Dehydration Clinical Presentation

Updated: Dec 07, 2018
  • 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

Next:

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. 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]

A prospective pilot cohort study of 242 Italian children at two emergency departments found that capillary refilling time was a useful and quick triage parameter for identifying pediatric dehydration requiring prompt rehydration. [10]

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 [11]

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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