Dehydration in Children: Causes and Treatments

Dehydration

• A common complication of illness in children
• Volume depletion in children is due to fluid losses from vomiting or diarrhea

Development and Biological

• Smaller children have a greater proportion of body water to weight and a larger proportion of extracellular fluid to intracellular fluid
• Infants have a larger proportional surface area of the GI tract than adults
• Infants have a greater body surface area and a higher metabolic rate than adults

Treatment Modalities

• For severe dehydration:
  • Treat shock if present
  • Administer oral rehydration solution (ORS)
  • Insert a peripheral IV line using a large IV catheter
  • Administer Lactated Ringer's solution and monitor infusion rate
  • Monitor for peri-orbital edema (sign of overhydration), regulate flow rate accurately
• For some dehydration:
  • Administer ORS for 4 hours for every loose stool or vomiting episode
  • Encourage additional age-appropriate fluid intake

Classification of Degree of Dehydration (WHO Adaption)

• Severe Dehydration: Lethargic or unconscious, weak or absent radial pulse, sunken eyes, skin goes back slowly (>2 seconds), drinks poorly or not at all
• Some Dehydration: Restless or irritable, palpable radial pulse, sunken eyes, skin goes back slowly (<2 seconds), thirst, drinks quickly
• No Dehydration: Normal mental status, easily palpable radial pulse, normal eyes, skin goes back quickly (<1 second), no thirst, drinks normally

Urinary Tract infection (UTI)

• Causes:
  • Bacterial infections (e.g., E. coli, Streptococcus group B, Staphylococcus saprophyticus)
  • Fungi (e.g., Candida species)
• Pathophysiology:
  • Asymptomatic bacteriuria – Significant bacteriuria with no evidence of clinical infection
  • Symptomatic bacteriuria – Accompanied by physical signs of UTI
  • Recurrent UTI – Repeated episode of bacteriuria or symptomatic UTI
  • Persistent – Persistent of bacteriuria despite antibiotic treatment
  • Febrile UTI – Accompanied by fever and other physical signs of UTI
    • Cystitis – Inflammation of the bladder
    • Urethritis – Inflammation of the urethra
    • Pyelonephritis - Inflammation of upper urinary tract and kidneys
    • Urosepsis – Febrile UTI coexisting with systemic signs of bacterial illness; blood culture reveals the presence of the urinary pathogen

Clinical Manifestation of UTI

• Pain, burning, or a stinging sensation when peeing
• Increased urge to urinate or frequent urination
• Fever (though not always present)
• Frequent night waking to go to the bathroom (Enuresis)

Treatment Management of UTI

• Antibiotics prescribed for 1-2 weeks
• Diuretics may be given
• If with heart failure: keep the child in a semi-Fowler's position, give digitalis and oxygen
• If with hypertension: an anti-hypertensive medication be given
• Diet: restrict salt to avoid edema and low protein intake to reduce protein in the urine
• Weigh the child every day
• Monitor intake and output
• Bed rest may be advised

Nursing Diagnosis for UTI

• Excessive fluid volume
• Activity intolerance
• Risk for injury

Contributing Factors to UTI in children

• Infrequent urination
• Incomplete emptying of the bladder
• Constipation
• Catheterization
• Previous UTIs
• Children who receive antibiotics
• Tight clothing or diapers
• Sexual intercourse
• Altered urine and bladder chemistry

Preventative measures for UTI

• Avoid bubble baths and strong soaps
• Wear cotton underwear instead of nylon
• Drink plenty of fluids
• Avoid caffeine

Burn

• A type of injury to skin or flesh

Common Causes of Burns

• Thermal:
  • Scalding
  • Contact with hot objects
  • Fireworks
• Electrical:
  • High voltage
  • Low voltage
• Chemicals:
  • Ingestion
  • Spilling onto the skin

Prevention of Burns

• Remove child's safety seat or stroller from the hot sun when not in use
• Before leaving the car on a hot day, hide the seat belts' metal latch plates in the seats to prevent the sun from hitting them directly
• Apply sunscreen 20-30 minutes before going out and reapply every 2 hours or more often if in water
• Use a product with an SPF of 15 or higher
• Do not use sunscreen on infants under 6 months of age

Common Complications of Burns

• Infection
• Pneumonia
• Cellulitis
• Urinary tract infections
• Respiratory failure
• Anemia
• Compartment syndrome
• Rhabdomyolysis
• Keloids
• Breathing problems
• Circumferential burns
• Burns to areas with flexion creases
• Fluid and electrolyte problems
• Shock
• Risk of death

Prognosis of Burns

• Prognosis is worse in those with larger burns, older age, and females
• The Baux score is used to determine prognosis of major burns
• The score is determined by adding the size of the burn (%TBSA) to the age of the person, to predict percent mortality after trauma

This quiz covers essential knowledge about dehydration in children, a common complication during illness. It includes causes such as fluid losses from vomiting or diarrhea, and outlines effective treatment modalities, from oral rehydration solutions to intravenous catheter insertion. Test your understanding of the risks and management strategies involved.