Definition
- Loss of water or reduction in the water content of the body.
- Children have about 80% water making up their body weight.
Functions of Water (H₂O)
- Regulation of blood pressure (BP)
- Transportation of nutrients
- Maintenance of electrolyte balance
- Excretion of waste
- Digestion
- Acts as a lubricant in joints
- Maintains shape and structure of cells
- Acts as a shock absorber, protecting vital organs and tissues
Causes
- Infections (e.g. Rotavirus)
- Vomiting
- Diarrhoea (most common cause)
- Trauma
- Malnutrition
- Acute Kidney Injury (AKI)
Classification of Dehydration (by % body water loss)
- < 5% → No dehydration
- 5–10% → Some dehydration
- > 10% → Severe dehydration
Signs and Symptoms
|
Parameter |
No Dehydration (<5%) |
Some (5-10%) |
Severe (>10%) |
|
Eyes |
Not sunken |
Sunken |
Very sunken |
|
Anterior fontanelle |
Not sunken |
Sunken |
Very sunken |
|
Skin turgor (pinch test) |
Goes back very fast |
Goes back slowly |
Goes back very slowly |
|
Capillary refill |
< 2 sec |
> 2 sec |
> 3 sec |
|
Tears |
Present |
Present |
Absent |
|
Sucking |
Normal |
Eager |
Poor sucking |
|
Mental status |
Alert |
Alert |
Not alert / lethargic / unconscious |
|
Shock |
No signs |
No signs |
Signs present |
|
Mucous membranes |
Moist |
Dry |
Very dry |
Management of Dehydration
1. No Dehydration → Plan A
- 10 ml/kg ORS after every loose stool
- ORS preparation (home-made solution):
- 750 ml boiled water
- 6 teaspoons sugar
- 1 teaspoon salt
2. Some Dehydration → Plan B
- 75 ml/kg body weight ORS orally over 4 hours
- Zinc supplementation:
- < 6 months → 10 mg daily
- 6 months → 20 mg daily
3. Severe Dehydration → Plan C
- IV fluids (Normal Saline or Ringer’s Lactate)
- 100 ml/kg body weight IV (bolus dose)
< 1 year (give over 6 hours):
- 1st hour → 30 ml/kg (30%)
- Next 5 hours → 70 ml/kg (70%)
≥ 1 year (give over 3 hours):
- First 30 minutes → 30 ml/kg (30%)
- Next 2.5 hours → 70 ml/kg (70%)