Signs and Management of Pediatric Dehydration
Correctly grading dehydration is the foundation of management. The WHO classification system is the gold standard for clinical assessment and treatment planning.
1. Clinical Assessment (WHO Classification)
| Classification | Key Clinical Signs |
|---|---|
| No Dehydration | Well, alert; normal eyes, mouth, and skin pinch. |
| Some Dehydration | Restless, irritable; sunken eyes, thirsty; skin pinched, goes back slowly. |
| Severe Dehydration | Lethargic/unconscious; sunken eyes; drinks poorly; skin pinch goes back very slowly (≥ 2 seconds). |
2. Summary of Management (The “Plans”)
- Plan A (No Dehydration): Treat at home. Increase fluids, continue breastfeeding, and provide Zinc.
- Plan B (Some Dehydration): Oral Rehydration Therapy (ORT) in the clinic. Give 75 mL/kg of ORS over 4 hours.
- Plan C (Severe Dehydration): Immediate IV resuscitation. Give 100 mL/kg of Ringer’s Lactate or Normal Saline (split: 30 mL/kg bolus followed by 70 mL/kg maintenance).
3. High-Yield Clinical Pearls
- Skin Pinch: The most reliable sign of dehydration, but can be misleading in obese or severely malnourished children (lack of subcutaneous fat).
- Early Signs: Tachycardia is often the earliest sign of hypovolemia; hypotension is a late, ominous sign of decompensated shock.
- Weight-Based Monitoring: Rapid weight loss in a child with diarrhea is the most accurate measure of fluid loss.
NEET PG Hint: Remember: In severe dehydration (Plan C), the fluid bolus (30 mL/kg) should be given faster in infants (< 12 months) than in older children. For more high-yield protocols and free medical questions, visit mymedschool.org.