Elsevier

The Lancet

Volume 334, Issue 8663, 9 September 1989, Pages 605-607
The Lancet

Hospital Practice
CLINICAL SIGNS OF DEHYDRATION IN CHILDREN

https://doi.org/10.1016/S0140-6736(89)90723-XGet rights and content

Abstract

102 children with acute gastroenteritis were thought by the admitting junior doctors to be 5% or more dehydrated. As judged by subsequent weight recovery in hospital, the main indicators of mild to moderate dehydration were decreased peripheral perfusion, deep breathing, decreased skin turgor, high urea, low pH, and a large base deficit; a history of increased thirst was just short of statistical significance. Dehydration was not indicated by a history of oliguria, by the presence of restlessness or lethargy, sunken eyes, dry mouth, or a sunken fontanelle or by the absence of tears. Clinical signs of dehydration became apparent at 3-4% rather than 5% dehydration. The degree of dehydration was overestimated by a mean of 3·2%; this caused unnecessary hospital admissions and overtreatment with intravenous fluid.

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    Citation Excerpt :

    These include an overall hydration assessment by: (1) junior doctors, who were instructed to classify children as being 5%-10% dehydrated based on their hospital's guideline32; (2) the fellow or attending physician, by using a 9-item “standard clinical scale”33; (3) the attending physician, blinded to ultrasound findings and using an ordinal scale (<5%, 5%-10%, >10%)4; (4) the pediatric emergency physician, who estimated the child's degree of dehydration by using a 7-point Likert scale (very mild to very severe)34; and (5) having the treating pediatric emergency medicine attending physicians record their clinical impression (1-10 scale) for percent dehydration.35 Excluding a study with 100% sensitivity because it included only children deemed to be 5%-10% dehydrated (ie, excluded children who might have been false negatives),32 the sensitivity of this approach to detect ≥5% dehydration ranged from 33% to 78%. The pooled results from 4 studies for positive and negative LRs were 2.13 (95% CI 1.33-3.44) and 0.48 (95% CI 0.28-0.82), respectively.

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