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WHO (World Health Organisation) suggested management of dehydration secondary to diarrhoeal illness

Last reviewed 1 Jan 2018

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If severe dehydration then excessively rapid rehydration may result in cerebral oedema.

World Health Organization (WHO) scale for dehydration

It is important to determine the degree of dehydration in order to select the appropriate plan to treat or prevent dehydration.

Clinical assessment for degree of dehydration associated with diarrhoea is as follows

	A	B	C
general appearance	well, alert	restless, irritable	lethargic or unconscious
eyes	normal	sunken	sunken
thirst	drinks normally, not thirsty	thirsty, drinks eagerly	drinks poorly, or not able to drink
skin turgor	goes back quickly	goes back slowly	goes back very slowly

if two or more of the signs in column C are present - the patient has "severe dehydration"
if two or more signs from column B (and C) are present - the patient has "some dehydration".
patients who fall under column A - "no signs of dehydration"

Estimation of fluid deficit (and the requirement) in children with some dehydration or severe dehydration should be carried out by weighing them without clothing. (if weighing is not possible, a child's age may be used to estimate the weight) (1).

assessment	fluid deficit as % of body weight	fluid deficit in ml/kg body weight	treatment
no signs of dehydration	<5%	<50 ml/kg	use treatment plan A
some dehydration	5-10%	50-100 ml/kg	use treatment plan B
severe dehydration	>10%	>100 ml/kg	use treatment plan C

Note:

treatment should never be delayed because a scale is not readily available (1)
the three most useful predictors of 5% or more dehydration are abnormal capillary refill, abnormal skin turgor, and abnormal respiratory pattern (2)

fluid management following rehydration

Following rehydration, some children may be at risk of recurrence of dehydration.

Recomendations on fluid management following rehydration:

encourage breastfeeding and other milk feeds
encourage fluid intake
in children at increased risk of dehydration recurring, consider giving 5 ml/kg of ORS solution after each large watery stool. These include:
children younger than 1 year, particularly those younger than 6 months
infants who were of low birth weight
children who have had more than five diarrhoeal stools in the previous 24 hours
children who have vomited more than twice in the previous 24 hours.

Restart oral rehydration therapy if dehydration recurs after rehydration (3)

Reference:

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WHO (World Health Organisation) suggested management of dehydration secondary to diarrhoeal illness

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