P KZN AGE

Worldwide, it has been estimated that approximately one in five paediatric deaths can be attributed to dehydration related to gastroenteritis


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Clinical Dehydration Scale

Items	0	1	2
General appearance	Normal	Thirsty, restless, or lethargic but irritable when touched	Disoriented, hypotonic, cold or sweaty skin, unconscious
Eyes	Normal	Slightly sunken	Very sunken
Mucous membranes	Moist	‘Sticky’	Dry
Tears	Tears	Decreased tears	Absent tears

• A score of 0 represents no dehydration (<3 1="" 5="" a="" and="" dehydration="" moderate="" of="" p="" score="" severe="" some="">

/////////////////////Measuring serum urea and creatinine levels is helpful when assessing severe dehydration only with very high serum urea values (greater than 16.7 mmol/L) and creatinine values (greater than 80 μmol/L) reliably predicting severe dehydration.10 13 Unfortunately, urea and creatinine levels are unhelpful in mild and moderate dehydrations

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Experimental testing

The digitally measured capillary refill time (DCRT) is an innovative approach for predicting dehydration severity. The test requires use of specific software to analyse ‘frame-by-frame’ the video of one of the child’s fingertips both before and after a light pressure is applied for 5 s. Studies have demonstrated that a DCRT of >0.4 s was 100% sensitive (95% CI 75% to 100%) and had a specificity of 91% (95% CI 82% to 97%) for predicting the presence of at least moderate dehydration.19

Ultrasound (US) scanning has been proposed as a quick method to determine the severity of dehydration in children. Two different US measures (aorta to inferior vena cava (IVC) ratio and IVC inspiratory collapse) have been studied as methods of estimating dehydration in children. The aorta to IVC ratio demonstrated a sensitivity of 93% and specificity of 59% compared with 93% and 35% for IVC inspiratory collapse.20 The use of US remains experimental but could become of greater clinical relevance as point-of-care US becomes more widely available.20

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