Dehydration Follow-up

  • Author: Lennox H Huang, MD, FAAP; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Mar 12, 2012
 

Further Inpatient Care

  • Severe dehydration warrants hospital admission for rehydration, as do hypernatremic or hyponatremic states.
  • Inability to tolerate oral rehydration therapy (ORT) may necessitate hospital admission for nasogastric or intravenous fluid therapy.
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Further Outpatient Care

  • ORT may be continued at home if clear instructions are provided for the family and if the family members can be relied upon to carry out the hydration regimen. Close follow-up by the primary physician is recommended.
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Complications

  • Complications may include irreversible shock, sagittal or other venous sinus thrombosis, intractable seizures, and renal failure.
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Prognosis

  • Prognosis is excellent if the child is promptly and effectively treated. However, the child with severe dehydration and hypovolemic shock can have significant morbidity and mortality if treatment is delayed.
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Patient Education

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Contributor Information and Disclosures
Author

Lennox H Huang, MD, FAAP  Associate Professor and Chair, Department of Pediatrics, McMaster University School of Medicine; Chief of Pediatrics, McMaster Children's Hospital

Lennox H Huang, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Physician Executives, Canadian Medical Association, Ontario Medical Association, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Krishnapriya R Anchala, MD, MS, FAAP  Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, McMaster University

Krishnapriya R Anchala, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics, Canadian Medical Association, and Ontario Medical Association

Disclosure: Nothing to disclose.

Dan L Ellsbury, MD  Consulting Staff, Pediatrix Medical Group of Iowa; Consulting Staff, Department of Pediatrics, Neonatology Intensive Care Unit, Mercy Medical Center of Des Moines

Dan L Ellsbury, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Caroline S George, MD  Associate Professor, Consulting Staff, Department of Pediatrics, Division of Critical Care Medicine, University of Minnesota Medical School

Caroline S George, MD is a member of the following medical societies: American Academy of Pediatrics and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

G Patricia Cantwell, MD, FCCM  Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

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.

Barry J Evans, MD  Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

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, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

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Table 1. Clinical Findings of Dehydration
Symptom/SignMild DehydrationModerate DehydrationSevere Dehydration
level of consciousnessAlertLethargicObtunded
Capillary refill*2 s2-4 s>4 s, cool limbs
Mucous membranesNormalDryParched, cracked
TearsNormalDecreasedAbsent
Heart rateSlightly increasedIncreasedVery increased
Respiratory rate/pattern*NormalIncreasedIncreased and hyperpnea
Blood pressureNormalNormal, but orthostasisDecreased
PulseNormalThreadyFaint or impalpable
Skin turgor*NormalSlowTenting
FontanelNormalDepressedSunken
EyesNormalSunkenVery sunken
Urine outputDecreasedOliguriaOliguria/anuria
* Best indicators of hydration status[6]
Table 2. Estimated Fluid Deficit
SeverityInfants (weight < 10 kg)Children (weight >10 kg)
Mild dehydration5% or 50 mL/kg3% or 30 mL/kg
Moderate dehydration10% or 100 mL/kg6% or 60 mL/kg
Severe dehydration15% or 150 mL/kg9% or 90 mL/kg
Table 3. Composition of Appropriate Oral Rehydration Solutions
SolutionCarbohydrate (g/dL)Sodium (mEq/L)Potassium (mEq/L)Base (mEq/L)Osmolality
Pedialyte2.5452030250
Infalyte3502530200
Rehydralyte2.5752030310
WHO/UNICEF*2902030310
* World Health Organization/United Nations Children's Fund
Table 4. Composition of Inappropriate Oral Rehydration Solutions
SolutionCarbohydrate (g/dL)Sodium (mEq/L)Potassium (mEq/L)Base (mEq/L)Osmolality
Apple juice120.4260700
Ginger ale93.50.13.6565
Milk4.9223630260
Chicken broth0233330
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