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Dehydration in Children

By Liji Thomas, MD

Dehydration is a state in which the body lacks its normal complement of water and electrolytes. Severe dehydration can lead to multi-system failure and death, and is therefore considered a life-threatening condition that demands urgent hospital treatment. Brain damage, convulsions, thrombus formation and death are just some of the serious complications of severe dehydration.

Causes of dehydration

Dehydration can occur due to various reasons, some of which have to do with loss of excessive fluid from the body, while others have to do with failure to take in adequate amounts of fluids. Common causes include:

  • Exercise in a hot environment which promotes sweating and hard breathing, leading to dehydration if enough fluids are not taken
  • Severe diarrheal disease or vomiting
  • High fever with inadequate intake of fluids
  • Inappropriate use of diuretics which results in excessive loss of fluids and salts from the body
  • Uncontrolled diabetes which promotes diuresis and dehydration

Who is at risk?

Almost anyone can become dehydrated, but the following groups are observed to have a higher incidence:

  • The very old and the very young: in infants, the incidence of dehydration following diarrheal disease episodes is higher if the fluid loss is not properly and carefully replaced. This may be traced to not giving breast milk or other fluids to a child with diarrhea, especially with inexperienced mothers and in developing countries.
  • Children who have chronic illnesses.

Symptoms

Dehydration may be mild or severe.

Mild to moderate dehydration may present as:

  • Thirst
  • Dryness of the mouth
  • Headache
  • Darker urine than normal
  • Feeling of giddiness on standing up
  • Sleepiness or tiredness
  • In babies, a failure to wet the diaper or pass the urine for three hours or more

Severe dehydration manifests as an exaggeration of all the above. In addition, there may be:

  • A racing heart beat
  • A low blood pressure
  • Fever or a rise in body temperature
  • Irritability or confusion
  • Low urine output
  • In babies, sunken fontanelles that reveal the presence of dehydration

Treatment

As we are still lacking clinically sound and prospective diagnostic tool for determining the exact level of dehydration in children, clinical examination is thus the best path for determining adequate treatment. Dehydration is treated by rapidly increasing the intake of balanced electrolyte-rich fluids, rather than water.

In the case of mild dehydration, the simplest way at home is to make an oral rehydration solution with 6 teaspoons of sugar to 1 teaspoon of salt to 1 liter of boiled and cooled water. If a chemist is handy, readymade oral rehydration salt packages are available.

Water alone in large amounts may dilute the salt content of the body and lead to other serious symptoms. Whenever fluid replacement is given by mouth, young children and infants may drink and retain more if a teaspoon or a syringe is used to administer it.

If severe dehydration is present, hospital treatment is mandatory. Intravenous fluid administration is the usual first-line therapy. In cases of diarrhea or vomiting that last for more than one day, or the onset of severe vomiting or diarrhea, or the inability to retain an adequate amount of fluids (as shown by the above indicators), medical management is essential to prevent and/or treat dehydration.

Reviewed by: , MD, PhD

Further Reading

Last Updated: Nov 17, 2016

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