DEHYDRATION IN OLDER CHILDREN AND ADULTS

Assess degree of dehydration following the table below.

CLINICAL
FEATURE
DEGREE OF DEHYDRATION
MILD MODERATE SEVERE
General
appearance
Thirsty,
alert
Thirsty,
alert
Generally
conscious,
anxious,
clammy, cold
extremities,
cyanosis,
wrinkly skin
of fingers,
muscle
cramps, dizzy
if standing
Pulse Normal Rapid Rapid,
thready,
sometimes
absent
Respiration Normal Deep, may
be rapid
Deep and
rapid
Systolic BP Normal Normal Low, may be
immeasurable
Skin pinch Returns
rapidly
Returns
slowly
Returns very
slowly (>2
seconds)
Eyes Normal Sunken Very sunken
Tears Present Absent Absent
Mucous
membranes
Moist Dry Very dry
Urine
output
Normal Reduced,
dark urine
Anuria, empty
bladder

Note
At least 2 of these signs must be present

Management

Mild dehydration

  • Give oral ORS 25 ml/kg in the first 4 hours
    • Increase or mantain until clinical improvement

Moderate dehydration

  • Give oral ORS 50 mg/kg in the first 4 hours

Severe dehydration

  • Ringer’s lactate (or Normal Saline 0.9%) IV, 50 ml/kg in the first 4 hours
    • Give IV fluids rapidly until radial pulse can be felt, then adjust rate
    • Re-evaluate vitals after 4 hours

Volumes that are given over the first 24 hours in adults are shown in the table below

TIME PERIOD VOLUME
OF IV FLUID
First hour 1 L
Next 3 hours 2 L
Next 20 hours 3 L
  • After 4 hours, evaluate rehydration in terms of clinical signs (NOT in terms of volumes of fluid given)
  • As soon as signs of dehydration have disappeared (but not before), start fluid maintenance therapy alternating ORS and water (to avoid
    hypernatraemia) as much as the patient wants

Continue for as long as the cause of the original dehydration persists

Notes

  • Volumes shown are guidelines only. If necessary, volumes can be increased or initial high rate of administration maintained until clinical improvement
    occurs
  • In addition to ORS, other fluids, such as soup, fruit juice, and safe clean water may be given
    • Initially, adults can take up to 750 ml ORS/hour.
  • If sodium lactate compound IV infusion (Ringer’s Lactate) is not available, use half-strength Darrow’s solution in glucose 2.5% or sodium chloride infusion
    0.9%, However, both of these are less effective
  • Continued nutrition is important, and food should be continued during treatment for dehydration

Caution

  • Avoid artificially sweetened juices

Prevention (for all age groups)

  • Encourage prompt use of ORS at home if the person is vomiting and/or having diarrhoea