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Pediatric Gastroenteritis in Emergency Medicine Differential Diagnoses

  • Author: Adam Levine, MD, MPH; Chief Editor: Kirsten A Bechtel, MD  more...
 
Updated: Jul 23, 2015
 
 
 
Contributor Information and Disclosures
Author

Adam Levine, MD, MPH Assistant Professor of Emergency Medicine, Brown University Alpert School of Medicine

Adam Levine, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Public Health Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Karen A Santucci, MD, MD 

Karen A Santucci, MD, MD is a member of the following medical societies: Alpha Omega Alpha, Academic Pediatric Association, American Academy of Pediatrics, Sigma Xi, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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 Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

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

Disclosure: Nothing to disclose.

Chief Editor

Kirsten A Bechtel, MD Associate Professor of Pediatrics, Section of Pediatric Emergency Medicine, Yale University School of Medicine; Co-Director, Injury Free Coalition for Kids, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Additional Contributors

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

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, David W Marby, MD †, to the development and writing of this article.

References
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Child with sunken eyes.
Child with slow skin pinch (reduced skin turgor).
Child with absent tears.
Child with lethargy/poor general appearance.
Child with hyperpnea (deep, acidotic breathing)
Table 1. Assessment of Dehydration*
Symptom or Sign No or Minimal Dehydration Mild to Moderate Dehydration Severe Dehydration
Mental statusAlertRestless, irritableLethargic, unconscious
ThirstDrinks normallyDrinks eagerlyDrinks poorly
Heart rateNormalNormal to increasedTachycardia
Quality of pulsesNormalNormal to decreasedWeak or unpalpable
BreathingNormalNormal or fastDeep
EyesNormalSlightly sunkenDeeply sunken
TearsPresentDecreasedAbsent
Mouth and tongueMoistDryParched
Skin foldInstant recoilRecoil < 2 secondsRecoil >2 seconds
Capillary refillNormalProlongedProlonged or minimal
ExtremitiesWarmCoolCold, mottled, cyanotic
Urine outputNormalDecreasedMinimal
*Adapted from King et al. MMWR Recomm Rep. 2003;52(RR-16):1-16.[15]
Table 2. Assessment of Dehydration According to the World Health Organization*
Severe DehydrationTwo of the following signs:



-Lethargic or unconscious



-Sunken eyes



-Not able to drink or drinking poorly



-Skin pinch goes back very slowly



Some DehydrationTwo of the following signs:



-Restless, irritable



-Sunken eyes



-Thirsty, drinks eagerly



-Skin pinch goes back slowly



No DehydrationNot enough of the above signs to classify as some or severe dehydration
*Adapted from World Health Organization.[10]
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