Risk Stratification

The following children are at increased risk of dehydration [9-11]:

• Young age (<1 year of age and especially < 6 months)
• Infants who were of low birth weight
• Those with signs of malnutrition
• Frequent symptoms (>5 diarrhoeal stools or >2 vomits within the previous 24 hours)
• Those who are not offered supplementary fluids or stopped breastfeeding prior to presentation

Be more cautious with these children before considering discharge.

Red Flags

Current best practice is to stratify the degree of dehydration into minimal, mild to moderate, and severe based on the overall clinical picture of the child. These roughly correspond to the NICE categories of “Not clinically detectable”, “Clinical dehydration” and “Clinical shock” [1].

Evidence has shown that prolonged capillary refill time (CRT), abnormal skin tone and respiratory pattern are important signs and significantly associated with the degree of dehydration [12], but there is poor agreement between clinicians in estimating the presence of these signs.

‘Red flags’ may help to identify those at risk of progression to shock.

Table 2: Symptoms and signs of clinical dehydration and shock [1]