Question

A mother brings her 5-year-old child of weight 20 kg, with complaints of loose stools since morning.

Hint:

Early recognition of dehydration severity and prompt intervention is critical in children with diarrhea and vomiting.

Answer 1

Step 1: Importance of Dehydration Assessment.
Dehydration is a common and serious complication of diarrhea and vomiting in children. The degree of dehydration should be assessed early to guide management and prevent complications such as shock.
Step 2: Clinical Signs of Dehydration.
Dehydration is classified based on the severity of symptoms:
(1) Mild Dehydration:
- Thirsty but alert.
- Slight decrease in urine output (normal or slightly decrease.
- Moist mucous membranes (slightly dry).
(2) Moderate Dehydration:
- Thirsty and irritable or lethargic.
- Reduced urine output (not passing as much urine, darker in color).
- Dry mouth and skin, sunken eyes.
- Skin may lose elasticity (skin pinch test may take longer to return).
(3) Severe Dehydration:
- Very lethargic, weak, or unconscious.
- Very reduced or absent urine output (no urine passed for several hours).
- Deeply sunken eyes, very dry skin.
- Sunken fontanel (in infants), cold extremities.
- Rapid, weak pulse, and low blood pressure.
Step 3: Fluid Loss Estimation.
- Dehydration can also be estimated based on the degree of weight loss.
- A mild case may result in <5% weight loss, moderate 5-10%, and severe dehydration >10% weight loss.