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Dehydration in Pediatric patients

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A presentation created and delivered by me in the pediatric department of Ibrahim Malik Teaching Hospital (Khartoum, Sudan) on the 10th of May 2017. It is composed of the following parts:

- Definition
- Epidemiology
- Causes
- Assessment
- Management

The total number of slides is 19 slide. One of the slides contain a video from the IMCI program by World Health Organization (WHO) for assessment of children with dehydration. The youtube link of the video added in this online version instead of the complete video that was shown in the original presentation.

Published in: Health & Medicine
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Dehydration in Pediatric patients

  1. 1. Dehydration Abdalla Mutwakil Gamal House Officer Department of Pediatrics Ibrahim Malik Teaching Hospital Khartoum, Sudan 10/5/2017
  2. 2. Contents • Definition • Epidemiology • Causes • Assessment • Management
  3. 3. Definition • dehydration is a deficit of total body water, with an accompanying disruption of metabolic processes. • - ECF: 1/3 • - ICF: 2/3
  4. 4. Epidemiology • In USA: – 3 million visit – 10% of admissions (220,000) – 2 episodes per year – $2 billion
  5. 5. Prepared by Delfin S. Go. Unless otherwise indicated, text and charts based on Global Monitoring Report 2010: The MDGs after the Crisis, published by the World Bank in 2010. The report is available at www.worldbank.org/gmr2010
  6. 6. Causes • Related to intake • Related to loss • Translocations
  7. 7. • The Most common cause for dehydration is …………….
  8. 8. Assessment • 1995. • By United Nations Children's Fund and the World Health Organization in 1995. • Systemic. • Treatment and prevention.
  9. 9. IMCI training video Exercise G How to assess a child for diarrhoea • https://www.youtube.com/watch?v=Y1HBGj VRHXk
  10. 10. Mild Moderate Severe Weight Loss 3-5% 6-9% >10% Blood pressure Normal Orthostatic Shock Pulse Normal Increase Tachycardic Behavior Normal Irritable Lethargic Membranes Moist Dry Parched Tears Present Decrease Absent Cap. Refill 2 seconds 2-4 seconds >4 seconds Urine SG >1.020 >1.030 Oliguria
  11. 11. Management of dehydration: 1) Resuscitation (if shocked). 2) If severe dehydration but no shock. 3) If some dehydration/moderate dehydration 4) Child with hypernatremic dehydration 5) How to calculate the maintainace?
  12. 12. 1. Resuscitation (if shocked) • PR, BP. • ABC. • 20 ml/kg NS or RL. • Reasses. • Repeat till PR, BP and mental state are normal.
  13. 13. 2 - If severe dehydration but no shock. • child with severe dehydration and no shock 100ml/kg ringers lactate or glucose 5%+1/2 saline. • If the child is <1yr 30ml/kg over 1hr then 70ml/kg over 5 hr. • If >1yr 30 ml/kg over ½ hr then 70 ml/kg over 2 ½ hrs. • Give Zinc after rehydration.
  14. 14. 3 – If some dehydration (mild or moderate dehydration) • ORS 75 ml/kg over 4 hrs., unless there is severe vomiting or patient is unable to drink give i.v fluids glucose 5% with ½ saline or Ringer's lactate. • Give Zinc after rehydration ORS (7 – 10 ml/kg) or homemade fluid after motion Give Zinc.
  15. 15. 4 - Child with hypernatremic dehydration: • Start slow rehydration, give fluids over 48hours: – Day 1: 1/2deficit + maintenance for the first 24 hrs. – Day 2: 1/2deficit + maintenance for the second 24 hrs. • Usual replacement fluid is D5 1/5 NS or D5 ½ NS. • If Na>180 mmol/l, may need dialysis.
  16. 16. 5 – How to calculate the maintainace? • According to patient weight: – 0-10 kg: 100 kcal/kg – 10-20 kg: 50 kcal/kg – > 20kg: 20 kcal/kg

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