Version June 2024
This algorithm summarizes guidance on initial fluid therapy for children with severe dehydration without shock who are cared for in regions where access to advanced pediatric critical care and trained critical care personnel is variable or not available. These regions are most common in low- and low-middle income countries.
Clinical improvement during treatment of severe dehydration is indicated by improved mental status, perfusion (decreased capillary refill time), and vital signs (ie, reduction in tachycardia). Fluid replacement should be titrated to effect and discontinued if the patient develops clinical signs of fluid overload (eg, tachypnea and/or increased work of breathing with crackles on lung examination, hypoxemia, gallop cardiac rhythm, hepatomegaly, jugular venous distension, and/or cardiomegaly on chest radiograph [if available]).
This algorithm does not apply to children with severe dehydration who have shock by the WHO criteria (hypotension or cold hands and feet, delayed capillary refill time [>3 seconds], and fast and weak pulse). Refer to UpToDate topics on treatment of pediatric shock in resource-limited settings for guidance on management of shock and for additional details of management of severe dehydration, including guidance for ongoing fluid administration and a discussion of the evidence supporting our approach.BG: blood glucose; BP: blood pressure; D5LR: lactated Ringer's with 5% dextrose; D10LR: lactated Ringer's with 10% dextrose; HCT: hematocrit; Hgb: hemoglobin; IV: intravenous; LR: lactated Ringer's; ORS: oral rehydration solution; ORT: oral rehydration therapy; PCV: plasma cell volume; pRBC: packed red blood cells; WHO: World Health Organization.
* For details of oral rehydration, refer to separate UpToDate topic on oral rehydration therapy and management of diarrhea in resource-limited settings.
¶ If blood transfusion is not available within 30 minutes, administer dextrose-containing balanced crystalloid solution (eg, D5LR) at a maintenance rate and replace ongoing losses from vomiting or diarrhea until blood is available.
Δ For calculation of maintenance and replacement fluids in children, refer to UpToDate content on treatment of hypovolemia (dehydration) in children and approach to the child with diarrhea in resource-limited settings.
◊ For details on oral rehydration of children with severe dehydration and severe acute malnutrition, refer to UpToDate topics on management of severe acute malnutrition in children in resource-limited settings.
§ If LR or another balanced crystalloid solution is unavailable, use normal saline.
¥ If the patient remains or becomes lethargic or develops seizures, check blood glucose and treat hypoglycemia as needed. If rapid blood glucose is not available, give a rapid infusion of dextrose (eg, 0.25 g/kg) empirically. Refer to UpToDate content on treatment of hypoglycemia in children.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
