A common condition in pediatric practice. Early signs and symptoms in infants and children are often nonspecific and frequently not recognized.
Signs and symptoms vary by age and specific etiology but can include generalized irritability, decreased activity, tachycardia, delayed capillary refill, dry mucous membranes, sunken eyes, decreased skin turgor, and decreased urination.
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
Katherine Mason, MD
Case Western Reserve University
Associate Vice Chair of Education
Director of Subspecialty Training Programs
Department of Pediatrics Fellowship Director
Division of Pediatric Critical Care
University Hospitals Rainbow Babies & Children's Hospital
KM declares that she has no competing interests.
Marla R. Carter, DO, FAAP
Pediatric Critical Care Fellow
Division of Pediatric Critical Care Medicine
University Hospitals Rainbow Babies & Children’s Hospital
MRC declares that she has no competing interests.
Dr Katherine Mason and Dr Marla R. Carter would like to gratefully acknowledge Dr Risha Moskalewicz, Dr Vincent J. Wang, Dr Naseem Sulayman, and Anne Stormorken, previous contributors to this monograph. VJW is an author of a number of references cited in this monograph. RM, NS, and AS declare that they have no competing interests.
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
AERY declares that she has no competing interests.
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