Comparison of clinical signs of dehydration and septic shock in the severely malnourished child

Clinical sign	Some dehydration	Severe dehydration	Incipient septic shock	Developed septic shock
Watery diarrhea	Yes	Yes	Yes or no*	Yes or no*
Thirst	Drinks eagerly^¶	Drinks poorly	No*	No*
Mental state	Restless, irritable^¶	Lethargic, comatose	Apathetic*	Lethargic
Hypothermia	No	No	Yes* or no	Yes* or no
Weak or absent radial pulse	No^¶	Yes	Yes	Yes
Cold hands and feet	No^¶	Yes	Yes	Yes
Sunken eyes	Yes^¶^Δ	Yes^¶^Δ	No*	No*
Urine flow	Yes	No	Yes	No
Hypoglycemia	Sometimes	Sometimes	Sometimes	Sometimes

* Signs that may be useful in diagnosing septic shock.
¶ Signs that may be useful in diagnosing dehydration.
Δ If confirmed as recent by the mother.

Reproduced with permission from: Management of Severe Malnutrition: A Manual for Physicians and other Senior Health Workers. World Health Organization, Geneva, 1999. Copyright © 1999 World Health Organization.

Graphic 63299 Version 6.0

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Comparison of clinical signs of dehydration and septic shock in the severely malnourished child