- Clinical assessment of dehydration can be difficult, especially in young infants, and rarely predicts the exact degree of dehydration accurately.
- The most useful individual signs for predicting 5% dehydration in children are an abnormal capillary refill time, abnormal skin turgor and abnormal respiratory pattern. Combinations of examination signs provide a much better method than any individual signs in assessing the degree of dehydration.
- Clinical assessment therefore comprises some of the following indicators of dehydration:
Loss of body weight:
- Normal: no loss of body weight.
- Mild dehydration: 5-6% loss of body weight.
- Moderate: 7-10% loss of body weight.
- Severe: over 10% loss of body weight.
Clinical features of mild-to-moderate dehydration; 2 or more of:
- Restlessness or irritability.
- Sunken eyes (also ask the parent).
- Thirsty and drinks eagerly.
Clinical features of severe dehydration; 2 or more of:
- Abnormally sleepy or lethargic.
- Sunken eyes.
- Drinking poorly or not at all.
- Pinch test (skin turgor): the sign is unreliable in obese or severely malnourished children.
- Normal: skin fold retracts immediately.
- Mild or moderate dehydration: slow; skin fold visible for less than 2 seconds.
- Severe dehydration: very slow; skin fold visible for longer than 2 seconds.
- Other features of dehydration include dry mucous membranes, reduced tears and decreased urine output.
- Additional signs of severe dehydration include circulatory collapse (e.g. weak rapid pulse, cool or blue extremities, hypotension), rapid breathing, sunken anterior fontanelle.