Pediatric Dehydration Assessment
Child with fluid loss or decreased intake
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PediatricsManagement
Pediatric Dehydration and Fluid Resuscitation (AAP/WHO)
Pediatric Dehydration and Fluid Resuscitation (AAP/WHO): Pediatric Dehydration Assessment → Assess Degree of Dehydration → Signs of Shock? → Bolus Resus...
Pathway Overview
10 steps
Algorithm Steps
10 total
01Start 02Action Assess Degree of Dehydration
Clinical assessment
- MILD (3-5%):
- • Slightly dry mucous membranes
- • Normal capillary refill, good skin turgor
- • Normal mental status, alert
- MODERATE (6-9%):
- • Dry mucous membranes, decreased tears
- • Delayed capillary refill (2-3 sec)
- • Decreased skin turgor (1-2 sec tenting)
- • Irritable or lethargic
- SEVERE (≥10%):
- • Very dry mucous membranes
- • Cap refill >3 sec, tenting >2 sec
- • Tachycardia, weak pulses
- • Lethargy, sunken eyes, sunken fontanelle
03Decision Signs of Shock?
Hypovolemic shock assessment
- SHOCK PRESENT IF:
- • Tachycardia with weak/absent pulses
- • Hypotension (late sign)
- • Delayed capillary refill >4 sec
- • Altered mental status
- • Cold, mottled extremities
04Action Bolus Resuscitation for Shock
Rapid IV/IO fluid resuscitation
- NS or LR 20 mL/kg IV bolus over 5-20 min
- Reassess after each bolus
- May repeat x2-3 if needed
- Max typically 60 mL/kg in first hour
- REASSESS AFTER EACH BOLUS:
- • HR, BP, cap refill, mental status
- • Avoid fluid overload (pulmonary edema)
05Action Severe Dehydration - IV Fluids
IV rehydration required
- PHASE 1: Deficit replacement
- NS 20 mL/kg bolus, then assess
- PHASE 2: Replace deficit
- Calculate: Weight × % deficit × 10 = mL deficit
- Replace over 24-48 hours
- Use isotonic fluids (NS or LR)
- Add dextrose if hypoglycemic
06Action Maintenance Fluids
Use isotonic fluids for maintenance
- USE ISOTONIC FLUIDS:
- NS (0.9% NaCl) or LR with dextrose
- HOLLIDAY-SEGAR (4-2-1 rule):
- • First 10 kg: 4 mL/kg/hr
- • Next 10 kg: 2 mL/kg/hr
- • Each kg >20: 1 mL/kg/hr
- Add KCl 20-40 mEq/L once urinating
- Check electrolytes q6-12h
07Action Monitor Response
Reassess frequently
- Track I/O strictly
- Weigh daily (same scale)
- Monitor for hyponatremia
- Target urine output 1-2 mL/kg/hr
- IMPROVING:
- • HR normalizing
- • Mental status improving
- • Urine output increasing
- • Weight stabilizing
08Outcome Discharge When
Safe for home
- Tolerating oral fluids
- Urine output adequate
- Mental status normal
- Parents understand ORS use
- Follow-up plan in place
09Action Mild Dehydration - ORS
Oral rehydration therapy at home
- ORAL REHYDRATION SOLUTION (ORS)
- 50 mL/kg over 3-4 hours
- Small, frequent sips
- Continue breastfeeding
- Avoid sugary drinks (juice, soda)
- Follow up if not improving in 24h
- Path rejoins step 08Shared downstream outcome
10Action Moderate Dehydration - ORS Trial
Supervised ORS with backup plan
- ORAL REHYDRATION:
- 100 mL/kg over 3-4 hours
- Supervised in ED/clinic
- If vomiting: Give small amounts frequently (5mL q1-2min)
- Ondansetron may help: 0.15 mg/kg (max 8mg)
- If ORS fails → IV fluids
- Path rejoins step 05Shared downstream outcome
- Path rejoins step 05Shared downstream outcome
Guideline Source
AAP Clinical Practice Guideline: Maintenance IV Fluids + WHO ORS Guidelines
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address specific electrolyte abnormalities
- Hyponatremia management separate
- Not for burn or surgical patients
Applicable Regions
USEU
Version 1Next review: 2027-01-11
Next steps
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Related Resources
Frequently Asked Questions
What is the Pediatric Dehydration and Fluid Resuscitation (AAP/WHO)?
The Pediatric Dehydration and Fluid Resuscitation (AAP/WHO) is a management clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on AAP Clinical Practice Guideline: Maintenance IV Fluids + WHO ORS Guidelines.
What guideline is the Pediatric Dehydration and Fluid Resuscitation (AAP/WHO) based on?
This algorithm is based on AAP Clinical Practice Guideline: Maintenance IV Fluids + WHO ORS Guidelines (DOI: 10.1542/peds.2018-3083).
What are the limitations of the Pediatric Dehydration and Fluid Resuscitation (AAP/WHO)?
Known limitations include: Does not address specific electrolyte abnormalities; Hyponatremia management separate; Not for burn or surgical patients. Individual patient factors may require deviation from these recommendations.
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