Medscape Reference

Pediatric Dehydration Differential Diagnoses

Author: James Kimo Takayesu, MD, MSc; more...

Updated: Nov 4, 2011

What would you like to print?

Differential Diagnoses

Diabetic Ketoacidosis
Hypernatremia
Hyperosmolar Hyperglycemic Nonketotic Coma
Hypokalemia
Hyponatremia
Hypovolemic Shock
Metabolic Acidosis
Pediatrics, Diabetic Ketoacidosis
Pediatrics, Gastroenteritis
Pediatrics, Pyloric Stenosis

Proceed to Workup

Contributor Information and Disclosures

Author

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.

Additional Contributors

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.

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

Mange K, Matsuura D, Cizman B, et al. Language guiding therapy: the case of dehydration versus volume depletion. Ann Intern Med. Nov 1 1997;127(9):848-53. [Medline].
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. [Medline].
Steiner MJ, DeWalt DA, Byerley JS. Is this child dehydrated?. JAMA. Jun 9 2004;291(22):2746-54. [Medline].
Wathen JE, MacKenzie T, Bothner JP. Usefulness of the serum electrolyte panel in the management of pediatric dehydration treated with intravenously administered fluids. Pediatrics. Nov 2004;114(5):1227-34. [Medline].
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. Jul 2009;54(1):117-9. [Medline].
Lozon MM. Pediatric vascular access and blood sampling techniques. In: Roberts JR, Hedges JR. Clinical Procedures in Emergency Medicine. 4^th ed. Philadelphia: WB Saunders; 2004:357-8.
[Best Evidence] Spandorfer PR, Alessandrini EA, Joffe MD, Localio R, Shaw KN. Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial. Pediatrics. Feb 2005;115(2):295-301. [Medline].
[Best Evidence] Freedman SB, Adler M, Seshadri R, Powell EC. Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med. Apr 20 2006;354(16):1698-705. [Medline].
Kersten H. Oral ondansetron decreases the need for intravenous fluids in children with gastroenteritis. J Pediatr. Nov 2006;149(5):726. [Medline].
[Best Evidence] Alhashimi D, Alhashimi H, Fedorowicz Z. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database Syst Rev. Oct 18 2006;CD005506. [Medline].
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. Mar 1996;97(3):424-35. [Medline].
Barkin RM, Ward DG. Infectious diarrheal disease and dehydration. In: Marx JA. Rosen's Emergency Medicine: Concepts and Clinical Practice. Vol 3. 6^th ed. Philadelphia, Pa: Mosby/Elsevier; 2006:2623-34.

Previous

Next

Table. Physical Examination Findings in Pediatric Dehydration

Table. Physical Examination Findings in Pediatric Dehydration

Symptom	Degree of Dehydration
Symptom	Mild (< 3% body weight lost)	Moderate (3-9% body weight lost)	Severe (>9% body weight lost)
Mental status	Normal, alert	Restless or fatigued, irritable	Apathetic, lethargic, unconscious
Heart rate	Normal	Normal to increased	Tachycardia or bradycardia
Quality of pulse	Normal	Normal to decreased	Weak, thready, impalpable
Breathing	Normal	Normal to increased	Tachypnea and hyperpnea
Eyes	Normal	Slightly sunken	Deeply sunken
Fontanelles	Normal	Slightly sunken	Deeply sunken
Tears	Normal	Normal to decreased	Absent
Mucous membranes	Moist	Dry	Parched
Skin turgor	Instant recoil	Recoil < 2 seconds	Recoil >2 seconds
Capillary refill	< 2 seconds	Prolonged	Minimal
Extremities	Warm	Cool	Mottled, 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.^[2]

Previous

Next

View Table List

Read more about Pediatric Dehydration on Medscape

Related Reference Topics

Related News and Articles

Medscape Reference © 2011 WebMD, LLC

About Medscape Reference

[ CLOSE WINDOW ]

About Medscape Reference

Medscape Reference is the most authoritative and accessible point-of-care medical reference for physicians and health care professionals. All content is available free of charge, both online and via mobile devices.

Medscape Reference articles represent the expertise and practical knowledge of top physicians and pharmacists from leading academic medical centers in the US and worldwide. In addition, our rigorous literature survey process allows us to rapidly integrate new practice-changing information into the relevant topics by systematically reviewing the major medical and pharmacy journals, news announcements, and important practice guidelines.

Medscape Reference provides comprehensive coverage across more than 30 medical specialties and is composed of the following areas:

Diseases and Conditions

More than 6,300 evidence-based and physician-reviewed disease and condition articles are organized to rapidly and comprehensively answer clinical questions, as well as to provide in-depth information in support of diagnosis, treatment, and other clinical decision-making. Topics are richly illustrated with more than 30,000 clinical photos and radiographic images.

Procedures

More than 650 clinical procedure articles provide clear, step-by-step instructions, and include instructional videos and images to allow clinicians to master the newest techniques or to improve their skills in procedures they have previously performed.

Drugs

More than 2,100 monographs, including prescription and over-the-counter drugs, plus over 5,000 corresponding brand-name drugs, herbals, and supplements, are provided. Drug images and pricing are also included. In addition, a Drug Interaction Checker provides rapid access to tens of thousands of interactions between brand and generic drugs, over-the-counter drugs, and herbals and supplements.

Anatomy

More than 70 anatomy articles feature clinical images and diagrams of the major human body systems and organs. The articles assist with the understanding of the anatomy involved in treating specific conditions and performing procedures. They can also facilitate physician-patient discussions.

Special Features
Best Evidence

This email newsletter features current and clinically relevant journal citations that are selected via our rigorous literature survey review process. These same citations are incorporated into the relevant Medscape Reference articles. This newsletter serves as a quick and easily accessible way to stay up to date with clinically relevant journal articles that impact clinical practice.

Case Studies

These challenging and classic case presentations provide a quick way for practicing physicians to sharpen their diagnostic and patient-management skills. Each case starts with how the patient presented in the clinic and then using a question and answer format, progresses through diagnosis and on to treatment and includes follow up information about outcome for the patient.

Image collections

Image collections are a visually-engaging presentation of both common and uncommon diseases, case presentations, and current controversies in medicine. They are presented in an image rich, slideshow format and are designed to challenge and expand physicians' knowledge of clinically important topics.

Medscape is the leading online destination for healthcare professionals for clinical information. In addition to clinical reference tools, Medscape also offers:

Medscape News Learn more
Medscape Education Learn more

All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.