Pediatrics: Dehydration and ORT

What is dehydration?

A physiological disturbance caused by decreased or translocation of body fluids.

What are the three classifications of dehydration?

Mild, moderate, and severe.

What can severe dehydration lead to?

Hypovolemic shock.

What happens to total body water during dehydration?

Total body water decreases, primarily extracellular fluid.

Which pediatric age group is at the highest risk of dehydration?

Neonates and infants.

Why are infants at higher risk of dehydration?

Higher body water content, increased water turnover, renal immaturity, and inability to independently meet fluid needs.

What is the most common cause of pediatric dehydration?

Diarrhea.

What are other causes of pediatric dehydration?

Gastroenteritis, febrile illness, stomatitis, DKA, heat, and burns involving more than 25% of the body.

What is the first step in treating pediatric dehydration?

Assess dehydration severity.

What information should be collected when assessing dehydration?

Pre-illness weight, current weight, labs, past medical history, and caregiver interview.

What is the formula for percent dehydration?

[(Pre-illness weight − Current weight) ÷ Pre-illness weight] × 100.

What percentage of weight loss indicates mild dehydration in infants?

1–5%.

What percentage of weight loss indicates moderate dehydration in infants?

6–9%.

What percentage of weight loss indicates severe dehydration in infants?

More than 10%.

What percentage of weight loss indicates shock in infants?

15% or greater.

What percentage of weight loss indicates mild dehydration in children?

1–3%.

What percentage of weight loss indicates moderate dehydration in children?

4–6%.

What percentage of weight loss indicates severe dehydration in children?

More than 6%.

What percentage of weight loss indicates shock in children?

9% or greater.

Why are dehydration classification percentages higher in infants?

Infants have a higher percentage of total body water.

What are signs of mild dehydration?

Slightly dry mucosa, decreased urine output, and normal or slightly increased heart rate.

What are signs of moderate dehydration?

Tachycardia, dry mucosa, sunken eyes, decreased tears, delayed capillary refill, and listlessness.

What are signs of severe dehydration?

Weak tachycardia, hypotension, oliguria, parched mucosa, very sunken eyes, absent tears, and lethargy or coma.

What happens to heart rate as dehydration severity increases?

Heart rate increases and may become weak in severe dehydration.

What happens to blood pressure in severe dehydration?

Systolic blood pressure decreases significantly.

What happens to urine output as dehydration worsens?

Urine output decreases.

What urine output indicates oliguria in the dehydration lecture?

Less than 1 mL/kg/hr.

How does thirst differ in moderate versus severe dehydration?

Moderate: thirsty and eager to drink. Severe: drinks poorly or cannot drink.

What is first-line treatment for mild pediatric dehydration?

Oral rehydration therapy (ORT).

What is first-line treatment for moderate pediatric dehydration?

ORT if the patient can tolerate oral or enteral intake.

What is first-line treatment for severe pediatric dehydration?

Intravenous fluids.

What are contraindications to ORT?

Severe dehydration, shock, unconsciousness, ileus, and severe electrolyte abnormalities.

Why is ORT preferred for mild-to-moderate dehydration?

It is convenient and has a lower infection potential.

What are the major components of commercial ORT solutions?

Glucose, sodium, potassium, and lactate/citrate/acetate.

What is the sodium concentration range in commercial ORT solutions described in the lecture?

45–90 mEq/L.

What are examples of commercial ORT products?

Ceralyte, Enfalyte, Pedialyte, and Rehydralyte.

Why are sports drinks and sodas not recommended for rehydration?

Inappropriate electrolyte concentrations and high carbohydrate content that may worsen diarrhea.

What is the ORT correction dose for mild dehydration?

50 mL/kg over 4 hours plus replacement of ongoing losses.

What is the ORT correction dose for moderate dehydration?

100 mL/kg over 4 hours plus replacement of ongoing losses.

How much ORT replaces each vomiting episode?

2 mL/kg per episode.

How much ORT replaces each watery stool episode?

10 mL/kg per episode.

How often should hydration be assessed during mild dehydration treatment?

Every 2 hours.

How often should hydration be assessed during moderate dehydration treatment?

Every hour.

When is IV therapy indicated?

Severe dehydration, moderate dehydration with inability to tolerate oral intake, unconsciousness, ileus, or severe electrolyte abnormalities.

What are the two phases of IV dehydration therapy?

Phase I: Emergency management. Phase II: Deficit management.

What is the initial IV bolus for hemodynamically unstable pediatric patients?

20 mL/kg of 0.9% NaCl or lactated Ringer's within the first 30 minutes.

How much IV fluid may be given through repeated boluses if perfusion remains poor?

Generally up to 60 mL/kg.

What is the goal of Phase I emergency IV therapy?

Restore circulating volume and improve tissue perfusion.

What is the goal of Phase II deficit management?

Replace existing fluid and electrolyte deficits and ongoing losses.

What IV fluid is preferred for maintenance in most hospitalized children according to the lecture?

0.9% NaCl.

When can a child transition from IV to oral rehydration?

When alert, hemodynamically stable, adequately perfused, and tolerating oral intake.

What signs indicate successful rehydration?

Normal urine output and moist mucous membranes.