Management of Severe Dehydration
Severe dehydration in a pediatric patient is a medical emergency requiring immediate and aggressive fluid resuscitation to prevent hypovolemic shock and end-organ damage.
1. Clinical Assessment (Signs of Severity)
- Lethargy/Unconsciousness: Altered mental status.
- Sunken Eyes/Fontanelle: Severe volume depletion.
- Inability to drink: A sign of shock or profound weakness.
- Skin pinch: Returns very slowly (≥ 2 seconds).
- Signs of Shock: Weak/absent pulses, cool extremities, tachycardia, hypotension (a late/pre-terminal sign).
2. Emergency Fluid Resuscitation (Plan C)
In patients with severe dehydration/shock, initiate Plan C using Ringer’s Lactate (RL) or Normal Saline (NS).
| Age Group | Phase 1 (Bolus) | Phase 2 (Remainder) |
|---|---|---|
| < 12 Months | 30 mL/kg in 1 hour | 70 mL/kg in 5 hours |
| > 12 Months | 30 mL/kg in 30 mins | 70 mL/kg in 2.5 hours |
3. High-Yield Clinical Pearls
- Reassessment: Reassess every 15–30 minutes until a radial pulse is strong.
- Oral Rehydration: As soon as the patient is alert and can drink (usually after 1–3 hours), start oral rehydration therapy (ORT) alongside IV fluids.
- The “Plan C” Trap: Never rely on Oral Rehydration Solutions (ORS) alone for *severe* dehydration/shock; IV access is mandatory.
- Monitoring: Watch for signs of fluid overload (e.g., puffiness of eyelids) during rapid infusion.
NEET PG Hint: Remember: Ringer’s Lactate (RL) is the fluid of choice for resuscitation. Do not wait for labs before starting the bolus in a shocked patient. For more high-yield pediatric emergency protocols and free medical questions, visit mymedschool.org.