The normal skin turgor is the elasticity (stretch) which enables skin to rapidly return to its previous position after it is gently pinched into a tent shape for 2 seconds. Normally skin returns to its position immediately after being pinched and then released. With decreased skin turgor, the skin takes longer than normal to return [...]
Dehydration develops when excessive amounts of fluid are lost from the body. Diarrhoea can rapidly lead to dehydration, especially if vomiting is also present. Both the history and the clinical examination are important in assessing whether a child is dehydrated. In all children with diarrhoea the following signs must be looked for: Offer the child [...]
Dehydration Shock Acidosis Electrolyte loss Ileus Hypoglycaemia Septicaemia Malnutrition Severe dehydration is the commonest cause of death in infants with diarrhoea and by far the most important complication. Dehydration is the most important complication and the commonest cause of death in infants with diarrhoea.
The most important sign of shock is a delayed capillary filling time of more than 3 seconds. The capillary filling time is measured by pressing on the sole of the child’s foot or palm of the hand, then releasing the pressure and counting how many seconds it takes for the pale area to regain its [...]
Shock (hypovolaemic shock in dehydration) is the failure of the heart to maintain adequate circulation due to the loss of fluid. With excessive fluid loss in the stools, the volume of fluid in the circulation falls and there is not enough fluid to allow normal blood flow to the small capillaries of the body. As [...]
Weight loss is the best measure of the degree of dehydration. Unfortunately the child’s weight at the onset of the diarrhoea is often not known. Therefore, this method of assessing the degree of dehydration is only of limited use. With ‘some’ dehydration, less than 10% of body weight is lost while 10% or more of [...]
All children with diarrhoea must be examined for signs of dehydration. The degree of dehydration can be roughly assessed clinically into ‘no visible’ dehydration, ‘some’ dehydration or ‘severe’ dehydration. This is important as it is essential to identify children with severe dehydration. ‘No visible’ dehydration: The child has no signs of dehydration or not enough [...]
Repeated, severe vomiting A markedly distended abdomen Bile stained vomiting Passing a lot of blood and mucus with little stool Severe, continuing abdominal pain (not just intermittent cramping pains) These children must be referred to hospital urgently for further investigation.
Some infants with diarrhoea appear very ill and have bacteria circulating in their blood. This is called septicaemia. Septicaemia should be suspected if the child has a high temperature (pyrexia) or appears a lot sicker that you would expect for the degree of dehydration or does not improve after the dehydration is corrected. Septicaemia is [...]
Hypoglycaemia in children is defined as a blood glucose concentration of less than 3 mmol/l. Severe diarrhoea, especially in malnourished children who refuse feeds or have severe vomiting, may cause hypoglycaemia. This can result in loss of consciousness or convulsions. Hypoglycaemia must always be suspected in children with diarrhoea who have fits or a decreased [...]
Ileus is distension of the abdomen due to a decrease or absence of the bowel movements (peristalsis). No bowel sounds can be heard. This lack of peristalsis is due to infection and loss of potassium. Ileus usually does not cause abdominal pain or bile stained vomiting.
Children with diarrhoea lose both fluid and electrolytes in the stool. Important electrolytes which are lost include sodium, potassium, calcium, magnesium, chloride, phosphate, and bicarbonate. Electrolytes are also lost with excessive vomiting. Children with diarrhoea lose excessive amounts of fluid and electrolytes in the stool. An electrolyte imbalance (too much or too little of one [...]
With poor peripheral perfusion due to shock, many cells in the body no longer receive enough oxygen and, therefore, are no longer able to produce energy by fully breaking down carbohydrates and fats. This failure of metabolism results in the formation and accumulation of lactic acid, which causes metabolic acidosis. Metabolic acidosis is made worse [...]
