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Dehydration Management in Children

Mild dehydration is characterized by a 5% fluid loss in infants/young children and 3% in older children/adolescents with normal vital signs. Moderate dehydration shows a 10% loss in infants/young children and 6% in older groups with rapid heart rate and normal blood pressure. Severe dehydration presents as over 15% and 9% loss respectively with rapid heart rate, decreased blood pressure, dry mucous membranes, and sunken fontanelles or eyes. Management of mild to moderate dehydration involves oral rehydration with diluted juices or solutions and continuing usual diet. Severe dehydration requires calculating intravenous fluid needs using a four-step process: determining bol

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268 views1 page

Dehydration Management in Children

Mild dehydration is characterized by a 5% fluid loss in infants/young children and 3% in older children/adolescents with normal vital signs. Moderate dehydration shows a 10% loss in infants/young children and 6% in older groups with rapid heart rate and normal blood pressure. Severe dehydration presents as over 15% and 9% loss respectively with rapid heart rate, decreased blood pressure, dry mucous membranes, and sunken fontanelles or eyes. Management of mild to moderate dehydration involves oral rehydration with diluted juices or solutions and continuing usual diet. Severe dehydration requires calculating intravenous fluid needs using a four-step process: determining bol

Uploaded by

Chinenye Modesta
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We take content rights seriously. If you suspect this is your content, claim it here.
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DEHYDRATION & FLUID REPLACEMENT

Clinical Signs of Dehydration


Degree of Dehydration Mild Moderate Severe
Infant/Young Child 5% 10% >15%
Older Child/Adolescent 3% 6% >9%
Heart Rate Normal Rapid Rapid
Blood Pressure Normal Normal Decreased
Urine Output Mildly Decreased Markedly Decreased Anuria
Mucous Membranes Moist Tacky Dry
Fontanelles Normal Sunken Markedly Sunken
Capillary Refill Normal (<3s) Normal to Increased Increased (>3s)
(>3s)

Management of Dehydration* 4-2-1 Rule


Mild and Oral Rehydration Up to 10 kg 4mL/kg

Moderate à Fluid: dilute juice or oral rehydration solutions. 40mL + 2mL/kg


10-20 kg
à Continue age-appropriate diet as tolerated. above 10 kg
à Children >6mo can receive a 0.15mg/kg dose
60mL + 1mL/kg
(max dose 8mg) of Ondansetron for >20 kg
above 20 kg
vomiting.
à If ineffective, move to IV hydration.
Example

A 18kg child is 9%
Severe Calculating IV Fluids dehydrated
à STEP 1: Bolus = NS 10-20mL/kg or 5-10mL/kg
if worried about myocardial or renal ü Bolus= 20mL/kg x 18kg =
360mL
dysfunction.
ü Deficit = 0.09 x 18 = 1.62L
à STEP 2: Calculate deficit= % dehydrated x ü Maintenance fluid =
weight in kg. 40mL + 2(8kg) = 56mL/h
à STEP 3: Calculate maintenance fluids in mL/hr ü 24h Total Fluid
with 4-2-1 rule. Replacement Required =
à STEP 4: Calculate Total Fluid Replacement 1620 + (56 x 24) - 360 =
Over 24h = deficit + maintenance – bolus. 2604mL
ü Divide over 24 hours =
à STEP 5: Divide volume over 24 hours.
2604/24 hr = 108.5 mL/hr
à STEP 6: Measure ongoing losses (i.e. vomit, ü Replace losses as
diarrhea, sweat etc.) and replace as needed. needed
à STEP 7: IV Fluid Selection – Typically D5NS ü IV Fluid = D5NS +/-
+/- 20mEq/L KCl depending on kidney function 20mEq/L KCl
and electrolytes.

* Refer to different references for fluid management in infants <28 days old
March, 2022
Grace Georgopoulos (Medical Student, University of Alberta) and Dr. Chris Novak (Pediatrician, Alberta
Children’s Hospital) for www.pedscases.com

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