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Table 3 Assessment of dehydration status and recommendations on therapy.

From: Guidelines on acute gastroenteritis in children: a critical appraisal of their quality and applicability in primary care

 

No dehydration

Mild to moderate dehydration

Severe dehydration

Consistent?Yes/No (â„–/Total)

Setting

 

Normal mental status*#∞§

Normal to altered mental status*#∞§ ±

Normal, altered to comatose mental status *# $ ∞ ± Φ

Y (7/8)

Hospital± ∞

 

Normal*# to slight increase in thirst#*∞$

Thirsty #∞*$

Greatly increased thirst or drinking poorly or not at all$*#∞

N (4/8)

Hospital∞

 

Normal to slightly elevated heart rate#∞$§

Heart rate normal to increased #∞$§Φ

Tachycardia, (with bradycardia in most severe cases)#$ ∞§

Y (5/8)

Hospital ∞Φ

 

Normal pulse quality#∞§

Quality of pulses normal§ to decreased #∞ΦΨ

Weak, thready or impalpable pulses#∞§

Y (7/8)

Hospital ∞ΦΨ

 

Normal breathing∞§

Normal, fast or deep (acidotic± ) breathing #§Φ Ψ

Deep (acidotic± ) breathing #Φ§ ±

Y (5/8)

Hospital ΦΨ ± §

 

No sunken eyes*#∞§

Sunken eyes ±#∞*$§Φ

(deeply) sunken eyes*$ ∞# ±

Y (7/8)

Hospital ± Φ∞§

Diagnosis

Normal/present tears#∞

Decreased± # or absent ΦΨ tears∞

Absent tears#∞ ±

Y (5/8)

Hospital ± Φ∞

 

Moist#§ to slightly dry∞$ mucous membranes

Dry mucous membranes# ± ∞$§Φ

Very dry mucous membrane#$ ∞

Y (6/8)

Hospital ± Φ∞§

 

Immediate skin pinch*#§

Skin pinch in 1- 2 seconds (decreased) # ± *∞$§ΦΨ

Very low skin pinch (>2 seconds)*∞#$ ±

Y (8/8)

Hospital Ψ ± Φ§

 

Normal capillary refill#∞§

Normal§ to prolonged capillary refill #∞ΦΨ

Prolonged or minimal capillary refill#∞§

Y (5/8)

Hospital ΨΦ§∞

 

Warm extremities#§

Warm§ to cool extremities #ΦΨ

Cold, mottled or cyanotic extremities# $ ± §

Y (6/8)

Hospital Ψ ± Φ

 

Urine output normal#§ to slightly decreased∞$

Decreased urine output#∞$§

Minimal (to no) urine output#$∞

N (4/8)

Hospital ∞

 

"No signs"±

Normal blood pressure∞§

Hypotension/circulatory collapse$ ± ∞§

N (4/8)

Hospital ∞

 

Normal anterior fontanel∞

Sunken anterior fontanel ∞$Φ

Very sunken anterior fontanel$∞

N (3/8)

Hospital ∞Φ

 

(Premixed) reduced osmolarity or hypotonic ORS should be used for rehydration*#$ ± §ΦΨ

Y (7/8)

In/outpatient $± §ΦΨ

 

Continue breastfeeding throughout rehydration Φ ± §Ψ$∞ #*

Y (8/8)

In/outpatient Φ ± §Ψ

 

Start age-appropriate diet during∞ or after initial rehydration Φ ± §Ψ$#*

Y (7/8)

In/outpatient Φ ± §Ψ$∞#

 

High sugar beverages, canned or carbonated drinks should be avoided #ΦΨ$§*

Y (6/8)

Hospital §Ψ

 

Dilution of formula and the use of milk-free formula is unnecessary Φ ± §Ψ$#*

Y (7/8)

Hospital §∞Ψ$

 

Antiemetics are discouraged *#Φ∞§Ψ

Y (6/8)

In/outpatient Ψ§Φ

 

Racedotril is not (yet) recommended Φ§#

N (3/8)

Hospital Φ§#

Therapy

Racedotril may be useful∞Ψ

N (2/8)

Hospital ∞Ψ

 

Ondansetron is not (yet) recommended Φ§#

N (3/8)

Hospital Φ§

 

Antidiarrheals should not be used/have no benefit*Φ∞Ψ§ ±

Y (6/8)

In/outpatient ΦΨ§ ∇

 

Zinc supplementation is not (yet) recommended for developed countriesا#

N (3/8)

In/outpatient §Ψ

 

Probiotics can be used/considered ∞Ψ /do not have to be discouraged Φ

N (3/8)

In/outpatient ∞Ψ Φ

 

Probiotics are not recommended §

N (1/8)

In/outpatient §

 

Prebiotics are not recommended Ψ

N (1/8)

Outpatient Ψ

  1. ** Number of guidelines mentioning this symptom in at least one subgroup
  2. *WGO # CDC $CPS ± ARM
  3. ∞CCH ΦNHG ΨESP § NICE
  4. ∇ = research performed in developing countries