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o an s p us, wea a sen

pulse, and one of:

Capillary refill > 3 secs

Shock

Y

Not alert, AVPU < A

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How

severe

is

the

dehydration?Cold Hands plus, weak / absent pulse,

and one of:

Capillary refill > 3 secs

Not alert, AVPU < A

oc

Pulse easy to feel, but unable

to drink or AVPU < A plus: SevereY

Sunken Eyes

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How

severe

is

the

dehydration?Cold Hands plus, weak / absent pulse,

and one of:

Capillary refill > 3 secs

Not alert, AVPU < A

oc

Pulse OK but unable to drink plus:

Sunken Eyes

Skin pinch 2 secs? SevereY

Able to drink plus 2 of: Y

Sunken Eyes and / or

Skin inch 1 - 2 secs

omeDehydration

Restlessness / Irritability

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Howsevereisthedehydration?

Cold Hands plus, weak / absent pulse,

and one of:

Ca illar refill > 3 secs ShockY

Not alert, AVPU < A

Sunken Eyes

Skin pinch2 secs?

Severe

Dehydration

Y

Able to drink plus 2 or more of:

Sunken Eyes and / or

Skin inch 1 - 2 secs SomeY

Restlessness / Irritability Dehydration

Y

Dehydration

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Whichcommonivfluidshaveasimilar

compos t onto

p asma

Allconcentrationsareinmmol/l

a

RingersLactate

130 5.4

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Fluid deficit If the fluid deficit isfirst replaced with a

body sodium is

diluted.

g

fluid These low sodium

fluids are much less

,Existi

circulation and can

cause hyponatraemia

leading to

convulsions

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usedtocorrectshockorseveredehydrationunless

thereisseveremalnutrition

Na+ K+

Half Strength Darrows (&

5% Dextrose)61 17

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Lowsodiumconcentrationfluidsthatshouldnotbeusedtocorrectshockorseveredehydrationinany

situation.

Allconcentrationsareinmmol/l a

+ +

(0.18%)31 0

5%Dextrose 0 0

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Shock identifiedrway reat ng oxygen

effectively managed

Establish iv / io access

gns pers s

20 mls / kg bolus offluid (

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Full Strength

(Normal Saline ifunavailable)

Age < 12 months

to 5 years

Step 130 mls / kg over

1 hour

30 mls / kg over

30 mins

Step 270 mls / kg over

5 hours

70 mls / kg over

2.5 hours

Then re-assess child if sti ll signs of severedehydration repeat step. If signs improving treat

This is equivalent to correcting 10% dehydration in 3 6 hours

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ReassessafterSteps1and2 3 6hours

Cold Hands plus, weak / absent pulse,

and one of:

Ca illar refill > 3 secs ShockY

Not alert, AVPU < A

Sunken Eyes

Skin pinch

2 secs?

Severe

Dehydration

Y

Able to drink plus 2 or more of:

Sunken Eyes and / or

Skin inch 1 - 2 secs SomeY

Restlessness / Irritability Dehydration

Y

Dehydration

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ORS

Oralrehydration

(by

mouth

or

ngt)

works

just

.

Inonedetailedreviewof>1500childrendeaths

groupthanintheivtreatedgroup.

safelybegivendownanngtube.

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ORS++

FrequentORS

unt etter

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m s m s

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V mi in n f in ?

VomitingisNOTacontraindicationtoora re y rat on

Carefulcounselingabout,slow,steadyadministrationofORSishelpful.

Breastfeedingandotherformsoffeedingcanandshould continue

Thereis

no

evidence

of

benefit

fromusinghalfstrengthfeedsor .

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Ciprofloxacinfor

3days

severeillnessthentreatwithappropriate

antibiotics

Zincshouldbegiventoallchildrenwithdiarrhoeaasitspeedsresolutionofsymptoms:

10mgod(halftab)for14daysifage=6months

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classifyingthe

severity

of

dehydration.

treatedusingfluidswithphysiological

Classifyseverity,treatbyspecifyingfluid,

Then reassess.