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Symptoms and signs of clinical dehydration related to childhood gastroenteritis

Last edited 30 Jun 2018

symptoms and signs of clinical dehydration related to gastroenteritis

Dehydration caused by acute gastroenteritis is a major concern in the paediatric patients and clinicians must assess the circulatory volume status as part of the initial evaluation in these patients (1).

The following symptoms and signs can be used to detect clinical dehydration and shock. For clinical shock, one or more of the symptoms and/or signs listed would be expected to be present.

Note:

within the category of 'clinical dehydration' there is a spectrum of severity indicated by increasingly numerous and more pronounced symptoms and signs.

Symptoms indicating category of dehydration of child with gastroenteritis (remote and face-to-face assesssments)

No clinically detectable dehydration	Clinical dehydration	Clinical shock
appears well	**appears to be unwell or deteriorating	-------------
alert and responsive	**altered responsiveness (for example, irritable, lethargic)	decreased level of consciousness
normal urine output	decreased urine output	-------------
skin colour unchanged	skin colour unchanged	pale or mottled skin
warm extremities	warm extremities	cold extremities

Signs indicating category of dehydration of child with gastroenteritis (face-to-face assessments)

No clinically detectable dehydration	Clinical dehydration	Clinical shock
alert and responsive	**altered responsiveness (for example, irritable, lethargic)	decreased level of consciousness
skin colour unchanged	skin colour unchanged	pale or mottled skin
warm extremities	warm extremities	cold extremities
eyes not sunken	**sunken eyes	------------
moist mucous membranes (except after a drink)	dry mucous membranes (except for 'mouth breather')	------------
normal heart rate	**tachycardia	tachycardia
normal breathing pattern	**tachypnoea	tachypnoea
normal peripheral pulses	normal peripheral pulses	weak peripheral pulses
normal capillary refill time	normal capillary refill time	prolonged capillary refill time
normal skin turgor	**reduced skin turgor	------------
normal blood pressure	normal blood pressure	hypotension (decompensated shock)

Notes:

dashes (---------) in the tables above indicate that these clinical features do not specifically indicate shock
** red flag symptom - may help to identify children at increased risk of progression to shock. If in doubt, manage as if there are symptoms and/or signs with red flags (2).

Suspect hypernatraemic dehydration if there are any of the following:

jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma.

Reference:

(1) National Institute for Health and Care Excellence (NICE) 2009. Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management

Gastroenteritis in children

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Symptoms and signs of clinical dehydration related to childhood gastroenteritis

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