Pediatric emergency medicine trisk 0520 0520
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insufficiency, diuretic use, or renal injury or disease with resultant loss of
concentrating ability ( Fig. 22.1 ). Fluid intake should be recorded. A detailed
fluid history may reveal potential risk for electrolyte abnormalities. For example,
diluted juice or excessive water intake can lead to hyponatremic dehydration,
while improperly prepared infant formula can cause hypernatremic dehydration.
Physical Examination
The physical examination, including vital signs, is an important and objective
assessment of dehydration ( Table 22.2 ). Unfortunately, multiple studies have
demonstrated that using scales are not useful in assessing all degrees in
dehydration so these signs are most useful as a starting point for treatment. The
first sign of mild dehydration is tachycardia, whereas hypotension is a very late
sign of severe dehydration. In mild to moderate dehydration, the respiratory rate
is usually normal. As a child becomes more acidotic and fluid is depleted, the
respiratory rate increases and the breathing pattern becomes hyperpneic. Vital
signs alone are not always reliable. Tachycardia also may be caused by fever,
agitation, or pain; respiratory illness affects respiratory rates; and orthostatic signs
are difficult to obtain in babies and young children.
