dehydration

Question 1

causes of dehydration

Answer 1

losing a lot of fluid (e.g. D&V), or are not taking in enough fluid.

The most common cause of dehydration in the UK is simple gastroenteritis
- most commonly caused by viruses such as rotavirus.
- usually start with vomiting, then develop diarrhoea.
- In a normal child diarrhoea or vomiting has to be
severe or prolonged to cause serious dehydration.
This is more likely if they have an infection such as
Salmonella.
- you can usually rehydrate the child orally, using small
sips little and often, without having to resort to
nasogastric or intravenous fluids. This is an oral fluid
challenge. Use fluids that replace electrolytes.

beware of those with chronic condiitons e.g. CF or ileosotmy

Other causes:

• feeding problems
• GORD
• URTI/coughing
• intusseception
• UTI
• meningitis
• migraine

discharge - Babies need to be kept hydrated all the time. Infants and children may be OK for a few days if they are (by and large) keeping fluids down.

Question 2

key points in history

Answer 2

learning points: Key Points in History

In this section you should consider the following points:

In addition to quantifying vomits and loose stools, explore other systems to assess if the cause is true gastroenteritis:
- Cough? Fever? Sore throat? Urinary symptoms for
example
- Abdominal pain may not be due to gastroenteritis

Recent contact with others with similar symptoms?
Recent travel?
Blood in the stools? (infection vs intussusception vs food intolerance)
Quantify how much the child is drinking (eating is not as important)
Check urinary output (it is worrying to have no wet nappy for 12 hours). Ask if they have passed urine if they are toilet trained
Is there a record of any recent weight? This helps in calculating fluid loss if they have sought medical attention within the same illness

Question 3

General observation and management

Answer 3

General Observation

Alert – likely to manage on oral fluids at home

Drowsy – will require hospital admission for fluid management

Jittery baby – check Glucose level normal and not hypoglycaemic

Question 4

Signs of dehydration

Answer 4

Sunken eyes – ask the parents or look at recent photos

Sunken fontanelle in infant

Dry mucous membranes – look at the tongue

Mottled skin and cool extremities

Skin turgor – if loose when pinched, then is dehydrated

Prolonged capillary refill time

Increased heart rate poor pulse volume

Question 5

Red flags

Answer 5

Pyloric stenosis - babies aged 4-6 weeks, milky projectile vomit after every feed

Hypernatraemic dehydration:
- High blood sodium concentration in babies due to
immature kidneys not being able to retain water in
right proportions if child has diarrhoea or not feeding
- Skin, eyes and fontanelle can look hydrated
- More drowsy/lethargic may be the only sign
- The heart rate +/- respiratory rate may be fast
Common in
- Breastfed babies who have not established feeding
- Bottle fed babies with feed made incorrectly
- Babies with profuse diarrhoea

DKA
- Occurs in newly diagnosed or existing diabetics
- High glucose and high ketoacidosis cause
dehydration which is life-threatening
- Inter-current illnesses precipitate the condition
- Check blood and Urine glucose and ketone levels
- A high respiratory rate will result from the acidosis
- Immediate strict hospital fluid management is needed
urgently