It may help to think of childhood dehydration in terms of borrowing from various sources. Thus mild dehydration results in thirst, oliguria and restlessness. Moderate dehydration borrows from reserves; severe dehydration results in circulatory collapse.
Symptoms and signs of clinical dehydration and shock include the following:
no clinically detectable | clinical dehydration | shock |
appears well | red flag - appears to be unwell or deteriorating | - |
alert and responsive | red flag - altered responsiveness (for example, irritable, lethargic) | decreased level of |
normal urine output | decreased urine output | - |
skin colour unchanged | skin colour unchanged | pale or mottled skin |
warm extremities | warm extremities | cold extremities |
no clinically detectable | clinical dehydration | shock |
alert and responsive | red flag - altered responsiveness (e.g. - irritable, lethargic) | decreased level |
skin colour unchanged | skin colour unchanged | pale or mottled skin |
warm extremities | warm extremities | cold extremities |
eyes not sunken | red flag - sunken eyes | - |
moist mucous membranes (except after a drink) | dry mucous membranes | - |
normal heart rate | red flag - tachycardia | tachycardia |
normal breathing pattern | red flag - tachypnoea | tachypnoea |
normal peripheral pulses | normal peripheral pulses | weak peripheral pulses |
normal capillary refill time | normal capillary refill time | prolonged capillary refill time |
normal skin turgor | red flag - reduced skin turgor |
|
normal blood pressure | normal blood pressure | hypotension (decompensated shock) |
Hypernatraemic dehydration should be suspected if the child has:
Reference:
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