![]() ![]() Similarly, infants who are fed oral rehydration solution prepared from excess salt or who lost excess free water, as in diabetes insipidus, could have hypernatraemic dehydrationĮnd-tidal carbon dioxide measurements have been studied in an attempt to assess degrees of dehydration greater than five percent in children. In these cases, the children appear to be more dehydrated and could also present with hyponatremic seizure activity. This is also seen in the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Ĭhildren who were given free water when they have ongoing diarrhea disease can present with hyponatremic dehydration, excess of free water concurrent to excess sodium, and bicarbonate loss in diarrhea. Evaluation of urine specific gravity and the presence of ketones can assist in the evaluation of dehydration. For patients with vomiting who have not been able to tolerate oral fluids, hypoglycemia may be present. This includes derangements in sodium levels and acidosis characterized by low bicarbonate levels or elevated lactate levels. In selected cases, electrolyte abnormalities may exist. Most cases of dehydration are hyponatremic. Mental status Normal Listless, irritable Altered mentalĬapillary refill Normal Prolonged Prolongedĭehydration could be associated with hypo or hyper, or isonatremia. Dehydrated children have dry oral mucosa.ĭehydration% Mild 3% to 5% Moderate 6% to 10% Severe >10% An infant has to lose more body weight than an older child to get to the same level of dehydration. The degree of dehydration between an older child and an infant is slightly different as the infant could have total body water (TBW) content of 70% to 80% of the body weight, and older children have TBW of 60% of the body weight. The table below can assist with categorizing the patient's degree of dehydration. Dehydration is categorized as mild (3% to 5%), moderate (6% to 10%), and severe ( more than 10%). Various signs and symptoms can be present depending on the patient's degree of dehydration. A recently published article has shown that many children with pyloric stenosis may not have metabolic alkalosis. It is interesting to note that the kidney also excretes hydrogen ions to save sodium and water, which could be the reason for aciduria. The kidney excretes base in the form of HCO 3 ion to maintain acid-base balance of loss of hydrogen ion in the emesis in the form of hydrogen chloride. They lose chloride, sodium, and potassium in addition to volume resulting in hypochloremic, hypokalemic metabolic alkalosis. Hydrogen ion retention by the kidney from decreased renal perfusion and decreased glomerular filtration rate.Ĭhildren with pyloric stenosis have very unique electrolyte abnormalities from the excessive emesis of gastric contents. Lactic acid production secondary to poor tissue perfusionĤ. Ketosis secondary to the glycogen depletion seen in starvation which sets in infants and children much earlier when compared to adults.ģ. excess bicarbonate loss in the diarrhea stool or in the Urine is certain types of renal tubular acidosisĢ. Metabolic acidosis is seen in infants and children with dehydration, the pathophysiology of which is multifactorial.ġ. In much of the literature, the distinction between dehydration and volume depletion is a blur. Volume depletion is seen in acute blood loss and burns, whereas distributive volume depletion is seen in sepsis and anaphylaxis. As indicated earlier, dehydration is total water depletion with respect to sodium, and volume depletion is the decrease in the circulation volume. In infants, it is 70% of the total weight, whereas it is 65% and 60%, respectively, in children and adults. The total body water is higher in infants and children as compared to adults. two-thirds of the TBW is in the intracellular compartment, and the other one-third is distributed between interstitial space (75%) and plasma (25%). The total body water (TBW) in humans is distributed in two major compartments. Volume depletion closely correlates with the signs and symptoms of dehydration. Dehydration causes a decrease in total body water in both the intracellular and extracellular fluid volumes. ![]()
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