Note to myself and my readers: If you’ve purchased the twenty-third edition (2024) Harriet Lane Handbook, you recieved a free online e-book that you can sign in to at http://ebooks.health.elsevier.com/. And if you care for pediatric patients you should buy this book. See Chapter Eleven: Fluid And Electrolytes. Carefully review this resource for treating dehydrated pediatric patients.
Today, I link to and excerpt from PedsCases‘ Dehydration in Children.
All that follows is from the above resource.
Take-home Points
1. Dehydration is a common condition encountered in both acute and ambulatory care; pay close attention to clinical signs and symptoms to accurately assess dehydration.
2. Oral rehydration therapy is best for mild dehydration unless there are contraindications to oral ingestion (the goal being about 10 ml/kg/hr while keeping up with ongoing losses). Remember when orally hydrating to give small amounts frequently and to encourage ongoing breastfeeding. Intravenous fluid resuscitation is indicated in moderate to severe cases.
3. Fluid resuscitation includes 4 key steps: restoring circulatory volume, correcting fluid deficit, maintaining hydration, and replacing ongoing losses.
4. Hyponatremic and hypernatremic dehydration states need to be corrected slowly, over 48-72 hours to prevent cerebral complications which may lead to death. [If you’re not sure how to do it, be sure to ask for help.]5. Monitor level of consciousness and electrolytes frequently during the initial 12 hours of management. Check electrolytes every 2-4 hours to ensure sodium levels are not changing too rapidly.
6. Hyper and hyponatremic dehydration cases are challenging with potentially deadly consequences. Don’t hesitate to ask for help if you are not comfortable calculating the appropriate replacement.
Related Content:
- Case: Dehydration in an 18 month old male
- Case: Maintenance fluid requirements in a 3 year old female
- Case: Low grade fever and vomiting in a 6 year old girl
- Case: Hypokalemia in a 13 year old female
Specialty Area:Clinical Presentation:
