Dehydration in Children: A Comprehensive Guide for Nurses

Dehydration occurs when fluid loss exceeds fluid intake, resulting in an imbalance that affects the body's ability to function properly. In children, dehydration can progress rapidly due to their smaller fluid reserves, making early recognition and management essential. Nurses play a pivotal role in identifying dehydration, administering appropriate treatment, and educating caregivers on prevention strategies.

Causes of Dehydration in Children

1. Increased Fluid Loss:

Gastrointestinal:

• Diarrhea (e.g., gastroenteritis).
• Vomiting.

Fever:

• Increases insensible water loss through the skin and respiratory system.

Excessive Sweating:

• Physical activity, hot weather.

Urinary Loss:

• Diabetes mellitus (uncontrolled hyperglycemia), diabetes insipidus.

Burns:

• Fluid loss through damaged skin.

2. Decreased Fluid Intake:

• Poor appetite during illness.
• Inability to drink (e.g., due to mouth sores, fatigue).
• Neglect or limited access to fluids.

3. Other Causes:

• Blood loss or other forms of fluid loss.
• Medications like diuretics.

Types of Dehydration

Isotonic Dehydration:

• Equal loss of water and electrolytes.
• Most common in children with diarrhea.
• Serum sodium: Normal (135–145 mEq/L).

Hypotonic Dehydration:

• Greater loss of electrolytes than water.
• Often caused by excessive intake of plain water or low-sodium fluids.
• Serum sodium: <135 mEq/L.

Hypertonic Dehydration:

• Greater loss of water than electrolytes.
• Often associated with high fever, inadequate water intake, or concentrated formula feeding.
• Serum sodium: >145 mEq/L.

Signs and Symptoms of Dehydration in Children

Mild Dehydration (5% body weight loss):

• Thirst.
• Slightly dry mucous membranes.
• Normal urine output.

Moderate Dehydration (6–9% body weight loss):

• Increased thirst.
• Dry mucous membranes.
• Decreased skin turgor.
• Tachycardia.
• Sunken eyes and fontanelle (in infants).
• Reduced urine output (dark yellow urine).

Severe Dehydration (≥10% body weight loss):

• Lethargy or irritability.
• Very dry mucous membranes.
• Marked tachycardia.
• Hypotension (late sign).
• Poor capillary refill (>3 seconds).
• Cold extremities.
• Minimal to no urine output (oliguria or anuria).

Diagnosis of Dehydration

1. Clinical Assessment:

History:

• Duration and severity of symptoms (vomiting, diarrhea, fever).
• Fluid intake and output history.
• Recent illnesses or conditions contributing to fluid loss.

Physical Examination:

• Vital signs (tachycardia, hypotension).
• Assess mucous membranes, skin turgor, capillary refill, and weight changes.

2. Laboratory Tests (for moderate to severe dehydration):

Serum Electrolytes:

• Sodium, potassium, chloride levels.

Blood Urea Nitrogen (BUN) and Creatinine:

• To assess kidney function.

Acid-Base Status:

• Metabolic acidosis common in severe dehydration (e.g., due to diarrhea).

Urinalysis:

• Elevated specific gravity indicates concentrated urine.

Management of Dehydration

Goals of Treatment:

• Restore fluid and electrolyte balance.
• Address the underlying cause.
• Prevent complications like shock or kidney injury.

1. Oral Rehydration Therapy (ORT):

Indication:

• For mild to moderate dehydration.

Solution:

• Use oral rehydration solution (ORS) containing water, salts, and glucose.
• Commercial solutions (e.g., Pedialyte) are preferred over homemade mixtures.

Administration:

• Give small, frequent sips (5–10 mL every 1–2 minutes).
• Target volume: 50–100 mL/kg over 4 hours.
• Continue breastfeeding or normal diet as tolerated.

2. Intravenous Rehydration:

Indication:

• Severe dehydration or when ORT is not feasible (e.g., persistent vomiting, altered consciousness).

Fluid Choice:

• Isotonic Crystalloids: Normal saline or lactated Ringer’s solution.

Fluid Resuscitation:

• Initial bolus: 20 mL/kg over 15–30 minutes; repeat as needed for signs of shock.

Maintenance Fluids:

• Calculate based on the child’s weight using the Holliday-Segar formula:
• 4 mL/kg/hr for the first 10 kg.
• 2 mL/kg/hr for the next 10 kg.
• 1 mL/kg/hr for each additional kg.

3. Correction of Electrolyte Imbalances:

Hypernatremia:

• Rehydrate slowly to avoid cerebral edema.

Hyponatremia:

• Correct sodium deficit cautiously to prevent central pontine myelinolysis.

Potassium Replacement:

• Only after ensuring adequate urine output.

Nursing Interventions

1. Assessment and Monitoring:

• Regularly monitor vital signs, urine output, and hydration status.
• Assess for signs of fluid overload during IV therapy (e.g., pulmonary edema).
• Monitor weight daily to track fluid status.

2. Rehydration Support:

• Administer ORT or IV fluids as prescribed.
• Encourage caregivers to participate in ORT administration.

3. Education for Caregivers:

• Teach caregivers how to recognize early signs of dehydration.
• Emphasize the importance of adequate fluid intake during illnesses.
• Explain how to prepare and use ORS at home.

4. Documentation:

• Record fluid intake and output (I&O).
• Document interventions and child’s response to treatment.

Prevention of Dehydration

1. Adequate Hydration:

• Encourage increased fluid intake during hot weather, physical activity, or illness.
• Ensure age-appropriate fluids and feeding practices.

2. Timely Treatment of Illness:

• Address diarrhea and vomiting early with ORS.
• Administer antipyretics for fever as prescribed.

3. Parental Education:

• Teach parents to identify dehydration signs and seek medical attention promptly.

Complications of Dehydration

• Shock: Hypovolemic shock due to severe fluid loss.
• Electrolyte Imbalances: Hypernatremia, hyponatremia, or hypokalemia.
• Renal Failure: Acute kidney injury from prolonged hypoperfusion.
• Neurological Effects: Seizures or altered consciousness from severe imbalances.

Conclusion

Dehydration in children is a common yet potentially serious condition that requires early identification and appropriate intervention. Nurses are essential in assessing hydration status, administering treatments, and educating families to prevent recurrence. By employing evidence-based strategies, nurses can significantly improve outcomes and support the child’s recovery.