https://drtucom.blogspot.com/

1. Supervised by:
Dr. Mohammed Edress
Prepared by :
1. Ahmed Emad Sami Faris
2. Abdul-Rahman Atta-Allah Talab
3. Ahmed Abdul-Wahed Sameet
4. Abdul-Kareem Saleh Mohammed
Dehydrated child
Tikrit University college of medicine /Iraq (TUCOM)

2. Objectives
 Dehydration Overview.
 Definition of dehydration & pathophysiology .
 For understanding the main type of dehydrations depending on
degree of severity and amount of fluid & electrolyte loss, &
Differentiation between degree of dehydration.
 To know the causes of Dehydration .
 How we can diagnose dehydration and required investigations for
conforming diagnosis .
 To know the sign & symptoms of dehydration .
 Understanding further complications of dehydration .
 Appropriate Treatment of dehydration depending on patient age
and weight & severity of dehydration and its causes.
 Nursing considerations and nursing care plan .
 How we can prevent dehydration.

3. Dehydration overview
 Water is a essential element of the body..Up to 75% of the
body's weight is made up of water. Most of the water is found in
:
 (intracellular space)
 (extravascular space)
 (interstitial space).
 Dehydration occurs when the amount of water leaving the body is
greater than the amount being taken in.
 In normal situations the body is in water balance it means that
input is equal to out put

4. Definition
Dehydration
• is defined as an excessive loss of body fluid &
electrolytes.
• Output is more than input.

5. Normal routes of water gain and loss

6. •The normal response to dehydration, i.e. decreased effective arterial
blood volume or effective circulating volume is described. Due to water
retention and drinking following stimulation of ADH secretion and thirst,
osmoregulation is overruled by volume conservatory mechanisms, which
lead to hyponatremia. Only patients with impaired mental function or
those who are unable to drink will develop a progressive water deficit--
with or without salt depletion--recognizable by hypernatremia. Decreased
effective arterial blood volume and hypernatremia affect cerebral function
in a way that perception of external stimuli as well as perception of pain
will be impaired. Alert dehydrated patients are disturbed mainly by thirst
and dryness of the mouth. Both symptoms are perceived more intensely
by young than by elderly persons. Dryness of the mouth increase thirst on
its own. Distress by thirst and oral dryness increases as a function of the
level and the rapidity of developing hypernatremia. The simple act of
filling the oral cavity with fluid and swallowing alleviates thirst in the
absence of any change in plasma sodium concentration. Thirst quenching
efficacy is increased by administering chilled hypotonic fluid with lemon or
other fruit acid added (for stimulation of salivation).
Pathophysiology of dehydration

8. Types of dehydration based on type of fluid loss
Hyponatremic: primarily a loss of electrolytes,
particularly sodium less than 135 ml
Hypernatremic: primarily a loss of water , Na more
than 158 ml
Isonatremic: equal loss of water and electrolytes
sodium 135_154 ml

9. Types of dehydration based on severity
Mild :
when the total fluid loss reaches 5% or less .
Moderate :
when the total fluid loss reaches 5_10% .
Severe :
when the total fluid loss reaches more than 10%,
considered an emergency case .

10. Causes
• Diarrhea
• Vomiting
• Excessive Sweating
• Diabetes
• Burns
• Excessive blood loss caused by trauma or
accident

11. Tests and diagnosis
 Blood tests:
 to check level of electrolytes.
 BUN
 Creatinine
 Urine analysis test.

12. Mild dehydration
S&S
• No dehydration
• Thirsty
• Conscious
• Less than 5% of body Weight is lost.

13. Moderate dehydration
S&S
• Dry skin and mucous membranes
• Thirst
• Decreased urine output
• Crying baby with tears
• Muscle weakness
• Drowsiness
• light head ache
• sunken fontanels
• Decreased BP
• Increased Pulse rate (tachycardia)
• 5 to10 % of body Weight is lost
• Capillary refill
• Shallow rapid RR

15. Severe dehydration
S&S
• Extreme thirst
• Very dry mouth, skin and mucous membranes
• Sunken eyes
• Sunken fontanels
• No tears
• An urea
• Dry skin that lacks elasticity and slowly “bounces back” when
pinched into a fold
• Rapid heartbeat
• Rapid and shallow breath
• Unconsciousness
• More than 10 % of body Weight is loss
• Delay Capillary refill for more than 2 seconds

17. Possible Complications
• Permanent brain damage
• Seizures
• hypernatremia
• Hyponatremia
• hypovolemic shock
• renal failure
• Coma and death

18. Treatment
• dehydration treatment depends on age, weight , the
severity of dehydration and its cause.
 Oral rehydration solution (ORS) for mild and moderate
dehydration
 IV fluid replacement (for sever dehydration)
 Treating the cause of dehydration
 A single dose of ondansetron (Zofran) orally(tablet) used
to prevent nausea and vomiting

19. Treatment of mild and moderate
dehydration
Oral rehydration solution (ORS)
is a simple treatment for dehydration composed of:
Contraindications for ORS:
1. Severe dehydration.
2. Unconsciousness.
3. Frequent vomiting attacks.
Continues breastfeeding .
A single dose of ondansetron (Zofran)
orally(tablet)

20. Treatment of sever dehydration
• NPO.
• IV fluid replacement.

21. Daily Maintenance Fluid Requirements
• Calculate child’s weight in kg.
• Allow 100 ml/kg for first 10 kg body weight.
• Allow 50 ml/kg for second 10 kg body weight.
• Allow 20 ml/kg for remaining body weight.
Daily Maintenance Fluid Requirements

22. Calculating replacement
Correction of deficit:
• Deficit in ml = wt (kg) x % dehydrated x 10 (ideally the pre-
dehydration weight should be used).
 example :
14 kg child who is 5% dehydrated has a deficit of
14 x 5 x 10 = 700 ml.

23. Fluid requirements(burn victim )
TBSA burned(%) x Wt(kg) x 4 ml
example : a child weighs 15kg,he has his leg burned
TBSA=18
18x15x4=1080ml.
Give half of total requirements in first 8 hour, second
half over next 16 hour.
Give IV fluid to the burned victim (child )
If the TBSA is 10% or more .

24. Rule of nine for measuring TBSA

25. Calculating Drop rate per minutes
(Solution) ml x 15 /hr x min
Example :
540 ml x15/8 hr x 60 =16 drops per minute.
540mlx15/16x60=8 drops per minute.

26. Nursing Considerations
Assess vital signs, noting peripheral pulses.
Monitor blood pressure.
Monitor intake and output.
Observe the physical properties of the urine.
Correctly infuse the right amount of IVF in case
of sever dehydration .
Encourage small, frequent feedings.
Provide skin care
Administer medications as prescribe

27. Nursing care plan
• Nursing diagnosis :
1. Deficient fluid volume may be related to active fluid loss due to
(hemorrhage, vomiting, diarrhea, burns, wounds)
2. Poor skin turgor related to loss of fluid.
• Nursing intervention
1. Assist with identification and treatment of underlying cause.
2. Encourage fluid intake..
3. Monitor intake and output.
4. Give IV fluid as ordered if needed.
5. Provide skin care .
6. Turn frequently, gently massage skin, and protect bony prominences.
7. Encourage fluid intake.
8. Advice to use skin moisturizers .

28. Prevention and home care
FAMILY EDUCATION:
• If the child has vomiting or diarrhea more than four to five times
in 24 consecutive hours, start fluid replacement & increasing fluid
intake.
• Even when you are healthy, drink plenty of fluids every day and
drink more when the weather is hot.
• Begin fluid replacement as soon as vomiting and diarrhea start --
DO NOT wait for signs of dehydration.
• Remind family that fluid needs are greater with fever, vomiting, or
diarrhea .

29. • Notify physician immediately in case of continues
vomiting and diarrhea.
• teach the mother how to prepare ORS at home
in case of mild and moderate dehydration if Oral
rehydration solution (ORS) was not available :
• (6 tea spoon ) of sugar.
• (1/2 tea spoon) of salt.
• (4.25 Cups) of water.
Prevention and home care

30. References
1. http://www.emedicinehealth.com/dehydration_in_children/pag
e6_em.htm
2. http://www.aafp.org/afp/2009/1001/p692.html
3. http://www.medscape.com/viewarticle/710684
4. http://www.webmd.com/fitness-exercise/tc/dehydration-topic-
overview
5. http://bodyandhealth.canada.com/channel_condition_info_det
ails.asp?disease_id=153&channel_id=9&relation_id=10860