An Evidence-Based Review Of Dehydration In The Pediatric Patient

  • Nager, Alan L. MD
  • Hutchison, George R. MD, FAAEM
  • Whiteman, Paula MD

  • 1Authors

    2Director, Division of Emergency And Transport Medicine, Department Of Pediatrics, University Of Southern California And The Keck School Of Medicine, Los Angeles, CA

    3Peer Reviewers

    4President, Medical Emergency Trauma Associates Little Rock, AR

    5Attending Physician, Ruth And Harry Roman Emergency Department, Cedars Sinai Medical Center, Los Angeles, CA; Director Of Pediatric Emergency Services, Providence Tarzana Medical Center, Tarzana, CA

Date of original release: January 1, 2010

Date of most recent review: December 10, 2009

Termination date: January 1, 2013

Medium: Print and Online

Method of participation: Print or online answer form and evaluation

Prior to beginning this activity, see “Physician CME Information” on the back page.

Pediatric Emergency Medicine Practice 7(1):p 1-13, January 2010.

During a busy shift in the emergency department, you obtain a history and perform a physical examination on a 3-month-old male patient. The mother states that her son has become progressively more listless over the past 3 days, has been drinking less than normal, and has only urinated once in the previous 12 hours. She also notes that the patient has had “tremors intermittently all day.” In addition, he has had 3 episodes of vomiting without blood or bile and has a slight runny nose but no fever, diarrhea, or ill contacts.

The physical examination reveals a temperature of 37.9°C (100.2°F), a resting heart rate of 186 beats per minute, a respiratory rate of 56 breaths per minute, and a blood pressure reading of 78/50 mm Hg. The patient is visibly listless and has intermittent, erratic jerking in his arms and legs as well as a slightly sunken fontanel, no visible tears, and dry, sticky mucous membranes. Findings from an examination of his lungs, heart, and abdomen are normal, and further examination demonstrates slightly cool distal extremities, with a capillary refill time of 3 seconds.

This patient is clearly dehydrated, although the etiology of his signs and symptoms is unclear. As you evaluate the patient, you think about the following issues:

  1. Historically, are there other questions that should be asked?

  2. To what extent is the patient dehydrated (eg, mildly, moderately, severely)?

  3. What steps should be taken regarding treatment?

  4. Are laboratory tests required and if so, which ones?

  5. What differential diagnoses should be considered?

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