Expansion
Clinical signs graded against percentage body weight loss
Expansion
| Grade | Deficit | Signs |
|---|---|---|
| None | Under 5 per cent | Alert, normal observations, moist membranes |
| Clinical dehydration | 5 to 10 per cent | Irritable or lethargic, sunken eyes, dry membranes, reduced urine, reduced skin turgor, tachycardia, tachypnoea |
| Shock | Over 10 per cent | Decreased consciousness, pale or mottled, cold extremities, prolonged capillary refill, weak pulses, hypotension (very late) |
Red flag features suggesting progression to shock: altered responsiveness, sunken eyes, tachycardia, tachypnoea and reduced skin turgor.
Management
- No dehydration: continue feeding and fluids, oral rehydration solution after each loose stool
- Clinical dehydration: oral rehydration solution 50 ml/kg over 4 hours plus maintenance, given in small frequent volumes, by nasogastric tube if refused
- Shock: intravenous fluid bolus 10 ml/kg of isotonic crystalloid, repeated and reassessed, then deficit plus maintenance
Maintenance by the Holliday-Segar rule: 100 ml/kg for the first 10 kg, 50 ml/kg for the next 10 kg, 20 ml/kg thereafter, per 24 hours.
Hypotension is a very late and pre-terminal sign in children, who compensate by tachycardia and vasoconstriction until they decompensate suddenly. Capillary refill and conscious level are far more useful.