Volume depletion in children

Last reviewed: 2 Jan 2023
Last updated: 22 Mar 2022



History and exam

Key diagnostic factors

  • presence of risk factors
  • thirst
  • capillary refill >3 seconds
  • decreased skin turgor
  • dry mucous membranes
  • abnormal mental status or activity level
  • tachycardia
  • abnormal urinary output
  • elevated respiratory rate or deep respirations
More key diagnostic factors

Other diagnostic factors

  • vomiting
  • diarrhoea
  • abdominal pain
  • abnormal glucose test strip result
  • low core temperature or fever
  • abnormal BP
  • bruises or signs of neglect
Other diagnostic factors

Risk factors

  • vomiting and/or diarrhoea
  • age <3 years
  • trauma
  • burns >10% of body surface area
  • type 1 diabetes mellitus
  • history of poor oral intake
  • vigorous and prolonged exercise
  • history of diuretic use
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • serum electrolytes
  • blood glucose
  • urea/Cr
  • FBC
  • urinalysis
  • urine specific gravity
  • urine osmolality
  • urine microscopy and culture
  • blood culture
  • arterial blood gas
  • head ultrasound or CT scan
  • abdominal ultrasound or CT scan
More investigations to consider

Treatment algorithm


enteric losses

haemorrhagic losses

skin losses

renal losses

septic shock

anaphylactic shock



Katherine Mason, MD, FAAP

Vice Chair of Education, Department of Pediatrics

Associate Professor of Pediatrics

Brown University

Hasbro Children's Hospital



KM declares that she has no competing interests.

Sarah Spencer Welsh, MD, FAAP

Medical Director

Pediatric Intensive Care Unit

Hasbro Children’s Hospital

Assistant Professor of Pediatrics

The Warren Alpert Medical School of Brown University



SW declares that she has no competing interests.

Patricia Poitevien, MD, MSc

Residency Program Director

Hasbro Children’s Hospital

Department of Pediatrics

Assistant Dean

Office of Diversity and Multicultural Affairs

Warren Alpert Medical School at Brown University



PP declares that she has no competing interests.


Dr Katherine Mason, Dr Sarah Welsh and Dr Pat Poitevien would like to gratefully acknowledge Dr Marla R. Carter, Dr Risha Moskalewicz, Dr Vincent J. Wang, Dr Naseem Sulayman, and Anne Stormorken, previous contributors to this topic.


VJW is an author of a number of references cited in this topic. MC, RM, NS, and AS declare that they have no competing interests.

Peer reviewers

Jana A. Stockwell, MD, FAAP, FCCM

Assistant Professor of Pediatrics

Pediatric Critical Care Medicine

Emory University School of Medicine

Children's Healthcare of Atlanta




JAS declares that she has no competing interests.

Joe Brierley, MD

Consultant Paediatric & Neonatal Intensive Care Unit

Great Ormond St Hospital for Children




JB is an author of a reference cited in this monograph.

Amber E.R. Young, BSc, MB ChB, FRCA

Consultant Paediatric Anaesthetist

Department of Anaesthesia

Frenchay Hospital




AERY declares that she has no competing interests.

Akash Deep, MD, FRCPCH


Paediatric Intensive Care Unit

King’s College Hospital




AD declares that he has no competing interests.

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