How can the degree of dehydration be assessed?

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.

  1. ‘No visible’ dehydration: The child has no signs of dehydration or not enough signs to be classified as ‘some dehydration’. However, many children with ‘no visible dehydration’ have still lost more fluid than normal. They often are thirsty and pass little urine.
  2. ‘Some’ dehydration: They have 2 or more of the following signs:
    • Very thirsty and drinks eagerly
    • Restless and irritable
    • Sunken eyes
    • Moderate degree of decreased skin turgor. When pinched, the skin takes longer than usual, but less than 2 seconds, to return to normal.
  3. ‘Severe’ dehydration: They have 2 or more of the following signs:
    • Not able to drink or drinks very poorly
    • Lethargic or unconscious
    • Eyes very sunken.
    • Severe decrease in skin turgor. When pinched, the skin takes 2 seconds or more to return to normal.
    • Shock with delayed capillary filling time

Severe dehydration leads to shock, acidosis, electrolyte loss, an ileus and hypoglycaemia.

Always start by first looking for signs of severe dehydration. If the child has 2 or more signs of severe dehydration, then the child is classified as severe dehydration. If the child does not have 2 or more signs of severe dehydration, then look for signs of some dehydration. If there are 2 or more signs of some dehydration, the child is classified as some dehydration. If there are no signs or only 1 sign of some dehydration present the child is classified as no visible dehydration.

The degree of dehydration must always be assessed in children with diarrhoea.

Children with ‘some’ dehydration often also have a dry mouth, poor urine output and do not look well. Children with ‘severe’ dehydration appear severely ill and are hypotensive, with a rapid, weak pulse, cold peripheries, and have acidotic breathing.

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