Prepared by students :Raveen Ismail Abdullah

Hayman Ahmad A.Viyan Murad H.

Dehydration in pediatrics

Faculty of medical scienceSchool of nursing Kurdistan /Iraq

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.

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

Definition

Dehydration • is defined as an excessive loss of body fluid &

electrolytes.• Output is more than input.

Normal routes of water gain and loss

Pathophysiology of dehydration

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

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 .

Causes

• Diarrhea• Vomiting• Excessive Sweating • Diabetes• Burns• Excessive blood loss caused by trauma or

accident

Tests and diagnosis

Blood tests:

to check level of electrolytes. BUN Creatinine

Urine analysis test.

Mild dehydration S&S

• No dehydration • Thirsty • Conscious • Less than 5% of body Weight is lost.

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

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

Possible Complications

• Permanent brain damage• Seizures• hypernatremia • Hyponatremia• hypovolemic shock• Kidney failure• Coma and death

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)

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)

Treatment of sever dehydration

• NPO.• IV fluid replacement.

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

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.

Fluid requirements(burn victim )

TBSA burned(%) x Wt(kg) x 4 mlexample : 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 .

Rule of nine for measuring TBSA

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.

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

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.

• 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 .

Nursing care plan

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 .

• 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

References

1. http://www.emedicinehealth.com/dehydration_in_children/page6_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_details.asp?disease_id=153&channel_id=9&relation_id=10860