An infant has diarrhea for 3d with weight loss from 10 kg to 9 kg. Exam: he is noted to have dry
mucous membranes, poor skin turgor, markedly decreased urine output, and tachycardia. His
BP=normal and compression-release of the nail beds shows satisfactory refilling. Appropriate
treatment would include?
a. Plasmapheresis and plasma infusion
b. 0.5% Normal Saline
c. Lactated Ringer's injection
d. Packed cells
e. Whole blood
f. Platelets
g. FFP
h. double strength Normal Saline
i. 5% dextrose in 0.5N saline solution
j. IV heparin
answer:C
The child has moderate dehydration due to diarrhea, he is likely to have lost a lot of sodium, 0.5% NS is hypotonic, it leads to hyponatremia, should not be used in diarrhea and vomiting. Ideally the choice should be 0.9% NS but since it's not an option, ringers lactate can be used as it is also isotonic.
Mild dehydration (0–5%)
• Weight loss: 5% in infants and 3% in children.
• Skin turgor: may be decreased.
• Mucous membranes: dry.
• Urine: may be low.
• Heart rate: increased.
• Blood pressure: normal.
• Perfusion: normal.
• Skin colour: pale.
• Consciousness: irritable.
Moderate dehydration (5–10%)
• Weight loss: 10% in infants and 6% in children.
• Skin turgor: decreased.
• Mucous membranes: very dry.
• Urine: oliguric.
• Heart rate: increased.
• BP: may be normal.
• Perfusion: normal or prolonged capillary refill (capillary refill time (CRT) > 2s).
• Skin colour: grey.
• Consciousness: lethargic.
Severe dehydration (10–15%)
• Weight loss: 15% in infants and 9% in children.
• Skin turgor: poor with tenting.
• Mucous membranes: parched.
• Urine: anuric.
• Heart rate: increased.
• Blood pressure: decreased.
• Perfusion: prolonged CRT.
• Skin colour: mottled; blue or white.
• Consciousness: comatose.
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