Volume depletion is a common condition encountered in pediatric practice. Early signs and symptoms in infants and children are often nonspecific and frequently under recognized.
Signs and symptoms vary by age and specific etiology but can include generalized irritability, thirst, decreased activity, tachycardia, delayed capillary refill, dry mucous membranes, sunken eyes, decreased skin turgor, and decreased urination. Specific causes of volume depletion such as diabetic ketoacidosis and acute tubular necrosis may present with increased urination. A meticulous general pediatric history and physical exam is the most sensitive means of determining that a child is in a state of volume depletion.
Hypotension is a late sign of volume depletion in children and often heralds overt circulatory collapse.
Initial management of children with mild or moderate volume depletion is with oral rehydration therapy. Regardless of etiology, children with severe hypovolemia and shock should be treated promptly with intravenous isotonic crystalloid solution.
With timely recognition and appropriate intervention, volume depletion in children is readily reversible, with an excellent prognosis.
Volume depletion is a deficit in water and solutes from the extracellular component of total body fluid that results in decreased blood volume. This is distinct from dehydration, which more specifically indicates a total body water deficit. In children, the most common cause of dehydration is gastroenteritis, which can lead to severe volume depletion. Volume depletion can also be secondary to hemorrhage, excessive renal fluid and solute losses, increased insensible losses, and redistribution of body fluid into extravascular tissue (third spacing). Symptoms of volume depletion can range from thirst (with mild depletion) to irreversible shock and death in severe cases.
History and exam
Key diagnostic factors
- capillary refill >3 seconds
- decreased skin turgor
- dry mucous membranes
- abnormal mental status or activity level
- abnormal urinary output
- elevated respiratory rate or deep respirations
Other diagnostic factors
- abdominal pain
- abnormal glucose test strip result
- low core temperature or fever
- abnormal BP
- bruises or signs of neglect
- vomiting and/or diarrhea
- age <3 years
- burns >10% of body surface area
- type 1 diabetes mellitus
- history of poor oral intake
- vigorous and prolonged exercise
- history of diuretic use
1st investigations to order
- clinical diagnosis
Investigations to consider
- serum electrolytes
- blood glucose
- urine specific gravity
- urine osmolality
- urine microscopy and culture
- blood culture
- head ultrasound or CT scan
- abdominal ultrasound or CT scan
- Acute glomerulonephritis
- Adrenal insufficiency
- Surviving Sepsis Campaign Children's Guidelines
- Diabetic ketoacidosis and the hyperglycemic hyperosmolar state
Diarrhea in childrenMore Patient leaflets
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