Page 37 - 15Diarrhoeaandvomiting

Diarrhoea and vomiting caused by gastroenteritis

Chapter 4 Assessing dehydration and shock

4.1 Clinical assessment
During remote or face-to-face assessment ask whether the child:
• appears unwell
• has altered responsiveness, for example is irritable or lethargic
• has decreased urine output
• has pale or mottled skin
• has cold extremities.
Recognise that the following are at increased risk of dehydration:

• children younger than 1 year, particularly those younger than 6 months
• infants who were of low birthweight
• children who have passed more than five diarrhoeal stools in the previous 24 hours
• children who have vomited more than twice in the previous 24 hours
• children who have not been offered or have not been able to tolerate supplementary fluids
before presentation
• infants who have stopped breastfeeding during the illness
• children with signs of malnutrition.
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
Skin colour unchanged
Pale or mottled skin
Skin colour unchanged
Warm extremities
Alert and responsive Warm extremities Cold extremities
Altered responsiveness (for
Decreased level of
example, irritable, lethargic) consciousness
Skin colour unchanged Skin colour unchanged Pale or mottled skin
Warm extremities
Warm extremities
Cold 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
Tachycardia
Normal heart rate
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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