Page 34 - 15Diarrhoeaandvomiting

2 Summary of

recommendations

2.1 Key priorities for implementation (key recommendations)

Chapter 3 Diagnosis
Perform stool microbiological investigations if:
• you suspect septicaemia or
• there is blood and/or mucus in the stool or
• the child is immunocompromised.

Chapter 4 Assessing dehydration and shock
Use Table 4.6 to detect clinical dehydration and shock.

Table 4.6 Symptoms and signs of clinical dehydration and shock
Interpret symptoms and signs taking risk factors for dehydration into account. Within the category
of ‘clinical dehydration’ there is a spectrum of severity indicated by increasingly numerous and
more pronounced symptoms and signs. For clinical shock, one or more of the symptoms and/or
signs listed would be expected to be present. Dashes (–) indicate that these clinical features do
not specifically indicate shock. Symptoms and signs with red flags ( ) may help to identify
children at increased risk of progression to shock. If in doubt, manage as if there are symptoms
and/or signs with red flags.

Increasing severity of dehydration

No clinically detectable Clinical dehydration Clinical shock
dehydration
Appears well deteriorating –
Appears to be unwell or
Symptoms (remote and face-to- face assessments) Alert and responsive example, irritable, lethargic) Decreased level of
Altered responsiveness (for
consciousness
Normal urine output
–
Decreased urine output
Pale or mottled skin
Skin colour unchanged
Skin colour unchanged
Warm extremities
Alert and responsive Warm extremities Cold extremities
Decreased level of
Altered responsiveness (for
example, irritable, lethargic) consciousness
Skin colour unchanged Skin colour unchanged Pale or mottled skin
Cold extremities
Warm extremities
Warm extremities
–
Sunken eyes
Eyes not sunken
(except after a drink)
(except for ‘mouth breather’)
Signs (face-to-face assessments) Moist mucous membranes Dry mucous membranes – Tachycardia
Normal heart rate
Tachycardia
Normal breathing pattern
Tachypnoea
Tachypnoea
Normal peripheral pulses
Normal capillary refill time
Prolonged capillary refill time
Normal capillary refill time
Normal skin turgor Normal peripheral pulses Weak peripheral pulses
–
Reduced skin turgor
Normal blood pressure Normal blood pressure Hypotension (decompensated
shock)
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