Assistant Professor, Department of Emergency Medicine, University of Texas Southwestern Medical Center, Parkland Memorial Hospital

Alex Koyfman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Carrie Ng, MD Resident Physician, Department of Pediatrics, Bellevue Hospital Center, New York University School of Medicine

Carrie Ng, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Institute of Ultrasound in Medicine

Disclosure: Nothing to disclose.

Mark P Foran, MD, MPH Assistant Professor of Emergency Medicine, New York University School of Medicine; Attending Emergency Physician, Bellevue Hospital Center and NYU Langone Medical Center

Mark P Foran, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Richard G Bachur, MD Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Ann G Egland, MD Consulting Staff, Department of Operational and Emergency Medicine, Walter Reed Army Medical Center

Ann G Egland, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Association of Military Surgeons of the US, Medical Society of Virginia, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Terrance K Egland, MD Director, Business Planning and Development, Bureau of Medicine and Surgery

Terrance K Egland, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

James Li, MD Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine

Disclosure: Nothing to disclose.

Alison Wiley Lozner, MD Resident Physician, Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital; Clinical Fellow in Emergency Medicine, Harvard Medical School

Alison Wiley Lozner, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

James Kimo Takayesu, MD, MSc Assistant Professor in Surgery, Director of Undergraduate Medical Education, Consulting Staff, Massachusetts General Hospital; Associate Residency Director, Harvard Affiliated Emergency Medicine Residency Partners

James Kimo Takayesu, MD, MSc is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Sigma Xi, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Mange K, Matsuura D, Cizman B, et al. Language guiding therapy: the case of dehydration versus volume depletion. Ann Intern Med. 1997 Nov 1. 127(9):848-53. [Medline].

  2. Singhi SC, Shah R, Bansal A, Jayashree M. Management of a child with vomiting. Indian J Pediatr. 2013 Apr. 80(4):318-25. [Medline].

  3. Glaser NS, Ghetti S, Casper TC, Dean JM, Kuppermann N. Pediatric diabetic ketoacidosis, fluid therapy, and cerebral injury: the design of a factorial randomized controlled trial. Pediatr Diabetes. 2013 Mar 13. [Medline]. [Full Text].

  4. King CK, Glass R, Bresee JS, Duggan C. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 2003 Nov 21. 52:1-16. [Medline].

  5. Steiner MJ, DeWalt DA, Byerley JS. Is this child dehydrated?. JAMA. 2004 Jun 9. 291(22):2746-54. [Medline].

  6. Wathen JE, MacKenzie T, Bothner JP. Usefulness of the serum electrolyte panel in the management of pediatric dehydration treated with intravenously administered fluids. Pediatrics. 2004 Nov. 114(5):1227-34. [Medline].

  7. Lozon MM. Pediatric vascular access and blood sampling techniques. Roberts JR, Hedges JR. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia: WB Saunders; 2004. 357-8.

  8. Jauregui J, Nelson D, Choo E, Stearns B, Levine AC, Liebmann O, et al. The BUDDY (Bedside Ultrasound to Detect Dehydration in Youth) study. Crit Ultrasound J. 2014. 6 (1):15. [Medline].

  9. Jauregui J, Nelson D, Choo E, Stearns B, Levine AC, Liebmann O, et al. The BUDDY (Bedside Ultrasound to Detect Dehydration in Youth) study. Crit Ultrasound J. 2014. 6(1):15. [Medline]. [Full Text].

  10. Spandorfer PR, Alessandrini EA, Joffe MD, Localio R, Shaw KN. Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial. Pediatrics. 2005 Feb. 115(2):295-301. [Medline].

  11. Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med. 2006 Apr 20. 354(16):1698-705. [Medline].

  12. Kersten H. Oral ondansetron decreases the need for intravenous fluids in children with gastroenteritis. J Pediatr. 2006 Nov. 149(5):726. [Medline].

  13. Alhashimi D, Alhashimi H, Fedorowicz Z. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database Syst Rev. 2006 Oct 18. CD005506. [Medline].

  14. American Academy of Pediatrics. Practice parameter: the management of acute gastroenteritis in young children. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Pediatrics. 1996 Mar. 97(3):424-35. [Medline].

  15. Barkin RM, Ward DG. Infectious diarrheal disease and dehydration. Marx JA. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby/Elsevier; 2006. Vol 3: 2623-34.

  16. Hom J, Sinert R. Evidence-based emergency medicine/systematic review abstract. Comparison between oral versus intravenous rehydration to treat dehydration in pediatric gastroenteritis. Ann Emerg Med. 2009 Jul. 54(1):117-9. [Medline].

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Table. Physical Examination Findings in Pediatric Dehydration
SymptomDegree of Dehydration
Mild (< 3% body weight lost)Moderate (3-9% body weight lost)Severe (>9% body weight lost)
Mental statusNormal, alertRestless or fatigued, irritableApathetic, lethargic, unconscious
Heart rateNormalNormal to increasedTachycardia or bradycardia
Quality of pulseNormalNormal to decreasedWeak, thready, impalpable
BreathingNormalNormal to increasedTachypnea and hyperpnea
EyesNormalSlightly sunkenDeeply sunken
FontanellesNormalSlightly sunkenDeeply sunken
TearsNormalNormal to decreasedAbsent
Mucous membranesMoistDryParched
Skin turgorInstant recoilRecoil < 2 secondsRecoil >2 seconds
Capillary refill< 2 secondsProlongedMinimal
ExtremitiesWarmCoolMottled, cyanotic
Adapted from King CK, Glass R, Bresee JS, et al. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. Nov 21 2003;52(RR-16):1-16.[4]
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