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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 (№/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 countriesΨ§# 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
  4. = research performed in developing countries