Pediatric DehydrationAPPROACH

PEDIATRICS · 19 SECTIONS

⚲

547 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Fever In The Neonate And Young Infant Pediatric Fever By Age 0 To 28 Days Pediatric Fever By Age 29 To 60 Days Pediatric Fever By Age 2 To 24 Months Pediatric Respiratory Distress Croup And Stridor In Children Pediatric Dehydration Pediatric Abdominal Pain Febrile Seizure Rash In The Child Poor Feeding And Lethargy In The Infant Vomiting In The Child Diarrhea In The Child Pediatric Trauma Evaluation Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern Lethargy And Altered Mental Status In The Child

Environmental and Exposure4▾

01History/hx63

Presenting context

›Presentation pattern

›Age group

›Neonate 0 to 28 days

›Young infant 29 to 90 days

›Child older than 3 months

›Premorbid and trend

›Baseline weight

›Recent weight change

›Suspected source

›Acute gastroenteritis pattern

›Poor intake pattern without GI losses

›Heat exposure pattern

›Polyuria and polydipsia pattern

›Fluid losses

›Vomiting frequency

›Stool frequency

›Stool blood

›Stool mucus

›Intake and output

›Oral intake volume estimate

›Wet diapers count

›Urine color change

›Tears present

›Prior episodes and baseline

›Prior dehydration episodes

›Prior IV fluids

Onset

›OPQRST onset

›Time since symptoms started

›Abrupt onset

›Gradual onset

Provocation and palliation

›OPQRST provocation and palliation

›Worse with oral intake

›Worse with activity

›Relief with small frequent sips

›Relief with antiemetic

Quality

›OPQRST quality

›Vomiting description

›Diarrhea description

›Thirst behavior

Region and radiation

›OPQRST region and radiation

›Abdominal pain location

›Headache location

›No regional symptoms

Severity

›OPQRST severity

›Vomiting episodes per day

›Diarrhea episodes per day

›Urine output reduction estimate

Timing

›OPQRST timing

›Continuous losses

›Intermittent losses

›Improving trajectory

›Worsening trajectory

Associated symptoms

›Associated symptoms

›Fever

›Lethargy

›Irritability

›Reduced responsiveness

›Abdominal pain

›Dysuria

›Rash

›Respiratory symptoms

›Polyuria

›Polydipsia

02Alarm Features/alarm31

Immediate escalation triggers

›Resuscitation triggers

›Shock physiology

›Weak pulses

›Cool mottled skin

›Capillary refill longer than 3 seconds

›Altered mental status

›Difficult to arouse

›Unresponsive

›Respiratory compromise

›Apnea

›Severe work of breathing

›High risk vomiting

›Bilious vomiting

›Hematemesis

High risk vital sign patterns

›Vital sign danger patterns

›Hypotension for age

›Persistent tachycardia after fluids

›Persistent tachypnea

›Hypothermia in infant

High risk dehydration states

›High risk dehydration features

›No urine output

›Sunken fontanelle with lethargy

›Very dry mucous membranes with poor perfusion

›Severe weight loss concern

Alternate diagnosis red flags

›Red flags against simple gastroenteritis

›Abdominal distension

›Severe localized abdominal pain

›Neck stiffness

›Non blanching rash

›Bulging fontanelle

›Toxic appearance

03Medications/meds21

Current and recent exposures

›Medication and ingestion profile

›Prescribed medications

›Diuretics

›Laxatives

›Stimulants

›OTC medications

›Ibuprofen exposure

›Acetaminophen exposure

›Supplements and herbals

›Herbal teas

›Electrolyte powders

›Recent changes

›New medication in last 7 days

›Missed chronic medications

Medication interactions and contraindications

›Therapy relevant cautions

›Ondansetron cautions

›Known long QT syndrome

›Concomitant QT prolonging drugs

›NSAID cautions

›Dehydration with kidney injury risk

›Known chronic kidney disease

04Diet/diet20

Intake pattern

›Recent intake pattern

›Breastfeeding

›Continued feeds

›Reduced latch or duration

›Formula feeding

›Reduced volume

›Mixing errors concern

›Solids

›Reduced solids

›Refusal of all intake

›Fluids offered

›Oral rehydration solution

›Plain water

›Juice

›Sports drinks

Exposure risks

›Dietary and environmental exposures

›Undercooked foods

›Unpasteurized products

›Well water

›Daycare exposures

05Review of Systems/ros25

General and constitutional

›Constitutional

›Fever

›Chills

›Fatigue

›Weight loss

Gastrointestinal

›GI

›Vomiting

›Diarrhea

›Blood in stool

›Abdominal pain

›Poor feeding

Genitourinary

›GU

›Decreased urine output

›Dysuria

›Hematuria

Respiratory and cardiac

›Cardiorespiratory

›Cough

›Increased work of breathing

›Cyanosis

›Palpitations

Neurologic

›Neuro

›Headache

›Seizure

›Syncope

›Confusion

06Collateral History and Family History/chafh10

Source and reliability

›Collateral and supervision

›Primary caregiver source

›Daycare source

›Reliability concerns

›Ability to provide frequent fluids at home

Family history

›Family history risks

›Type 1 diabetes mellitus

›Inborn errors of metabolism

›Arrhythmia syndromes

›Inflammatory bowel disease

07Risk Factors/rf15

Patient level risks

›Higher risk groups

›Age younger than 6 months

›Prematurity history

›Low birth weight history

›Chronic disease

Exposure risks

›Infectious exposure risks

›Sick contacts

›Daycare attendance

›Recent travel

›Recent antibiotics

Complication risks

›Dehydration complication risks

›Chronic kidney disease

›Congenital heart disease

›Adrenal insufficiency

›Immunocompromised state

08Differential Diagnosis/ddx39

Life threatening

›Life threatening causes

›Hypovolemic shock

›Severe dehydration (E86.0)

›Hemorrhage

›Diabetic ketoacidosis

›Polyuria and polydipsia

›Kussmaul breathing

›Sepsis

›Toxic appearance

›Poor perfusion despite fluids

›Surgical abdomen

›Volvulus or malrotation

›Intussusception

›Adrenal crisis

›Refractory hypotension

›Hypoglycemia

Common

›Common causes

›Acute gastroenteritis (A09)

›Vomiting and diarrhea

›Sick contacts

›Viral illness with poor intake

›Fever

›Reduced oral intake

›UTI

›Fever without source

›Dysuria

Less common

›Less common causes

›Pneumonia with reduced intake

›Tachypnea

›Cough

›Meningitis

›Neck stiffness

›Bulging fontanelle

›Toxic ingestion

›Access to medications

›Unexplained altered mental status

›Inborn error of metabolism

›Recurrent episodes

›Poor feeding with lethargy

09Past Medical History/pmh18

Baseline conditions

›Baseline medical context

›Congenital heart disease

›Baseline oxygen saturation

›Prior heart failure

›Chronic kidney disease

›Baseline creatinine

›Nephrology follow up

›Diabetes mellitus

›Insulin regimen

›Sick day plan

›Adrenal insufficiency

›Stress dosing plan

›Prior crises

Prior care and access

›Prior episodes and supports

›Prior ED visits for vomiting or diarrhea

›Prior admissions for dehydration

›Immunization status

›Access to primary care

10Physical Exam/exam65

General appearance and severity

›General and hydration severity

›Appearance

›Alert and interactive

›Irritable

›Lethargic

›Work of breathing

›Normal

›Deep respirations

›Perfusion

›Capillary refill

›Skin temperature

Vitals interpretation

›Vital sign pattern

›Tachycardia pattern

›Tachypnea pattern

›Blood pressure trend

›Fever present

HEENT

›HEENT hydration signs

›Mucous membranes

›Moist

›Dry

›Tears

›Present

›Absent

›Eyes

›Normal

›Sunken

›Fontanelle

›Normal

›Sunken

Cardiovascular

›Cardiac and volume status

›Pulses

›Normal

›Weak

›Extremities

›Warm

›Cool

›Capillary refill

›2 seconds or less

›Longer than 3 seconds

Respiratory

›Respiratory assessment

›Tachypnea

›Retractions

›Kussmaul pattern

Abdomen

›Abdominal exam

›Distension

›Tenderness location

›Guarding

›Bowel sounds

Skin

›Skin and turgor

›Skin turgor

›Normal

›Reduced

›Rash

›None

›Non blanching

Neurologic

›Neuro status

›Mental status

›Baseline

›Altered

›Tone

›Normal

›Hypotonia

›Seizure activity

›None

›Present

11Lab Studies/labs32

Point of care tests

›Bedside tests

›Glucose

›Hypoglycemia less than 3.0 mmol/L

›Hyperglycemia concern

›Ketones

›Urine ketones

›Blood beta hydroxybutyrate local protocol dependent

Basic labs when indicated

›Targeted labs

›Electrolytes and renal function

›Sodium

›Potassium

›Chloride

›Bicarbonate

›Urea

›Creatinine

›Acid base assessment

›Venous blood gas

›Lactate if shock concern

Interpretation thresholds

›Clinically important thresholds

›Hyponatremia concern

›Sodium less than 130 mmol/L

›Seizure risk if rapid fall

›Hypernatremia concern

›Sodium 150 mmol/L or higher

›Cerebral edema risk with rapid correction

›Metabolic acidosis concern

›Bicarbonate less than 15 mmol/L

›Consider DKA if hyperglycemia

Pitfalls and limitations

›Common pitfalls

›Normal sodium does not exclude significant volume depletion

›Urea elevation may reflect dehydration and high protein intake

›Hemoconcentration may appear as elevated hemoglobin

12Imaging/img21

Scoring Systems

›Dehydration severity tools

›Clinical Dehydration Scale

›General appearance domain

›Eyes domain

›Mucous membranes domain

›Tears domain

›Gorelick scale

›Multiple clinical signs approach

›Best used as adjunct not sole determinant

MRI

›MRI indications

›Not routine for dehydration

›Consider if alternate diagnosis suspected

›Neuro imaging pathway local protocol dependent

›CT indications

›Not routine for dehydration

›Consider for surgical abdomen concern

›Contrast risk in dehydration

Ultrasound

›Ultrasound applications

›Intussusception pathway if episodic pain

›Pyloric stenosis pathway in young infant vomiting

›IVC variability POCUS as adjunct local protocol dependent

13Special Tests/spec17

Bedside volume assessment

›Bedside assessment aids

›Weight comparison

›Percent weight change estimate

›Use same scale when possible

›Capillary refill timing

›Prolonged suggests poor perfusion

›Interpret with ambient temperature

›Orthostatic changes in older child

›Dizziness on standing

›Heart rate rise with standing

Urine focused evaluation

›Urine evaluation

›Urinalysis

›Ketones

›Specific gravity

›Urine culture criteria

›Fever without source

›Dysuria

14ECG/ecg14

When relevant

›ECG indications

›Severe dehydration with shock

›Electrolyte abnormality concern

›Syncope or palpitations

High risk patterns

›ECG red flags

›QT prolongation

›Risk with electrolyte disturbance

›Risk with ondansetron in predisposed

›Hyperkalemia patterns

›Peaked T waves

›QRS widening

›Hypokalemia patterns

›U waves

›ST depression

15Assessment/ax30

Working diagnosis and severity

›Dehydration severity stratification

›Mild dehydration

›Normal perfusion

›Mild thirst

›Moderate dehydration

›Dry mucous membranes

›Reduced urine output

›Severe dehydration

›Altered mental status

›Poor perfusion

›Likely etiology

›Acute gastroenteritis associated dehydration (E86.0)

›Vomiting and diarrhea

›Sick contacts

›Poor intake dehydration

›Febrile illness

›Pain limiting intake

Complications to rule out

›Complications and alternate diagnoses

›Hypoglycemia

›Lethargy

›Seizure

›Electrolyte derangement

›Hyponatremia

›Hypernatremia

›DKA

›Hyperglycemia

›Kussmaul breathing

›Surgical abdomen

›Bilious vomiting

›Abdominal distension

16Plan/plan70

Approach to the Critical Patient

›First 5 minutes workflow

›Triage triggers

›Shock signs

›Altered mental status

›Monitoring

›Continuous pulse oximetry if ill appearing

›Cardiac monitor if shock or electrolyte concern

›Access

›IV access if moderate to severe dehydration

›IO access if shock and IV delay

›Oxygen

›Hypoxemia treatment

›Respiratory distress treatment

›Glucose

›POC glucose early

›Dextrose treatment if low

Rehydration strategy

›Fluids pathway by severity

›Mild dehydration

›Oral rehydration solution trial

›Continue breastfeeding

›Moderate dehydration

›Oral rehydration solution with antiemetic support

›IV fluids if failed oral trial

›Severe dehydration

›Isotonic crystalloid bolus

›Transition to deficit replacement and maintenance

Oral rehydration therapy

›ORT dosing

›Mild dehydration replacement

›50 mL/kg over 4 hours local protocol dependent

›Additional for ongoing stool losses

›Moderate dehydration replacement

›100 mL/kg over 4 hours local protocol dependent

›Small frequent volumes every 1 to 2 minutes

›Ongoing losses replacement

›10 mL/kg per loose stool

›2 mL/kg per emesis

IV fluid therapy

›IV fluids dosing

›Initial bolus for shock

›0.9% sodium chloride 20 mL/kg

›Repeat bolus based on perfusion reassessment

›Deficit replacement

›Isotonic fluids preferred

›Avoid hypotonic fluids in acute resuscitation

›Maintenance fluids

›Isotonic maintenance consideration

›Dextrose addition if hypoglycemia risk

Antiemetic support

›Ondansetron for ORT facilitation

›Single dose strategy

›0.15 mg/kg by mouth

›Maximum 8 mg

›Weight based options

›8 to 15 kg 2 mg by mouth

›15 to 30 kg 4 mg by mouth

›More than 30 kg 8 mg by mouth

Electrolyte correction principles

›Correction safety

›Hypernatremia

›Slow correction to reduce cerebral edema risk

›Frequent sodium checks in severe cases

›Hyponatremia

›Seizure management pathway if symptomatic

›Avoid rapid overcorrection

Reassessment loop

›Reassessment and response

›Timing

›After each bolus

›Every 30 to 60 minutes during ORT

›Repeat targets

›Heart rate trend

›Capillary refill trend

›Mental status trend

›Urine output trend

17Disposition/dispo18

ICU level care criteria

›ICU indications

›Persistent shock despite boluses

›Need for vasoactive support

›Severe hypernatremia with neurologic symptoms

Inpatient admission criteria

›Admission indications

›Moderate dehydration with failed ORT

›Ongoing high volume losses

›Significant electrolyte abnormality

›Hypoglycemia requiring IV dextrose infusion

Observation pathway criteria

›Observation suitable

›Moderate dehydration improving after therapy

›Needs short period ORT supervision

›Needs repeat exam and vitals

Discharge criteria

›Discharge appropriate

›Normal perfusion and mental status

›Tolerating oral fluids

›Caregiver reliability and access to follow up

›Return precautions understood

18Discharge Instructions/di20

Copy discharge instructions

›Home plan

›Oral rehydration solution small frequent sips

›Continue breastfeeding or usual diet as tolerated

›Avoid juice and sweet drinks for dehydration treatment

›Expected course

›Vomiting and diarrhea often improve over 1 to 3 days

›Appetite may lag behind hydration improvement

›Medications

›Use only prescribed antiemetic dosing if provided

›Avoid ibuprofen if poor intake or ongoing dehydration

›Follow up

›Primary care follow up within 24 to 48 hours

›Earlier follow up for infants or chronic disease

›Return to ED now

›No urine output

›Unable to keep any fluids down

›Blood in vomit or stool

›Bilious vomiting

›Increasing sleepiness or difficult to wake

›Fast breathing or labored breathing

19References/r18

Guidelines and key sources

›NICE guideline CG84 diarrhoea and vomiting caused by gastroenteritis in under 5s 2009 surveillance no update 2018

›ORT preferred for most clinical dehydration

›IV fluids for shock or ORT failure

›American Academy of Pediatrics endorsed guideline managing acute gastroenteritis among children 2004

›ORT for mild to moderate dehydration

›Early refeeding recommendation

›WHO oral rehydration salts updated formulation monograph 2006 with WHO UNICEF recommendation since 2003

›Reduced osmolarity ORS concept

›Electrolyte glucose balance rationale

›Canadian Paediatric Society position statement oral rehydration therapy and early refeeding 2006 reaffirmed 2016

›Avoid plain water in gastroenteritis dehydration

›ORT contraindication examples

›Canadian Paediatric Society position statement oral ondansetron for gastroenteritis vomiting 2018

›Single dose reduces vomiting and IV fluid use

›Use in mild to moderate dehydration or failed ORT

›StatPearls pediatric dehydration update 2024

›Practical differentiation mild vs moderate limitations

›ORT goal euvolemia

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Pediatric DehydrationAPPROACH

PEDIATRICS · 19 SECTIONS

⚲

547 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx63

Presenting context

›Presentation pattern

›Age group

›Neonate 0 to 28 days

›Young infant 29 to 90 days

›Child older than 3 months

›Premorbid and trend

›Baseline weight

›Recent weight change

›Suspected source

›Acute gastroenteritis pattern

›Poor intake pattern without GI losses

›Heat exposure pattern

›Polyuria and polydipsia pattern

›Fluid losses

›Vomiting frequency

›Stool frequency

›Stool blood

›Stool mucus

›Intake and output

›Oral intake volume estimate

›Wet diapers count

›Urine color change

›Tears present

›Prior episodes and baseline

›Prior dehydration episodes

›Prior IV fluids

Onset

›OPQRST onset

›Time since symptoms started

›Abrupt onset

›Gradual onset

Provocation and palliation

›OPQRST provocation and palliation

›Worse with oral intake

›Worse with activity

›Relief with small frequent sips

›Relief with antiemetic

Quality

›OPQRST quality

›Vomiting description

›Diarrhea description

›Thirst behavior

Region and radiation

›OPQRST region and radiation

›Abdominal pain location

›Headache location

›No regional symptoms

Severity

›OPQRST severity

›Vomiting episodes per day

›Diarrhea episodes per day

›Urine output reduction estimate

Timing

›OPQRST timing

›Continuous losses

›Intermittent losses

›Improving trajectory

›Worsening trajectory

Associated symptoms

›Associated symptoms

›Fever

›Lethargy

›Irritability

›Reduced responsiveness

›Abdominal pain

›Dysuria

›Rash

›Respiratory symptoms

›Polyuria

›Polydipsia

02Alarm Features/alarm31

Immediate escalation triggers

›Resuscitation triggers

›Shock physiology

›Weak pulses

›Cool mottled skin

›Capillary refill longer than 3 seconds

›Altered mental status

›Difficult to arouse

›Unresponsive

›Respiratory compromise

›Apnea

›Severe work of breathing

›High risk vomiting

›Bilious vomiting

›Hematemesis

High risk vital sign patterns

›Vital sign danger patterns

›Hypotension for age

›Persistent tachycardia after fluids

›Persistent tachypnea

›Hypothermia in infant

High risk dehydration states

›High risk dehydration features

›No urine output

›Sunken fontanelle with lethargy

›Very dry mucous membranes with poor perfusion

›Severe weight loss concern

Alternate diagnosis red flags

›Red flags against simple gastroenteritis

›Abdominal distension

›Severe localized abdominal pain

›Neck stiffness

›Non blanching rash

›Bulging fontanelle

›Toxic appearance

03Medications/meds21

Current and recent exposures

›Medication and ingestion profile

›Prescribed medications

›Diuretics

›Laxatives

›Stimulants

›OTC medications

›Ibuprofen exposure

›Acetaminophen exposure

›Supplements and herbals

›Herbal teas

›Electrolyte powders

›Recent changes

›New medication in last 7 days

›Missed chronic medications

Medication interactions and contraindications

›Therapy relevant cautions

›Ondansetron cautions

›Known long QT syndrome

›Concomitant QT prolonging drugs

›NSAID cautions

›Dehydration with kidney injury risk

›Known chronic kidney disease

04Diet/diet20

Intake pattern

›Recent intake pattern

›Breastfeeding

›Continued feeds

›Reduced latch or duration

›Formula feeding

›Reduced volume

›Mixing errors concern

›Solids

›Reduced solids

›Refusal of all intake

›Fluids offered

›Oral rehydration solution

›Plain water

›Juice

›Sports drinks

Exposure risks

›Dietary and environmental exposures

›Undercooked foods

›Unpasteurized products

›Well water

›Daycare exposures

05Review of Systems/ros25

General and constitutional

›Constitutional

›Fever

›Chills

›Fatigue

›Weight loss

Gastrointestinal

›GI

›Vomiting

›Diarrhea

›Blood in stool

›Abdominal pain

›Poor feeding

Genitourinary

›GU

›Decreased urine output

›Dysuria

›Hematuria

Respiratory and cardiac

›Cardiorespiratory

›Cough

›Increased work of breathing

›Cyanosis

›Palpitations

Neurologic

›Neuro

›Headache

›Seizure

›Syncope

›Confusion

06Collateral History and Family History/chafh10

Source and reliability

›Collateral and supervision

›Primary caregiver source

›Daycare source

›Reliability concerns

›Ability to provide frequent fluids at home

Family history

›Family history risks

›Type 1 diabetes mellitus

›Inborn errors of metabolism

›Arrhythmia syndromes

›Inflammatory bowel disease

07Risk Factors/rf15

Patient level risks

›Higher risk groups

›Age younger than 6 months

›Prematurity history

›Low birth weight history

›Chronic disease

Exposure risks

›Infectious exposure risks

›Sick contacts

›Daycare attendance

›Recent travel

›Recent antibiotics

Complication risks

›Dehydration complication risks

›Chronic kidney disease

›Congenital heart disease

›Adrenal insufficiency

›Immunocompromised state

08Differential Diagnosis/ddx39

Life threatening

›Life threatening causes

›Hypovolemic shock

›Severe dehydration (E86.0)

›Hemorrhage

›Diabetic ketoacidosis

›Polyuria and polydipsia

›Kussmaul breathing

›Sepsis

›Toxic appearance

›Poor perfusion despite fluids

›Surgical abdomen

›Volvulus or malrotation

›Intussusception

›Adrenal crisis

›Refractory hypotension

›Hypoglycemia

Common

›Common causes

›Acute gastroenteritis (A09)

›Vomiting and diarrhea

›Sick contacts

›Viral illness with poor intake

›Fever

›Reduced oral intake

›UTI

›Fever without source

›Dysuria

Less common

›Less common causes

›Pneumonia with reduced intake

›Tachypnea

›Cough

›Meningitis

›Neck stiffness

›Bulging fontanelle

›Toxic ingestion

›Access to medications

›Unexplained altered mental status

›Inborn error of metabolism

›Recurrent episodes

›Poor feeding with lethargy

09Past Medical History/pmh18

Baseline conditions

›Baseline medical context

›Congenital heart disease

›Baseline oxygen saturation

›Prior heart failure

›Chronic kidney disease

›Baseline creatinine

›Nephrology follow up

›Diabetes mellitus

›Insulin regimen

›Sick day plan

›Adrenal insufficiency

›Stress dosing plan

›Prior crises

Prior care and access

›Prior episodes and supports

›Prior ED visits for vomiting or diarrhea

›Prior admissions for dehydration

›Immunization status

›Access to primary care

10Physical Exam/exam65

General appearance and severity

›General and hydration severity

›Appearance

›Alert and interactive

›Irritable

›Lethargic

›Work of breathing

›Normal

›Deep respirations

›Perfusion

›Capillary refill

›Skin temperature

Vitals interpretation

›Vital sign pattern

›Tachycardia pattern

›Tachypnea pattern

›Blood pressure trend

›Fever present

HEENT

›HEENT hydration signs

›Mucous membranes

›Moist

›Dry

›Tears

›Present

›Absent

›Eyes

›Normal

›Sunken

›Fontanelle

›Normal

›Sunken

Cardiovascular

›Cardiac and volume status

›Pulses

›Normal

›Weak

›Extremities

›Warm

›Cool

›Capillary refill

›2 seconds or less

›Longer than 3 seconds

Respiratory

›Respiratory assessment

›Tachypnea

›Retractions

›Kussmaul pattern

Abdomen

›Abdominal exam

›Distension

›Tenderness location

›Guarding

›Bowel sounds

Skin

›Skin and turgor

›Skin turgor

›Normal

›Reduced

›Rash

›None

›Non blanching

Neurologic

›Neuro status

›Mental status

›Baseline

›Altered

›Tone

›Normal

›Hypotonia

›Seizure activity

›None

›Present

11Lab Studies/labs32

Point of care tests

›Bedside tests

›Glucose

›Hypoglycemia less than 3.0 mmol/L

›Hyperglycemia concern

›Ketones

›Urine ketones

›Blood beta hydroxybutyrate local protocol dependent

Basic labs when indicated

›Targeted labs

›Electrolytes and renal function

›Sodium

›Potassium

›Chloride

›Bicarbonate

›Urea

›Creatinine

›Acid base assessment

›Venous blood gas

›Lactate if shock concern

Interpretation thresholds

›Clinically important thresholds

›Hyponatremia concern

›Sodium less than 130 mmol/L

›Seizure risk if rapid fall

›Hypernatremia concern

›Sodium 150 mmol/L or higher

›Cerebral edema risk with rapid correction

›Metabolic acidosis concern

›Bicarbonate less than 15 mmol/L

›Consider DKA if hyperglycemia

Pitfalls and limitations

›Common pitfalls

›Normal sodium does not exclude significant volume depletion

›Urea elevation may reflect dehydration and high protein intake

›Hemoconcentration may appear as elevated hemoglobin

12Imaging/img21

Scoring Systems

›Dehydration severity tools

›Clinical Dehydration Scale

›General appearance domain

›Eyes domain

›Mucous membranes domain

›Tears domain

›Gorelick scale

›Multiple clinical signs approach

›Best used as adjunct not sole determinant

MRI

›MRI indications

›Not routine for dehydration

›Consider if alternate diagnosis suspected

›Neuro imaging pathway local protocol dependent

›CT indications

›Not routine for dehydration

›Consider for surgical abdomen concern

›Contrast risk in dehydration

Ultrasound

›Ultrasound applications

›Intussusception pathway if episodic pain

›Pyloric stenosis pathway in young infant vomiting

›IVC variability POCUS as adjunct local protocol dependent

13Special Tests/spec17

Bedside volume assessment

›Bedside assessment aids

›Weight comparison

›Percent weight change estimate

›Use same scale when possible

›Capillary refill timing

›Prolonged suggests poor perfusion

›Interpret with ambient temperature

›Orthostatic changes in older child

›Dizziness on standing

›Heart rate rise with standing

Urine focused evaluation

›Urine evaluation

›Urinalysis

›Ketones

›Specific gravity

›Urine culture criteria

›Fever without source

›Dysuria

14ECG/ecg14

When relevant

›ECG indications

›Severe dehydration with shock

›Electrolyte abnormality concern

›Syncope or palpitations

High risk patterns

›ECG red flags

›QT prolongation

›Risk with electrolyte disturbance

›Risk with ondansetron in predisposed

›Hyperkalemia patterns

›Peaked T waves

›QRS widening

›Hypokalemia patterns

›U waves

›ST depression

15Assessment/ax30

Working diagnosis and severity

›Dehydration severity stratification

›Mild dehydration

›Normal perfusion

›Mild thirst

›Moderate dehydration

›Dry mucous membranes

›Reduced urine output

›Severe dehydration

›Altered mental status

›Poor perfusion

›Likely etiology

›Acute gastroenteritis associated dehydration (E86.0)

›Vomiting and diarrhea

›Sick contacts

›Poor intake dehydration

›Febrile illness

›Pain limiting intake

Complications to rule out

›Complications and alternate diagnoses

›Hypoglycemia

›Lethargy

›Seizure

›Electrolyte derangement

›Hyponatremia

›Hypernatremia

›DKA

›Hyperglycemia

›Kussmaul breathing

›Surgical abdomen

›Bilious vomiting

›Abdominal distension

16Plan/plan70

Approach to the Critical Patient

›First 5 minutes workflow

›Triage triggers

›Shock signs

›Altered mental status

›Monitoring

›Continuous pulse oximetry if ill appearing

›Cardiac monitor if shock or electrolyte concern

›Access

›IV access if moderate to severe dehydration

›IO access if shock and IV delay

›Oxygen

›Hypoxemia treatment

›Respiratory distress treatment

›Glucose

›POC glucose early

›Dextrose treatment if low

Rehydration strategy

›Fluids pathway by severity

›Mild dehydration

›Oral rehydration solution trial

›Continue breastfeeding

›Moderate dehydration

›Oral rehydration solution with antiemetic support

›IV fluids if failed oral trial

›Severe dehydration

›Isotonic crystalloid bolus

›Transition to deficit replacement and maintenance

Oral rehydration therapy

›ORT dosing

›Mild dehydration replacement

›50 mL/kg over 4 hours local protocol dependent

›Additional for ongoing stool losses

›Moderate dehydration replacement

›100 mL/kg over 4 hours local protocol dependent

›Small frequent volumes every 1 to 2 minutes

›Ongoing losses replacement

›10 mL/kg per loose stool

›2 mL/kg per emesis

IV fluid therapy

›IV fluids dosing

›Initial bolus for shock

›0.9% sodium chloride 20 mL/kg

›Repeat bolus based on perfusion reassessment

›Deficit replacement

›Isotonic fluids preferred

›Avoid hypotonic fluids in acute resuscitation

›Maintenance fluids

›Isotonic maintenance consideration

›Dextrose addition if hypoglycemia risk

Antiemetic support

›Ondansetron for ORT facilitation

›Single dose strategy

›0.15 mg/kg by mouth

›Maximum 8 mg

›Weight based options

›8 to 15 kg 2 mg by mouth

›15 to 30 kg 4 mg by mouth

›More than 30 kg 8 mg by mouth

Electrolyte correction principles

›Correction safety

›Hypernatremia

›Slow correction to reduce cerebral edema risk

›Frequent sodium checks in severe cases

›Hyponatremia

›Seizure management pathway if symptomatic

›Avoid rapid overcorrection

Reassessment loop

›Reassessment and response

›Timing

›After each bolus

›Every 30 to 60 minutes during ORT

›Repeat targets

›Heart rate trend

›Capillary refill trend

›Mental status trend

›Urine output trend

17Disposition/dispo18

ICU level care criteria

›ICU indications

›Persistent shock despite boluses

›Need for vasoactive support

›Severe hypernatremia with neurologic symptoms

Inpatient admission criteria

›Admission indications

›Moderate dehydration with failed ORT

›Ongoing high volume losses

›Significant electrolyte abnormality

›Hypoglycemia requiring IV dextrose infusion

Observation pathway criteria

›Observation suitable

›Moderate dehydration improving after therapy

›Needs short period ORT supervision

›Needs repeat exam and vitals

Discharge criteria

›Discharge appropriate

›Normal perfusion and mental status

›Tolerating oral fluids

›Caregiver reliability and access to follow up

›Return precautions understood

18Discharge Instructions/di20

Copy discharge instructions

›Home plan

›Oral rehydration solution small frequent sips

›Continue breastfeeding or usual diet as tolerated

›Avoid juice and sweet drinks for dehydration treatment

›Expected course

›Vomiting and diarrhea often improve over 1 to 3 days

›Appetite may lag behind hydration improvement

›Medications

›Use only prescribed antiemetic dosing if provided

›Avoid ibuprofen if poor intake or ongoing dehydration

›Follow up

›Primary care follow up within 24 to 48 hours

›Earlier follow up for infants or chronic disease

›Return to ED now

›No urine output

›Unable to keep any fluids down

›Blood in vomit or stool

›Bilious vomiting

›Increasing sleepiness or difficult to wake

›Fast breathing or labored breathing

19References/r18

Guidelines and key sources

›NICE guideline CG84 diarrhoea and vomiting caused by gastroenteritis in under 5s 2009 surveillance no update 2018

›ORT preferred for most clinical dehydration

›IV fluids for shock or ORT failure

›American Academy of Pediatrics endorsed guideline managing acute gastroenteritis among children 2004

›ORT for mild to moderate dehydration

›Early refeeding recommendation

›WHO oral rehydration salts updated formulation monograph 2006 with WHO UNICEF recommendation since 2003

›Reduced osmolarity ORS concept

›Electrolyte glucose balance rationale

›Canadian Paediatric Society position statement oral rehydration therapy and early refeeding 2006 reaffirmed 2016

›Avoid plain water in gastroenteritis dehydration

›ORT contraindication examples

›Canadian Paediatric Society position statement oral ondansetron for gastroenteritis vomiting 2018

›Single dose reduces vomiting and IV fluid use

›Use in mild to moderate dehydration or failed ORT

›StatPearls pediatric dehydration update 2024

›Practical differentiation mild vs moderate limitations

›ORT goal euvolemia

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.