Dehydration in Children

This is a scenario about dehydration in children.

A 18 month old child has got frequent stools and vomiting. Symptoms have been present for 3 days. stools as watery with no mucus or blood. He's unable to keep anything down, vomiting after every feeding, even water. Six episodes of diarrhea and four episodes of vomiting per day. He attended daycare when he was well. There are some other symptoms appear: somnolent, tachycardia, his distal of extremities are cold, skin turgor is diminished. The doctor gives him a plan C re-hydration and considers giving antibiotic and zinc.

Now, we're gonna discuss this scenario. Get ready! :B
We start from unfamiliar terms. I think the unfamiliar terms are:

somnolent  : abnormal sleepy
tachycardia: abnormal heartbeat rate
turgor        : a condition being turgid (swollen and obstruct)
plan C re-hydration: giving liquid to treat severe dehydration

Let's take a look at the symptoms. The kid's got six times diarrhea and four times vomiting day, somnolent, tachycardia, skin turgor is diminished, and his distal extremities are cold.

Do you know? diarrhea can make lost bicarbonate that can cause metabolic acidosis. If there's persistent vomiting (pyloric stenosis) then loss of H+ ions can cause metabolic alkalosis.
So, what stage of dehydration do you think this kid suffers?

Dehydration is classified as mild, moderate, and severe. How could we know whether mild, moderate, or severe? Well, the classification is based on how much of the body fluid is lost, estimated by loss on body weight.
We call  it mild dehydration if the loss of no more than 5 to 6 percent loss of body weight. Moderate dehydration if the loss of 7 to 10 percent and severe if the loss of over 10 percent of body weight. The most life threatening condition is the severe one (of course :B).

Because there is no information about the weight loss, we can consider which dehydration the kid suffers from is by the treatment that the doctor gave. In this case, the doctor gave Plan C Re-hydration. What is Plan C Re-hydration? :/ hmmm, check this one out!

As we know re-hydration is giving liquid (oral) to treat dehydration. There are three kinds of re-hydration.
Plan A 
(for no dehydration)
the health worker should discuss home drinks with the mother feeding during diarrhea and proper home hygiene.

Plan B
giving ORS (Oral Rehydration Salt) solution to all. the amount of ORS solution:
after each loose stool:
50 - 100 ml (1/4 - 1/2 cup) -> child < 2 years old
100 - 200 ml -> older children
adult -> as much as they want.

(for some dehydration)
if the eyelids become puffy, stop and give other fluids. Use ORS solution again when the puffiness is gone. if child vomits, wait 10 minutes and then continue slowly giving small amounts of ORS solution.

Plan C
(for severe dehydration)
can we give intravenous (IV) fluids? yes. If it's possible to give IV, give IV fluids after 4 - 6 hours, reassess the child and choose the suitable treatment plan.
if it's not possible to give IV, start treatment with ORS solution, as treatment B if the child can drink. How if it's not possible? well, if you are trained to use a nasogastric tube for rehydration, we can use it, start rehydration using the tube if IV treatment is available nearby, send the child for immediate IV treatment. but if no and it's urgent, send the child for IV treatment.

Degree of dehydration also can be assessed by the pulse, blood pressure, mucous membranes, urine output, skin turgor.

ORT (Oral Rehydration Therapy): the giving of fluid by mouth to prevent and/or correct the dehydration that's a result of diarrhea. thus, preventing or treating dehydration and reducing the danger.
Giving ORT reduces nausea, vomiting, restores the appetite through correction of acidosis and potassium losses.
ORS (Oral Rehydration Salts): the treatment. reducing stools volume. (WHO and UNICEF)
2.6 gms sodium chloride, 13.5 gms glucose (anhydrous), 1.5 gms potassium chloride, 2.9 gms trisodium citrate dihydrate.
glucose in ORS can help to enable the intestine to absorb the fluid and the salts more efficiently.
ORT alone is an effective treatment for 90 - 95% of patients suffering from acute watery diarrhea regardless of cause.
Too rapid rehydration can lead to dangerous fluid shifts and hyponatremia.

the antibiotic that the doctor gave is to treat the diarrhea that can cause by bacteria. maybe the kid got it when he was in daycare.
Further information about the treatment of diarrhea, click this link: treatment of diarrhea.

Okay, that's all for today, Pals! Hope this could be beneficial information for you.

CHEERS!! :B