You will no doubt see a child with gastroenteritis with dehydration in the very near future. It is likely to be due to infections gastroenteritis. If you are sure that is the case then this post is for you. So, I present a simple, stepwise approach to the child with dehydration in the ED.

First, assess the degree of dehydration via your history and physical exam.

Mild dehydration table

Moderate dehydration table

Severe Dehydration table

A normal child with MILD dehydration should be rehydrated orally.

A child with MODERATE dehydration is at risk for IV fluids.

This is where the use of ONDANSETRON is advised, as it can reduce the risk of further episodes of vomiting, the patient needing IV fluids and the risk of immediate admission to the hospital.

SEVERE dehydration patients need immediate resuscitation with rapid administration of isotonic fluids. SEVERE patients should not have an oral fluid challenge. They are very sick and obtunded and should be managed accordingly.

WWDWWD gastro

Has the child failed oral fluid replacement?

If YES, and the child is MODERATELY dehydrated, then they will need fluids. In these cases I do the following:

  1. Administer 40 mL/kg Normal Saline over one hour – Note that if you need to give more than 999 mL (the IV pump limit) your time may be longer
  2. As long as the patient has OBJECTIVELY improved in terms of their degree of dehydration on exam/vitals then give D5 NS at twice maintenance rate. You could also give D5 1/2NS if you/your institution thinks hypotonic fluids are OK.

If the patient responds well to this fluid plan. Looks physiologically NORMAL and can tolerate oral fluids discharge home.

If they cannot tolerate oral fluids, are still ill appearing (perhaps because they have a metabolic acidosis that will take a longer time to correct) then further IV fluids are warranted and admission to the hospital is appropriate.