How Valid Are Clinical Signs of Dehydration in Infants?

Abstract

Our objective was to determine the ability of several clinical signs of dehydration to distinguish among degrees of dehydration in infants with acute diarrhea. The design was a prospective cohort study in a pediatric referral hospital in Cairo, Egypt. Infant boys, 3-18 months old, with a history of acute diarrhea (5 or more watery stools per day for no more than 7 days) were eligible, except those with frank protein-energy malnutrition, serious nongastrointestinal illness, or being exclusively breast-fed. Several clinical signs of dehydration were assessed upon study entry. Subjects were then rehydrated with an oral rehydration solution and fed a standardized diet until diarrhea ceased (no watery or loose stools for 16 h). The main outcome measure was percent body weight gain at rehydration and at resolution of illness. Data from 135 subjects were available for analysis. Average (SD) rehydration phase duration was 5.2 (2.1) h, and average (SD) duration of illness was 54.5 (38) h. Multiple regression analysis selected prolonged skinfold, altered neurologic status, sunken eyes, and dry oral mucosa as the clinical signs that correlated best with percent dehydration (R2 for model 0.244, p < 0.001). Mean weight gain for the two assessment systems was 3.6-3.9% for mild, 4.9-5.3% for moderate, and 9.5-9.8% for severe dehydration. The most valid clinical signs of dehydration include prolonged skinfold, altered neurologic status, sunken eyes, and dry oral mucosa. Children with clinical signs of mild or moderate dehydration have fluid deficits on the order of 3 or 5% body weight, respectively.

Management guidelines for acute infective diarrhoea / gastroenteritis in infants

“…The clinical signs of dehydration are variable; 30 the degree of dehydration is most accurately predicted with a combination of the observer's experience, 31,32 the measured acute weight loss, and the presence of metabolic acidosis. 33 Placed together, these allow an assessment of whether dehydration is mild, moderate or severe.…”

The Management of Children with Gastroenteritis and Dehydration in the Emergency Department

“…It is especially difficult to distinguish between mild and moderate dehydration because the first signs of dehydration appear at 3-4% dehydration, increase at 5% (the threshold for mild dehydration), and there is not another significant clinical difference until 9 -10% (the threshold for severe) (7,16). Overall, the ability of clinical signs to predict the degree of dehydration (mild, moderate, or severe) is, at best, problematic.…”

Physiology of the Developing Kidney: Fluid and Electrolyte Homeostasis and Therapy of Basic Disorders (Na/H2O/K/Acid Base)

“…It may be most useful if normal, as this does seem to exclude reliably severe dehydration. In a prospective cohort study of dehydrated children between 3 and 18 months of age, the best correlation between clinical assessment of degree of dehydration and actual volume depletion came in children who had obvious clinical parameters of significant dehydration such as prolonged skinfold tenting, a dry mouth, sunken eyes, and altered sensorium [86]. Similarly, in a review of preschool children with dehydration, the best clinical indicators of volume depletion -decreased skin turgor, poor peripheral perfusion, and Kussmaul breathing -accompanied more significant dehydration where there was little clinical question of volume depletion [87].…”