Makindo Medical Notes

Related Subjects: |Rotavirus |Norovirus |Diarrhoea (Children) |Dehydration (Child)

💧 Dehydration in children is common and potentially life-threatening. It often follows gastroenteritis, fever, or inadequate intake. ⚠️ Infants and young children are especially vulnerable due to higher surface area:volume ratio, faster metabolism, and reliance on caregivers. Early recognition and treatment prevent complications such as shock, electrolyte imbalance, and organ failure.

📋 Assessment of Dehydration

Clinical assessment is key. Classify as mild, moderate, or severe depending on signs and symptoms. WHO/NICE guidelines emphasise clinical features over labs in most cases.

🧾 History

• 🚼 Illness: vomiting, diarrhoea, fever, poor feeding.
• 🚽 Urine: fewer wet nappies, dark urine.
• ⏳ Duration: prolonged diarrhoea/vomiting = higher risk.
• 🏥 Other: chronic disease, medications, inability to access fluids.

🔎 Clinical Signs

🧪 Diagnosis

• Clinical: Mainstay — use signs above.
• Labs (if severe/complicated):
  • Serum electrolytes → hypo/hypernatraemia, hypokalaemia.
  • BUN/Creatinine → renal perfusion.
  • Venous blood gas → metabolic acidosis (esp. diarrhoea).
  • Urinalysis → concentrated urine, ketones.

💊 Management

Aim: restore fluid + electrolyte balance, correct deficits, and treat cause.

• Mild–Moderate:
  • 🍼 Oral Rehydration Therapy (ORT) – first line. 50–75 mL/kg over 4h (mild), 75–100 mL/kg (moderate).
  • Give small, frequent sips of ORS (e.g. Dioralyte). Use spoon/syringe if vomiting.
  • Continue breastfeeding or usual feeds alongside ORS.
  • Restart normal diet as soon as tolerated (avoid sugary drinks). 🍌🍞
• Severe:
  • 💉 IV fluids – 0.9% NaCl bolus 20 mL/kg, repeat if shocked.
  • Then give maintenance + replacement fluids (often 0.45% NaCl + 5% dextrose).
  • Careful monitoring: weight, urine output, electrolytes, glucose.
• Ongoing Monitoring:
  • Cap refill, turgor, urine output.
  • Daily weight (gold standard in hospital).

🧠 Case Vignette

👧 A 2-year-old girl presents with 3 days of diarrhoea and vomiting. Exam: dry mucous membranes, slightly sunken eyes, cap refill 2.5s, irritable. Diagnosis: moderate dehydration. Management: Oral rehydration solution (ORS) 75 mL/kg over 4h, continued breastfeeding, and parental education.

🛡️ Prevention

• Encourage regular fluids in illness, especially ORS early in gastroenteritis.
• Continue breastfeeding/formula even during diarrhoea.
• Educate parents to watch for early warning signs (reduced urine, drowsiness, poor intake).

📌 Summary

Dehydration in children can deteriorate rapidly. Mild/moderate → ORT 💊; severe → IV fluids 💉. Early recognition saves lives. 💡 OSCE tip: Always comment on skin turgor, mucous membranes, capillary refill, urine output.