Paediatric Dehydration Assessment

OVERVIEW

• 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

• 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.