Management of Pediatric Dehydration - Causes, Clinical Features, and Treatment.

Introduction

Dehydration is the depletion of body fluid and electrolytes in the body. It is one of the major causes of morbidity and mortality in infants. It causes thirst, lethargy, skin, and oral mucosa dryness, hypotension (reduced blood pressure), decreased urine output, shock, and tachycardia (increased heart rate). Children have higher metabolic rate, requiring a higher baseline fluid requirement. This high requirement of fluid makes the children more susceptible to dehydration. There is a higher fluid loss and an inability to communicate thirst. The child is diagnosed with pediatric dehydration based on physical examination and history. Replacement of fluid and electrolytes is indicated.

What Is Pediatric Dehydration?

According to the World Health Organization, pediatric dehydration results from excessive bodily fluid loss. It is commonly seen in infants and young children due to higher metabolic rates, inability to hydrate, and inability to communicate about their needs. There is the presence of total body fluid loss and electrolyte imbalance. In severe cases, children lose so much body fluid that they cannot maintain their ordinary functions.

What Are the Causes of Pediatric Dehydration?

Pediatric dehydration can result from increased fluid loss and decreased fluid intake.

Following are the various causes of pediatric dehydration.

• Increased Fluid Loss.

  • Vomiting.

  • Diarrhea.

  • Gastroenteritis (inflammation of the intestine and the stomach).

  • Diabetic ketoacidosis (a severe diabetic complication that results in excess production of blood acids called ketones).

  • Excessive sweating.

  • Burns.

  • Bowel obstruction.

  • Fever

  • Excessive perspiration (sweating).

  • Fistulas (a connection between two organs or structures).

  • Nasogastric drainage.

  • Ascites (fluid accumulation in the abdomen).

  • Pleural effusion (accumulation of water in the tissue present in the lining of the lungs and the chest).

• Decreased Fluid Intake.

  • Dysphagia (difficulty in swallowing).

  • Environmental factors affecting fluid intake.

  • Pharyngitis (sore throat or inflammation of the pharynx).

  • Mild illness.

  • Vomiting.

  • Fever.

  • Tachypnea (abnormal breathing that is shallow and rapid).

  • Neglect for hydration.

What Are the Clinical Features of Pediatric Dehydration?

The clinical signs and symptoms depend upon the salt concentration in the blood. The concentration falls and rises abnormally, resulting in the worsening of the symptoms. Following are the signs and symptoms of pediatric dehydration according to their severity.

1. Mild Dehydration

   1. The child tends to play less than normal.

   2. The child urinates less frequently.

   3. Dry mouth.

   4. Loose stools are observed if dehydration is caused by diarrhea.

   5. There is a decrease in bowel movements.

   6. There are soft, sunken spots on the head in infants and toddlers.

2. Moderate Dehydration

   1. Increased thirst.

   2. Dry mouth and dry lips.

   3. Rapid heartbeats and lightheadedness.

   4. The eyes appear to be sunken.

   5. Tears are absent when a child cries.

   6. The child's alertness is reduced, and the child appears lethargic.

3. Severe Dehydration

   1. Bluish discoloration of the skin, known as cyanosis.

   2. The child breathes rapidly.

   3. The child appears to be very fussy.

   4. The child feels excessively sleepy.

   5. The hands and feet of the child become cold.

   6. The child urinates only once or twice a day.

   7. The skin of the child appears to be wrinkled.

   8. In severe cases, the child may suffer seizures and coma.

What Are the Treatment Plans for Pediatric Dehydration?

The treatment plan for pediatric dehydration depends upon the severity of the dehydration. Replacement of body fluids and electrolytes such as sodium chloride, potassium chloride, and dextrose is the major goal of treatment.

1. Mild Dehydration - Children suffering from mild dehydration can be treated at home with proper fluid intake, rest, and care. Oral rehydration solution is indicated as it contains the right amount of salt, sugar, and electrolytes. The oral rehydration solution is in powder form, mixed with liquid, and given to the child for fluid and electrolyte balance. The amount of oral rehydration solution given depends upon the child's weight. The following steps should be followed if the child has mild dehydration.

• A few sips of oral rehydration solution should be given to the child at a frequency of ten milliliters every few minutes.

• Babies should be breastfed if they are not vomiting repeatedly.

• Electrolyte ice pops can be given to older children.

• If the child can tolerate the fluid intake for 24 hours, a regular diet can be given to the child.

• A regular diet should be given to the children unless the pediatrician recommends a change.

• The amount of fluid is slowly increased.

• If the child is suffering from diarrhea and vomiting, a small sip of fluid containing electrolytes is given frequently.

• If there is a fever, Acetaminophen is given.

• Proper rest is advised to the children.

2. Severe Dehydration - If the signs and symptoms of dehydration are severe and children cannot take fluid, emergency hospital treatment is indicated. Fluid and electrolyte solution is administered to the child intravenously and with the help of a nasogastric tube. Treating severe dehydration requires intravenous fluids used as normal saline and ringer lactate solution. The fluid selection depends upon the types of dehydration, symptoms, and sodium levels. Rehydration solution is given to severely malnourished children. Also, the oral rehydration solution of 5 milliliters per kilogram is given to the child every thirty minutes. Signs of hydration status are checked every two hours.

How to Prevent Pediatric Dehydration?

Pediatric dehydration can be prevented in the following ways.

• Parents should always give their children an extra fluid or oral rehydration solution if they are sick.

• Parents should give a very small amount of oral rehydration solution.

• Children need to drink water frequently during hot weather.

• Children who play sports and are physically active should be given water regularly.

• Sugary drinks like sodas, cold drinks, and flavored gelatin should be avoided.

Conclusion:

Mild and moderate dehydration is commonly seen in children. However, if there is severe dehydration the child requires immediate care and treatment. It is essential to rehydrate. Electrolyte replacement is essential for fast recovery. Repletion therapy is indicated for fluid loss and to retain normal fluid volume and electrolyte status. Children tend to get dehydrated easily if they suffer from diarrhea and vomiting. They are more susceptible to dehydration due to more body surface area per pound of weight. Parents should be aware of the early stage of dehydration, such as illness and dryness of the oral mucous membrane. Parents should have proper knowledge about preventing dehydration. If parents see the warning signs and symptoms in children, they should seek healthcare as soon as possible.