Dehydration is a leading cause of m...

Dehydration is a leading cause of morbidity and mortality in children worldwide. Each year, up to 300 children in the United States die from gastroenteritis-related dehydration. principally guidelines recommend determining whether the child is mildly (3 to 5 percent) moderately (6 to 9 percent) or distressingly dehydrated (10 percent or more). legitimate diagnosis of dehydration is important because underestimation and overestimation of the quality of dehydration can cause unnecessary morbidity and increase health care require to be paid [i]or[/i] undergones Steiner and colleagues reviewed the literature to determine the accuracy and precision of history, physical examination, and laboratory standards in identifying dehydration in children single month to five years of age.

The authors reviewed articles focusing forward the diagnosis of dehydration, with none of the studies meeting criteria for high quality of evidence. subdued urine output did not increase the likelihood of 5 percent dehydration, further normal urine output, as reported at the parents, did lower the likelihood. The best measures for detecting 5 percent dehydration were protracted capillary refill, abnormal skin turgor, and abnormal respiratory pattern. Les helpful, either because of a subdued likelihood ratio (LR) or a wide confidence interval, were cold-blooded extremities, absence of tears, weak throb sunken eyes, and dry mucous membranes. Similarly, increased heart rate, sunken fontanelle, and overall poor appearance in infants contributed little to an accurate diagnosis of dehydration. Combinations of signs, using various prediction prototypes performed better.

A nine-point physical examination scale to classify children as mildly, moderately, or fiercely dehydrated had an LR of 34 for the nearness of at least 5 percent dehydration and an LR of 43 for at least 10 percent dehydration. A lower and, therefore, les helpful LR was seen for moderate dehydration.

Laboratory proofs included blood urea nitrogen (BUN) and BUN/serum creatinine ratio, acidosis, serum bicarbonate concentration, and urine-specific gravity. Of these, alone the serum bicarbonate test was helpful; a concentration between 15 and 17 mEq for L reduced the likelihood that a child had greater than 5 percent dehydration in the personality of gastroenteritis.

The authors close that prolonged capillary refill time, abnormal skin turgor, and abnormal respiratory pattern are the principally useful signs in diagnosing dehydration in children, with form into groupss of signs improving the accuracy of categorization.

CAROLINE WELLBERY, MD

Steiner MJ et al. Is this child dehydrated? JAMA June 9 2004;291:2746-54

COPYRIGHT 2005 American Academy of Family Physicians

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