小结
定义
病史和体格检查
关键诊断因素
- 存在危险因素
- 口渴
- 毛细血管再充盈时间＞3 秒
- 皮肤弹性降低
- 黏膜干燥
- 异常精神状态或活动水平
- 心动过速
- 尿量异常
- 呼吸频率升高或呼吸深度增加
其他诊断因素
- 呕吐
- 腹泻
- 腹痛
- 葡萄糖试纸条检测结果异常
- 体核温度下降或发热
- 血压异常
- 瘀伤或被忽视的体征
危险因素
- 呕吐和/或腹泻
- 年龄＜3 岁
- 外伤
- 烧伤＞10% 体表面积
- 1 型糖尿病
- 经口摄入不良病史
- 剧烈和长期运动
- 利尿药使用史
诊断性检查
首要检查
- 临床诊断
需考虑的检查
- 血清电解质
- 血糖
- 血清尿素/肌酐比值
- 全血细胞计数 (FBC)
- 尿液分析
- 尿比重
- 尿液渗透压
- 尿液显微镜检查和培养
- 血液培养
- 动脉血气分析
- 头部超声或 CT 扫描
- 腹部超声检查或 CT 扫描
治疗流程
经肠丢失
出血丢失
经皮肤丢失
经肾丢失
脓毒性休克
过敏性休克
撰稿人
作者
Katherine Mason, MD, FAAP
Vice Chair of Education, Department of Pediatrics
Associate Professor of Pediatrics
Brown University
Hasbro Children's Hospital
RI
利益声明
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
利益声明
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
利益声明
PP declares that she has no competing interests.
鸣谢
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.
利益声明
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.
同行评议者
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
利益声明
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
利益声明
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
利益声明
AERY declares that she has no competing interests.
Akash Deep, MD, FRCPCH
Director
Paediatric Intensive Care Unit
King’s College Hospital
London
UK
利益声明
AD declares that he has no competing interests.
鉴别诊断
- 脱水
- 急性肾小球肾炎
- 肾上腺皮质功能不全
更多 鉴别诊断指南
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- 拯救脓毒症运动儿童指南
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烧伤（轻度）
儿童腹泻
更多 患者教育信息
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