Dehydration in children

TABLE 73-1. Clinical Assessment of Degree of Dehydration in Children Based on Percentage of Body Weight Loss... 

Clinical signs of dehydration in children include tachycardia, loss of skin turgor and dry tongue. 

Rotavirus is the most common cause of diarrhea worldwide. Most children will become infected by the age of 5 years. In the United States, rotavirus is responsible for approximately 50,000 hospitalizations for severe diarrhea and dehydration, and 20 to 40 deaths annually. Most hospitalizations occur in children less than 3 years of age. 

Promethazine is not recommended in children younger than 2 years of age. Exercise caution when administering promethazine to children because of the potential for fatal respiratory depression. Limit antiemetics to prolonged vomiting of known etiology. Avoid use in children whose signs and symptoms may suggest Reye syndrome or other hepatic diseases. In children with dehydration, there is an increased susceptibility to dystonias with the use of promethazine. 

Controlled-release aspirin Controlled-release aspirin, because of its relatively long onset of action, is not recommended for antipyresis or short-term analgesia. Not recommended in children older than 12 years of age contraindicated in all children with fever accompanied by dehydration. 

Children with acute illnesses (eg, chickenpox, CNS infections, measles, gastroenteritis) or dehydration seem to be much more susceptible to neuromuscular reactions, particularly dystonias, than are adults. Do not use dimenhydrinate in children under 2 years of age unless directed by a doctor. 

Encephalitides, gastroenteritis, dehydration, electrolyte imbalance (especially in children and the elderly or debilitated), and CNS reactions have occurred when used during acute febrile illness. 

Fiuid and eiectroiyte baiance The use of this drug does not preclude the administration of appropriate fluid and electrolyte therapy. Dehydration, particularly in children, may further influence the variability of response and may predispose to delayed difenoxin intoxication. Drug-induced inhibition of peristalsis may result in fluid retention in the colon, and this may further aggravate dehydration and electrolyte imbalance. 

Children Not recommended for use in children younger than 2 years of age. Use special caution in young children because of the greater variability of response in this age group. Dehydration may further influence variability of response. Dosage has not been established for children in treatment of chronic diarrhea. 

Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database Syst Rev 2002. 

Because it is stable, desmopressin is preferred for treatments especially if pressor effects are not desired. The primary indication for therapy is central diabetes insipidus, a disorder that results when ADH secretion is reduced and that is characterized by polydipsia, polyuria, and dehydration. Desmopressin is also used to reduce primary nocturnal enuresis, or bedwetting, in children. It is useful in people with mild hemophilia A or with some types of von Willebrand s disease, in which von Willebrand s factor is present at low levels. In these cases, desmopressin is given when excessive bleeding occurs or before surgery to help reduce bleeding indirectly by increasing the amounts of coagulation factors. 

When the Marseilles Poisons Centre analysed information on lithium overdose between 1991 and 2000, in addition to an unspecified number of suicide attempts and accidental poisonings in children, the next most frequent reports were prescription misinterpretation (n = 43), dehydration in the elderly (n = 35), renal insufficiency (n = 15), and diuretic interactions (n = 8) (533). 

If vomiting is present and is uncontrollable with antiemetics, nothing is taken by mouth. As bowel movements decrease, a bland diet is begun. Feeding should continue in children with acute bacterial diarrhea. Rehydration and maintenance of water and electrolytes are the primary treatment measures until the diarrheal episode ends. If vomiting and dehydration are not severe, enteral feeding is the less costly and preferred method. In the United States, many commercial oral rehydration preparations are available (Table 23-3). 

Saline laxatives (magnesium citrate, magnesium sulfate, sodium sulfate, and disodium phosphate) or saccharide laxatives (sorbitol, mannitol, lactulose) are also used in poisoned patients. Common adverse effects are abdominal cramps, excessive diarrhea, and abdominal distension. Dehydration and electroljde imbalance in children, and hjrpermagnesemia and magnesium toxicity (with magnesium-based cathartics) have also been reported. 

The clinical course of human salmonellosis is usually characterized by acute onset of fever, abdominal pain, diarrhea, nausea, and sometimes vomiting. In some cases, particularly in the very young and in the elderly, dehydration can become severe and life threatening. Antibiotic treatment is necessary in less than 2% of the clinical cases. Serious complications occur in a small proportion of cases. The incidence is particularly high in children and the elderly, accounting for up to 60% of all reported laboratory confirmed cases. Studies in developed countries indicate that more than 80% of all salmonellosis cases occur individually rather than as outbreaks. 

Comatose, those receiving large doses of other CNS depressants, acutely ill/dehydrated children, acute asthmatic attack, vomiting of unknown etiology in children, Reye s syndrome, those receiving MAO inhibitors. 

The diagnosis of dehydration and intravascular depletion in children is complicated by difficulties in obtaining an accurate history. In younger children, parental observations are important for estimating fluid deficits and deciding whether hospitalization is necessary. Fortunately, there are prospective data that suggest that parental histories are predictive of acidosis and the need for hospitalization. ... 

ReidSR, BonadioWA. Outpatient rapid intravenous rehydration to correct dehydration and resolve vomiting in children with acute gastroenteritis. Ann Emerg Med 1996 28 318-323. 

Laboratory abnormalities such as increased packed red blood cell volume and total protein, magnesium, and calcium levels are a result of hemoconcentration. Hypoglycemia, seizures, fever, and mental alterations are seen more often in children, perhaps as a reflection of the greater degree of dehydration and electrolyte losses observed with diarrhea in children. Other complications include metabolic acidosis, prerenal azotemia, iatrogenic water intoxication from overrehydration, and aspiration pneumonia. Children, the elderly, and pregnant women are at an increased risk of complications due to cholera. 

In collaboration with Professor A. Avramov of the Pediatric Department of the Bikur Holim Hospital in Jerusalem, we administered A6-THC, 3.5-5 mg total oral dose to 20 children, 0.5-10 years old, who had been admitted for various conditions (mostly G.I. infections) and whose vomiting could have led to dehydration. In 19 cases the vomiting ceased within ca. 30 min. In a few cases vomiting restarted after 6 h when a second dose was administered. No side-effects were observed [ 174]. 

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