Question

How will you classify and manage dehydration according to IMNCI?

Hint:

In cases of severe dehydration, immediate IV fluids are critical, while mild to moderate dehydration can be managed with ORS.

Answer 1

Step 1: Classification of Dehydration According to IMNCI.
The Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines classify dehydration into three categories:
(1) No Dehydration (Well Hydrate:
- The child has normal thirst and is able to drink fluids adequately.
- No signs of dehydration such as dry mouth or sunken eyes.
- Normal urine output.
(2) Some Dehydration (Moderate Dehydration):
- The child is moderately thirsty and may show irritability.
- Some dry mouth and skin, sunken eyes.
- Decreased urine output.
(3) Severe Dehydration:
- The child shows signs of severe lethargy, weakness, or unconsciousness.
- Profound sunken eyes, very dry skin, and absent urine output for prolonged periods.
- Shock-like symptoms, including rapid pulse and low blood pressure.
Step 2: Management of Dehydration Based on IMNCI.
(1) Mild Dehydration (No Dehydration):
- Oral Rehydration Solution (ORS): Encourage oral rehydration with ORS to maintain hydration.
- Home management: 50-100 mL of ORS for every diarrhea episode.
(2) Moderate Dehydration (Some Dehydration):
- Oral Rehydration Therapy (ORT): The child should be given ORS 75 mL/kg body weight over 4-6 hours.
- Continue feeding as usual (breastfeeding or normal diet).
- Monitor the child for improvement or worsening of dehydration.
- If vomiting is present, ORS should be given in small sips or by spoon, especially if the child resists drinking large amounts at once.
(3) Severe Dehydration:
- Intravenous (IV) Fluids: Immediate IV rehydration is essential, especially if the child is unable to take fluids orally.
- Start with Ringer's Lactate or Normal Saline: 20 mL/kg body weight in the first hour.
- Gradual rehydration with IV fluids should continue, and the child should be monitored for signs of shock.
- Once the child is stable and able to drink, ORT can be continued.
Step 3: Ongoing Management and Monitoring.
- Once rehydrated, continue to monitor the child for signs of dehydration or fluid imbalance.
- If dehydration is managed at home (mild to moderate cases), follow-up within 24-48 hours to reassess hydration status.
Step 4: Prevention of Further Dehydration.
- Encourage continued oral intake (ORS or breast milk) to prevent further fluid loss.
- Avoid sugary drinks (e.g., sod and undiluted fruit juices, as they may worsen diarrhea.