Pedemy All toolsEnter the weight and tap the four signs. You get the dehydration grade, the oral rehydration volume per hour, ondansetron dose and when to go IV.
This tool grades dehydration in a child with acute gastroenteritis and turns the grade into a fluid plan for the weight you enter. It uses the Clinical Dehydration Scale of Friedman and colleagues (2004). The scale scores four signs from 0 to 2: general appearance, eyes, mucous membranes and tears. A total of 0 means no dehydration (under 3%), 1–4 means some dehydration (3–6%), and 5–8 means moderate to severe (6% or more). The scale was validated in children 1–36 months, and the CDC categories (minimal under 3%, mild–moderate 3–9%, severe 10% or more) are shown alongside.
Mild to moderate dehydration is treated with oral rehydration solution, 50–100 mL/kg over 2–4 hours, as in the CDC 2003 recommendations. The tool uses 50 mL/kg for some dehydration and 100 mL/kg for more. It shows the total, the mL per hour and the amount every 5 minutes. Replace ongoing losses with 10 mL/kg per watery stool and 2 mL/kg per vomit. If a child cannot drink, give ORS by nasogastric tube. One dose of ondansetron, by weight band (2, 4 or 8 mg), helps children 6 months and older who are vomiting.
Some children need IV fluids. These include severe dehydration or shock, altered mental status, ileus or a possible surgical abdomen, and failure of oral and NG rehydration. For them the tool gives a 20 mL/kg isotonic bolus (normal saline or lactated Ringer’s), repeated until pulse, perfusion and mental status recover, with 10 mL/kg for frail infants. It lists labs, starting with point-of-care glucose. It also shows the Holliday–Segar maintenance rate, feeding advice and red flags that point to another diagnosis.
CDC recommends 50–100 mL/kg of ORS over 2–4 hours for mild to moderate dehydration. Add 10 mL/kg for each watery stool and 2 mL/kg for each vomit. Start with 5 mL every few minutes if the child is vomiting, then increase as tolerated.
In the Freedman 2006 trial, children got a single oral dose by weight: 2 mg for 8–15 kg, 4 mg for over 15–30 kg and 8 mg for over 30 kg. It is for children 6 months and older who are vomiting with some dehydration. Start ORS about 15 minutes later.
Give IV fluids for severe dehydration or shock, altered mental status, ileus or suspected surgical abdomen, or when oral and nasogastric rehydration fail. Give 20 mL/kg of normal saline or lactated Ringer’s and repeat until pulse, perfusion and mental status are normal. Check glucose.
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