Examination

Children should be assessed using an ABCDE approach, and potentially life-threatening problems such as shock and sepsis addressed before careful assessment to find an underlying cause.

Key examination points

The Clinical assessment of dehydration is difficult and subject to variability between clinicians, even when standardised scoring systems are used. [6]

The “gold standard” of assessing clinical dehydration is to weigh the child and compare this to previous weight (where available) and subsequent weights after rehydration.

1: What is the child’s fluid Status?

• Is there clinical evidence of dehydration or shock
• Have your weighed the child?
• Is there evidence of hypertension?
• Does the child appear to have a normal hydration status?
• Or does the child show evidence of fluid overload – eg peripheral oedema?

Learning bites

• Children who have passed more than five diarrhoeal stools in the previous 24 hours as at increased risk of dehydration and require careful evaluation. [8]
• Euvolaemia, hypervolaemia or hypertension may point to intrinsic renal causes, e.g. nephritic or nephrotic syndrome. Perform urinalysis to look for proteinurea and/or haematuria.

2) Is there evidence of sepsis? Sepsis is a common cause of AKI in paediatrics [7]

3) Is there evidence of urinary tract obstruction? Examine for a palpable bladder or other abdominal masses

Resource for assessment of dehydration and shock [9]