Pediatric Acute Dehydration

Pediatric Dehydration occurs when fluid losses (typically secondary to acute gastroenteritis vomiting and diarrhea) exceed fluid intake, leading to significant reduction in total body water and extracellular fluid volume in infants and young children, who have higher metabolic rates and fluid turnover.

• Mild Dehydration (3-5% fluid loss): Mildly dry mucous membranes, increased thirst, slightly reduced urine output
• Moderate Dehydration (6-9% fluid loss): Sunken anterior fontanelle (soft spot on head), sunken eyes, absence of tears when crying, dry tongue and mouth, prolonged capillary refill (2-3 seconds)
• Severe Dehydration (≥10% fluid loss): Lethargy, unresponsiveness, cool mottled extremities, tachycardia with weak thready peripheral pulses, skin tenting (skin turgor >2 seconds), anuria (no wet diapers for >8-12 hours)

Most commonly acute infectious gastroenteritis (Rotavirus, Norovirus, Adenovirus, bacterial enteritis), high environmental heat, febrile illness with decreased fluid intake, or diabetic ketoacidosis.

Clinical assessment using the World Health Organization (WHO) or Clinical Dehydration Scale (CDS). In moderate to severe cases, serum electrolytes (sodium, potassium), BUN, creatinine, venous blood gas, and blood glucose are measured.

Adheres strictly to WHO rehydration protocols:

• Mild to Moderate Dehydration (WHO Plan B): Oral Rehydration Solution (ORS - low osmolarity formula, 75 mEq/L sodium). Administer 50 to 100 mL/kg over 4 hours using a spoon, syringe, or cup. Continue breastfeeding throughout.
• Severe Dehydration / Shock (WHO Plan A/C): Immediate IV fluid resuscitation with isotonic crystalloid (Ringer Lactate or 0.9% Normal Saline): 20 mL/kg bolus pushed rapidly over 10 to 15 minutes, repeated as necessary until peripheral pulses and perfusion recover.
• Zinc Supplementation: 10-20 mg elemental zinc daily for 14 days reduces diarrheal duration and prevents future episodes.