- Clinical assessment of dehydration can be difficult, especially in young infants, and rarely predicts the exact degree of dehydration accurately.
- The most useful individual signs for predicting 5% dehydration in children are an abnormal capillary refill time, abnormal skin turgor and abnormal respiratory pattern. Combinations of examination signs provide a much better method than any individual signs in assessing the degree of dehydration.
- Clinical assessment therefore comprises some of the following indicators of dehydration:
Loss of body weight:
- Normal: no loss of body weight.
- Mild dehydration: 5-6% loss of body weight.
- Moderate: 7-10% loss of body weight.
- Severe: over 10% loss of body weight.
Clinical features of mild-to-moderate dehydration; 2 or more of:
- Restlessness or irritability.
- Sunken eyes (also ask the parent).
- Thirsty and drinks eagerly.
Clinical features of severe dehydration; 2 or more of:
- Abnormally sleepy or lethargic.
- Sunken eyes.
- Drinking poorly or not at all.
- Pinch test (skin turgor): the sign is unreliable in obese or severely malnourished children.
- Normal: skin fold retracts immediately.
- Mild or moderate dehydration: slow; skin fold visible for less than 2 seconds.
- Severe dehydration: very slow; skin fold visible for longer than 2 seconds.
- Other features of dehydration include dry mucous membranes, reduced tears and decreased urine output.
- Additional signs of severe dehydration include circulatory collapse (e.g. weak rapid pulse, cool or blue extremities, hypotension), rapid breathing, sunken anterior fontanelle.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.