Tuesday, December 21, 2010

DEHYDRATION IN CHILDREN

TYPES OF DEHYDRATION ( Based on serum Na Level)
  • Hypotonic Dehydration : S. Na <130>
  • Isotonic Dehydration : S.Na 130- 145mmol/L
  • Hypertonic Dehydration : S. Na .150 mmol/L

Causes

Common causes

  • Gastroenteritis
  • Stomatitis: Pain may severely limit oral intake.
  • Diabetic ketoacidosis (DKA): Dehydration is caused by osmotic diuresis.
  • Febrile illness: Fever causes increased insensible fluid losses and may affect appetite.
  • Pharyngitis: This may decrease oral intake.

Life-threatening causes
  • Gastroenteritis
  • DKA
  • Burns: Fluid losses may be extreme.
  • Congenital adrenal hyperplasia: This may have associated hypoglycemia, hypotension,hyperkalemia, and hyponatremia.
  • GI obstruction: This is often associated with poor intake and emesis.
  • Heat stroke: Hyperpyrexia, dry skin, and mental status changes may occur.
  • Cystic fibrosis: This results in excessive sodium and chloride losses in sweat, placing patients at risk for severe hyponatremic hypochloremic dehydration
  • Diabetes insipidus: Excessive output of very dilute urine can result in large free water losses and severe hypernatremic dehydration.
  • Thyrotoxicosis: Weight loss is observed, despite increased appetite. Diarrhea occurs.
Management
  • Early Re hydration
  • Maintain daily fluid replacement
  • Replace ongoing fluid losses
  • maintain Nutritional Needs
  • Avoid anti diarrheal Agents

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