How do you assess a patient for dehydration?
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Urine output, including the frequency of voiding (last wet diaper), presence of concentrated or dilute urine, hematuria Show Method of mixing infant formula; volume of water to powder being used Stool output, frequency of stools, stool consistency, presence of blood or mucus in stools Emesis, including frequency and volume and whether bilious or nonbilious, hematemesis Contact with ill people, especially others with gastroenteritis, use of daycare Underlying illnesses, especially cystic fibrosis, diabetes mellitus, hyperthyroidism, renal disease Fever Appetite patterns Weight loss; measure of recent weight versus weight on presentation Travel Recent antibiotic use Possible ingestions  Next: Physical ExaminationA complete physical examination may assist in determining the underlying cause of the patient's dehydration and in defining the severity of dehydration. The clinical assessment of severity of dehydration determines the approach to management. Rather than attempting to assign an exact percentage of dehydration, one should attempt to place the child in one of 3 broad categories. The determination of dehydration severity should be based on the overall constellation of symptoms. Patients in a given category need not exhibit all the signs and symptoms listed below. Literature reviews have suggested that delayed capillary refill, delayed skin turgor, and abnormal respiratory pattern are the most reliable clinical signs of dehydration in children. Validated clinical dehydration scales may be a useful adjunct to predict need for intravenous fluid and longer stays in the emergency department. [9] A prospective pilot cohort study of 242 Italian children at two emergency departments found that capillary refilling time was a useful and quick triage parameter for identifying pediatric dehydration requiring prompt rehydration. [10] Table 1. Clinical Findings of Dehydration (Open Table in a new window) Symptom/Sign Mild Dehydration Moderate Dehydration Severe Dehydration Level of consciousness Alert Lethargic Obtunded Capillary refill* 2 s 2-4 s >4 s, cool limbs Mucous membranes Normal Dry Parched, cracked Tears Normal Decreased Absent Heart rate Slightly increased Increased Very increased Respiratory rate/pattern* Normal Increased Increased and hyperpnea Blood pressure Normal Normal, but orthostasis Decreased Pulse Normal Thready Faint or impalpable Skin turgor* Normal Slow Tenting Fontanel Normal Depressed Sunken Eyes Normal Sunken Very sunken Urine output Decreased Oliguria Oliguria/anuria * Best indicators of hydration status [11] Table 2. Estimated Fluid Deficit (Open Table in a new window) Severity Infants (weight < 10 kg) Children (weight >10 kg) Mild dehydration 5% or 50 mL/kg 3% or 30 mL/kg Moderate dehydration 10% or 100 mL/kg 6% or 60 mL/kg Severe dehydration 15% or 150 mL/kg 9% or 90 mL/kg Previous Differential Diagnoses
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Table 1. Clinical Findings of Dehydration Symptom/Sign Mild Dehydration Moderate Dehydration Severe Dehydration Level of consciousness Alert Lethargic Obtunded Capillary refill* 2 s 2-4 s >4 s, cool limbs Mucous membranes Normal Dry Parched, cracked Tears Normal Decreased Absent Heart rate Slightly increased Increased Very increased Respiratory rate/pattern* Normal Increased Increased and hyperpnea Blood pressure Normal Normal, but orthostasis Decreased Pulse Normal Thready Faint or impalpable Skin turgor* Normal Slow Tenting Fontanel Normal Depressed Sunken Eyes Normal Sunken Very sunken Urine output Decreased Oliguria Oliguria/anuria * Best indicators of hydration status [11] Table 2. Estimated Fluid Deficit Severity Infants (weight < 10 kg) Children (weight >10 kg) Mild dehydration 5% or 50 mL/kg 3% or 30 mL/kg Moderate dehydration 10% or 100 mL/kg 6% or 60 mL/kg Severe dehydration 15% or 150 mL/kg 9% or 90 mL/kg Table 3. Composition of Appropriate Oral Rehydration Solutions Solution Carbohydrate (g/dL) Sodium (mEq/L) Potassium (mEq/L) Base (mEq/L) Osmolality Pedialyte 2.5 45 20 30 250 Infalyte 3 50 25 30 200 Rehydralyte 2.5 75 20 30 310 Table 4. WHO-UNICEF Oral Rehydration Solutions Solution Sodium (mEq/L) Chloride (mEq/L) Glucose, Anhydrous (mEq/L) Potassium (mEq/L) Citrate (mEq/L) Osmolality Standard 90 801112010311Reduced osmolarity 75 65752010245UNICEF = United Nations International Children's Emergency Fund, WHO = World Health Organization. [16, 17] What 3 things can we use to assess for dehydration?Assessment. Take a detailed intake history regarding both food and fluid intake in comparison to normal feeding pattern.. Take a detailed output history regarding urine and stool, similarly in comparison to normal output pattern.. Ask about excessive losses (eg vomiting, frequent urination or diarrhoea). How can you determine if a patient is dehydrated?What are the symptoms of dehydration?. Feeling very thirsty.. Dry mouth.. Urinating and sweating less than usual.. Dark-colored urine.. Dry skin.. Feeling tired.. Dizziness.. Which assessment finding indicates dehydration?Sunken eyes, decreased skin elasticity, weak radial pulse and general appearance are an optimal four variable model. Of these four findings, the presence of any two indicates a deficit of 5% or more, and three or more findings indicates a deficit of at least 10%.
What technique can be used to assess the hydration of a patient?Urinalysis is a frequently used clinical measure to distinguish between normal and pathological conditions. Urinary markers for dehydration include a reduced urine volume, a high urine specific gravity (USG), a high urine osmolality (UOsm), and a dark urine color (UCol).
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