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 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 |