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- Dehydration is a pathologic state of negative fluid balance in the body. Severity is generally expressed as a percentage of body weight. Mild, moderate, and severe dehydration correspond to volume loss of <5%, 5–10%, and >10%, respectively.
- Dehydration can also be classified as isotonic (Sodium [Na] 130 to 150 mmol/L), hypotonic (Na <130 mmol/L), or hypertonic (Na >150 mmol/L).
- Dehydration can be the result of a wide range of illnesses.
- Accurate clinical recognition and classification of dehydration determines rehydration treatment options.
- Globally, dehydration from diarrheal illness is one of the leading causes of mortality in children <5 years old.
- Incidence of moderate to severe dehydration in the United States has declined since the introduction of routine rotavirus immunization.
- Despite a reduction in morbidity attributed to routine rotavirus vaccination, >100,000 children per year are hospitalized in the United States for dehydration from diarrheal illness.
Dehydration is caused by either excessive fluid and salt losses or inadequate intake of fluids.
- Common sources of fluid loss include
- GI losses: vomiting, diarrhea (most common cause of dehydration in pediatric patients)
- Renal losses: diabetes mellitus, diabetes insipidus, diuretics
- Insensible losses: sweating, fever, tachypnea, increased ambient temperature, large burns
- Common causes of inadequate fluid intake include
- Pain from stomatitis, pharyngitis, herpangina, oral trauma
- Anorexia or malaise
- Altered mental status
- Inadequate access to fluids or neglect