Dehydration-1.pptx slide for paediatrics
- 1. DEHYDRATION
- 2. Outline • Definition • Epidemiology • Aetiology • Pathophysiology • Clinical features • Investigations • Management • Complications
- 3. Definition • Dehydration is a condition that results from the excessive loss of body water • This occurs when the loss of fluids exceeds the fluid intake
- 4. Epidemiology • Dehydration is one of the most significant causes of morbidity and mortality in children • Worldwide, over 3 million children under 5 years die from dehydration every year
- 5. Aetiology Dehydration is generally caused by • excessive fluid loss • reduced fluid intake • third-space shift or a combination of these factors
- 6. Aetiology Some common condition in children that pose a risk for dehydration are • Diarrheal diseases • Vomiting • Fever • Burns • Dysphagia • Urinal losses as in glucosuria, diuretic therapy, diabetes insipidus • Ascites • Peritonitis
- 7. Aetiology • Children are particularly susceptible to dehydration due to frequent episodes of gastroenteritis, high surface area to volume ratio and inability to fully communicate or independently meet their fluid needs
- 8. Pathophysiology • Dehydration is caused from a negative fluid balance that results from excessive loses(renal, GI or insensible losses), reduced fluid intake or a shift of fluids into third spaces • The decrease in total body water affects both intracellular and extracellular fluid volumes though most clinical manifestations result from intracellular volume depletion and the physiologic compensatory attempts that take place
- 9. Pathophysiology • Dehydration when allowed to progress ultimately leads to hypovolemic shock which leads to end organ damage and then subsequently death.
- 10. Clinical features • History of diarrhea and vomiting • Dry mouth • Absence of tears • Reduced urine output • Sunken eyes, sunken fontanelles in babies • Dry mucous membranes • Delayed capillary refill time • Reduced skin turgor • Thirst • Altered consciousness
- 11. The clinical features are used in assessing a child and also to ascertain the degree of dehydration. According to WHO, dehydration is classified as • No dehydration • Some dehydration • Severe dehydration
- 12. WHO Assessment and classification for hydration status SEVERE DEHYDRATION At least 2 of the following signs SOME DEHYRATION At least 2 of the following signs NO DEHYDRATION No signs of some or severe dehydration MENTAL STATUS Unconscious or Lethargic Restless or irritable Well and alert EYES Sunken Sunken Normal SKIN PINCH Very slow recoil > 2s Slow recoil < 2s Fast recoil < 1s THIRST Drinks poorly or not able to drink Thirst, drinks quickly No thirst, drinks normally
- 13. Other areas that can be used to assess dehydration include • Urine output • Anterior fontanelles • Mucous membranes • Respiratory rate • Blood pressure • Tears
- 14. Investigations • FBC • Random blood sugar • Urinalysis • BUE, Cr • Serum lactate
- 15. Management No Dehydration Management of a child with no dehydration can be done at home Aim of treatment is to prevent dehydration by • encouraging fluid intake; continue breastfeeding in young children • Administration of ORS according to the WHO Treatment Plan A after each loose stool.
- 16. WHO TREATMENT PLAN A Age Volume of ORS < 2years 50-100ml 2 to 10 years 100-200ml > 10 years As much as wanted
- 17. Some dehydration • Children with some dehydration are to be managed in a health facility with ORS according to the WHO Treatment Plan B • WHO Treatment Plan B equates to 75ml/kg ORS given over 4 hours • Review after 4 hours to assess degree of dehydration and continue appropriate management
- 18. • Approximate amount of ORS to be given in the first 4 hours • Child’s age should only be used when weight is unknown Age <4 months 4 – 11 months 12-23 months 2-4 years 5-14 years Weight < 5kg 5 – 7.9kg 8-10.9 kg 11-15.9kg 16-29.9kg Quantity of ORS 200-400 400-600 600-800 800-1200 1200-2200
- 19. Severe dehydration • Admit child • Treat shock if present • If child is able to drink even if poorly, ORS can be started whilst obtaining IV access • Administer Ringers lactate according to the WHO Treatment Plan C
- 20. WHO Treatment Plan C Reassess after 6 hours (infants) or 3 hours (older child) and then continue with the appropriate Treatment Plan Age First, give 30ml/kg over Then give 70ml/kg over Infant (<1 year) 1 hour 5 hours Older child > 1 year 30 minutes 2 hours 30 minutes
- 21. A child with Severe Acute Malnutrition • Rehydration should be done slowly either orally or via a nasogastric tube • Standard ORS is not to be used • Give Resomal 5ml/kg every 30min for 2hrs • If sill dehydrated, 5 - 10ml/kg/hr should be given in alternate hours with F- 75 for up to 10hrs. • Reassess half hourly for the first 2 hours then hourly. • If child is improving, give Resomal according to WHO treatment plan A
- 22. Complications • Hypotension • Hypovolemic shock • Tissue damage • Multiple organ failure
- 23. • Thank you
- 24. References • World Health Organization. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. World Health Organization. 2005 • World Health Organization. Pocket book of Hospital Care for children. Guidelines for the Management Of Common Childhood Illnesses. 2013. • Standard Treatment Guidelines. Ministry of Health. Sixth Edition, 2010.