Dehydration Clinical Presentation

Updated: Nov 27, 2016
  • Author: Lennox H Huang, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
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Presentation

History

The following should be considered in patients with dehydration:

  • Intake of fluids, including the volume, type (hypertonic or hypotonic), and frequency
  • Urine output, including the frequency of voiding (last wet diaper), presence of concentrated or dilute urine, hematuria
  • Method of mixing infant formula; volume of water to powder being used
  • Stool output, frequency of stools, stool consistency, presence of blood or mucus in stools
  • Emesis, including frequency and volume and whether bilious or nonbilious, hematemesis
  • Contact with ill people, especially others with gastroenteritis, use of daycare
  • Underlying illnesses, especially cystic fibrosis, diabetes mellitus, hyperthyroidism, renal disease
  • Fever
  • Appetite patterns
  • Weight loss; measure of recent weight versus weight on presentation
  • Travel
  • Recent antibiotic use
  • Possible ingestions
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Physical Examination

A complete physical examination may assist in determining the underlying cause of the patient's dehydration and in defining the severity of dehydration. The clinical assessment of severity of dehydration determines the approach to management. In general, physical signs of dehydration have poor precision and accuracy. Rather than attempting to assign an exact percentage of dehydration, one should attempt to place the child in one of 3 broad categories.

The determination of dehydration severity should be based on the overall constellation of symptoms. Patients in a given category need not exhibit all the signs and symptoms listed below. Literature reviews have suggested that delayed capillary refill, delayed skin turgor, and abnormal respiratory pattern are the most reliable clinical signs of dehydration in children. Validated clinical dehydration scales may be a useful adjunct to predict need for intravenous fluid and longer stays in the emergency department. [9]

Table 1. Clinical Findings of Dehydration (Open Table in a new window)

Symptom/Sign Mild Dehydration Moderate Dehydration Severe Dehydration
level of consciousness Alert Lethargic Obtunded
Capillary refill* 2 s 2-4 s >4 s, cool limbs
Mucous membranes Normal Dry Parched, cracked
Tears Normal Decreased Absent
Heart rate Slightly increased Increased Very increased
Respiratory rate/pattern* Normal Increased Increased and hyperpnea
Blood pressure Normal Normal, but orthostasis Decreased
Pulse Normal Thready Faint or impalpable
Skin turgor* Normal Slow Tenting
Fontanel Normal Depressed Sunken
Eyes Normal Sunken Very sunken
Urine output Decreased Oliguria Oliguria/anuria
* Best indicators of hydration status [10]

Table 2. Estimated Fluid Deficit (Open Table in a new window)

Severity Infants (weight < 10 kg) Children (weight >10 kg)
Mild dehydration 5% or 50 mL/kg 3% or 30 mL/kg
Moderate dehydration 10% or 100 mL/kg 6% or 60 mL/kg
Severe dehydration 15% or 150 mL/kg 9% or 90 mL/kg
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