Volume depletion in children

Last reviewed: 18 Apr 2022
Last updated: 22 Mar 2022

Summary

Definition

History and exam

Key diagnostic 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
  • diarrhea
  • 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 diarrhea
  • 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
  • BUN/Cr
  • CBC
  • urinalysis
  • urine specific gravity
  • urine osmolality
  • urine microscopy and culture
  • blood culture
  • ABG
  • head ultrasound or CT scan
  • abdominal ultrasound or CT scan
More investigations to consider

Treatment algorithm

ACUTE

enteric losses

hemorrhagic losses

skin losses

renal losses

septic shock

anaphylactic shock

Contributors

Authors

Katherine Mason, MD, FAAP

Vice Chair of Education, Department of Pediatrics

Associate Professor of Pediatrics

Brown University

Hasbro Children's Hospital

RI

Disclosures

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

RI

Disclosures

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

RI

Disclosures

PP declares that she has no competing interests.

Acknowledgements

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.

Disclosures

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

Atlanta

GA

Disclosures

JAS declares that she has no competing interests.

Joe Brierley, MD

Consultant Paediatric & Neonatal Intensive Care Unit

Great Ormond St Hospital for Children

London

UK

Disclosures

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

Bristol

UK

Disclosures

AERY declares that she has no competing interests.

Akash Deep, MD, FRCPCH

Director

Paediatric Intensive Care Unit

King’s College Hospital

London

UK

Disclosures

AD declares that he has no competing interests.

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