Monday 3 October 2016

Hydration in Children

 Children are the highest risk group for dehydration. Most commonly caused by severe vomiting, diarrhea, gastroenteritis, diabetic hyperglycemia, ketoacidosis, or high urine output, dehydration progresses quickly and is sometimes life threatening. Dehydration is classified into mild <5%, moderate 5% to 10%, and severe >10%, with signs and symptoms becoming more severe with increased water losses.    
Clinical signs of dehydration include:
•Increased urine output, fluid loss, oliguria, anuria
•Skin color ranging from pale to pink-grey to mottled
•Decrease in skin turgor, with decreased elasticity and return to normal when pinched
•Dry mucous membranes
•Decreased blood pressure
•Rapid respiration or changes in breathing (rapid to shallow to slow)
•Elevated heart rate, tachycardia, or bradycardia
•Weakened pulse
•Weight loss
•Change in mental status from mild signs to irritability to lethargy 
Also look for:
•Dry mouth
•Crying with no tears
•No urine output for 4 to 6 hours
•Blood in the stool
•High fever
•Vomiting a greenish color or vomiting for more than 24 hours
•Lethargy or difficulty waking 

Recommendations from the Academy of Nutrition and Dietetics for maintenance involve using the Holliday-Segar formula for estimating fluid requirements based on weight:
•1- to 10-kilogram (kg) child requires 100 milliliters (mL)/kg body weight
•11- to 20-kg child requires 1000 mL+50 mL/kg body weight for each kg >10 kg
•>20-kg child requires 1500 mL+20 mL/kg body weight for each kg >20 kg  

It is important to note that children age birth to 2 years of age have much higher requirements than older children and adults. They have a significantly higher basal metabolic rate, and their calorie and fluid requirements may be three to four times those of an adult. 
Good sources of fluids include water, Pedialyte ®, breast milk or iron-fortified infant formula, cow’s milk, ice, soups, freezer pops, gelatin, and smoothies. Rehydration is administered orally as the primary intervention. Intravenous (IV) therapy is a less preferred method of repletion and used only in the most severe of cases.

Do not offer sports drinks, sodas, caffeinated beverages, and juices to a dehydrated child, because these often contain too much carbohydrate and not enough sodium, which may result in adding to the fluid losses.

Even if the child seems to vomit all of the fluids given, offer small sips every few minutes, because some repletion is made. Usually replacement of fluids will result in alleviation of symptoms. If the child does not improve or you or the child’s caregiver is concerned, call the pediatrician or visit an emergency room immediately.

BOTTOM LINE:  You cannot over react in this situation. If at any time you become concerned head straight to your closes A&E.   



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