This document provides guidelines for assessing and treating severe dehydration in pediatric patients. It outlines signs of severe dehydration including diarrhea and two of lethargy, sunken eyes, or slow skin pinch. Treatment involves rapid intravenous fluid resuscitation for dehydrated patients without severe malnutrition or shock. For those with severe malnutrition or shock, oral or nasogastric rehydration is preferred over intravenous fluids to avoid complications. The guidelines provide detailed treatment plans involving fluid amounts and types based on the patient's age, weight, and presence of other conditions like malnutrition or shock.

1. SEVERE DEHYDRATION
BY
LINDA AMEAH MSC, PNO, BSC, GCNM PEADIATRIC ASSOCIATE

2. Assess for Severe Dehydration
Diarrhoea
+ 2 of these:
•Lethargy
•Sunken Eyes
•Slow Skin Pinch
(>2 seconds)

3. Assess for Malnutrition
 Visible wasting
–Skin appears too large for body (no fat)
–Visible outline of ribs
–Severe muscle wasting (arms, legs, buttocks)
–Large head relative to body size
 Oedema of both feet
–Thinning “rust” hair

4. Treatment of Severe Dehydration:No
Malnutrition and No SHOCK
 Determine age and weight of patient.
 Determine initial amount of fluid to give 30ml/kg then 70ml/kg.
 Insert an IV line and start giving fluids. (Time according to age.)
 Reassess patient every 30 -60 minutes.
 Repeat once if patient not improving.
 Give ORS solution (5ml/kg/hr) as soon as able to drink.

5. Treatment of Severe Dehydration: PLAN C
 Tamika (6 months, 9kg, well nourished)
 FIRST hour
270ml Ringer’s Lactate IV (30ml x 9kg)
 THEN start (over next 5 hours)
630ml Ringer’s Lactate IV (70ml x 9kg)
 Assessed 30 -60 min –hydration improving
 After 4 hours IV fluids Tamika able to drink
ORS 45mls/hr (5ml x 9kg) started
 At 6 hours –reassessed and hydration improved from severe dehydration
 Continue as per dehydration guidelines

6. Treatment of Severe Dehydration:No
Malnutrition With SHOCK
 Treat initial shock with 20ml/kg RL or NS.
 Then jump to step 2 of Dehydration treatment plan and give 70ml/kg of RL or NS.
 Note: You are not giving 30ml/kg which is in normal dehydration.
 See Chart 7 and 11 in WHO Pocket book of hospital care for children.

7. Alternate Plan of Care
 If an IV cannot be established, insert Nasogastic (NG) Tube.
 Give ORS 20ml/kg every hour for 6 hours.
 Continue to monitor NG tube infusion tolerance and hydration status.

8. Treatment of Severe Dehydration: With
Severe Malnutrition and No Shock
 Do NOT give IV fluids if possible.
 Give ReSoMal orally or via NG tube.
–5ml/kg every 30 minutes first 2 hours
–5 -10ml/kg/hour next 4 -10 hours
 Give more ReSoMal if patient wants more or large stool loss or vomiting.
 Monitor every 30 -60 minutes and check blood glucose.
–Treat if blood glucose low (< 3mmol/litre).

9. Treatment of Severe Dehydration: With
Severe Malnutrition and Shock
 15ml/kg of available solution with 5% glucose over 1 hour (treating the shock)
 Monitor HR and RR every 5 -10 minutes.
 With signs of improvement and no evidence of fluid overload, repeat infusion of 15ml/kg over 1
hour.
–Give oral or NG ReSoMal 10ml/kg/hr up to 10 hours.
–Initiate re-feeding with F-75.
 With NO signs of improvement
–Give IV maintenance of 4ml/kg/hr while waiting for blood.
–Transfuse 10ml/kg over 3 hours (packed cells if overloaded).
–Initiate re-feeding with F-75.
–Start IV antibiotics.

10. Assessment and Treatment of Circulation
Emergencies
D
SEVERE
DEHYDRATIO
Diarrhoea
plus any two
of these:
Lethargy
Sunken
Eyes
Very Slow
Skin Pinch
IF NO SEVERE
MALNUTRTION
•Insert IV line and
begin giving fluids
rapidly.
IF SEVERE
MALNUTRITION
•DO NOT insert IV
(unless shock).
•Proceed to full
assessment and
treatment as per
guidelines.
Diarrhoea
plus 2
positive signs