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.

1. Dehydration
Abdalla Mutwakil Gamal
House Officer
Department of Pediatrics
Ibrahim Malik Teaching Hospital
Khartoum, Sudan
10/5/2017

2. Contents
• Definition
• Epidemiology
• Causes
• Assessment
• Management

3. Definition
• dehydration is a deficit of total body
water, with an accompanying disruption
of metabolic processes.
• - ECF: 1/3
• - ICF: 2/3

4. Epidemiology
• In USA:
– 3 million visit
– 10% of admissions (220,000)
– 2 episodes per year
– $2 billion

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

7. Causes
• Related to intake
• Related to loss
• Translocations

8. • The Most common cause for dehydration
is …………….

9. Assessment
• 1995.
• By United Nations Children's
Fund and the World Health
Organization in 1995.
• Systemic.
• Treatment and prevention.

11. IMCI training video Exercise G How to
assess a child for diarrhoea
• https://www.youtube.com/watch?v=Y1HBGj
VRHXk

12. 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

13. 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?

14. 1. Resuscitation (if shocked)
• PR, BP.
• ABC.
• 20 ml/kg NS or RL.
• Reasses.
• Repeat till PR, BP and mental state are
normal.

15. 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.

16. 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.

17. 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.

18. 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