This document discusses dehydration in pediatrics. It defines dehydration and explains its pathophysiology and types based on severity and fluid/electrolyte loss. Causes of dehydration include diarrhea, vomiting, excessive sweating, diabetes and burns. Diagnosis involves blood and urine tests to check electrolyte levels. Signs and symptoms range from mild thirst to severe complications depending on the percentage of fluid loss. Treatment involves oral or IV fluid replacement depending on severity. Nursing care focuses on monitoring fluid intake and output, providing skin care and educating families on prevention.

1. Faculty of medical science
School of nursing
Kurdistan /Iraq
Dehydration in pediatrics
Prepared by students :
Raveen Ismail Abdullah
Hayman Ahmad A.
Viyan Murad H.

3. 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.

4. 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

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

6. Normal routes of water gain and loss

7. 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
• Kidney 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) oraly(tablet)

19. Treatment of mild and moderate
dehydration
 Oral rehydration solution (ORS)
is a simple treatment for dehydration composed of:
• 30 ml of sugar.
• 2.5 ml of salt.
• 1 liter of water.
Contraindications for ORS:
1. Severe dehydration.
2. Unconsciousness.
3. Frequent vomiting attacks.
 Continues breastfeeding .
 A single dose of ondansetron (Zofran) oraly(tablet)

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

21. Daily Maintenance Fluid Requirements
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.

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 :
Deficient fluid volume may be related to active fluid loss due to
(hemorrhage, vomiting, diarrhea, burns, wounds)
• Nursing intervention
• Assist with identification and treatment of underlying cause.
• Encourage fluid intake..
• Monitor intake and output.
• Give IV fluid as ordered if needed.

28. Nursing care plan
• Nursing diagnosis
Poor skin turgor related to loss of fluid.
• Nursing intervention
• Provide skin care .
• Turn frequently, gently massage skin, and protect bony
prominences.
• Encourage fluid intake.
• Advice to use skin moisturizers .

29. Prevention and home care
FAMILY EDUCATION:
• If your 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 .

30. Prevention and home care
• 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.

31. 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