What is the medical treatment for severe dehydration?

Updated: Dec 07, 2018
  • Author: Lennox H Huang, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
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Answer

Laboratory evaluation and intravenous rehydration are required. The underlying cause of the dehydration must be determined and appropriately treated.

Phase 1 focuses on emergency management, the restoration of hemodynamic integrity. Severe dehydration is characterized by a state of hypovolemic shock requiring rapid treatment. Initial management includes placement of an intravenous or intraosseous line and rapid administration of 20 mL/kg of an isotonic crystalloid (eg, lactated Ringer solution, 0.9% sodium chloride). Additional fluid boluses may be required depending on the severity of the dehydration. The child should be frequently reassessed to determine the response to treatment. As intravascular volume is replenished, tachycardia, capillary refill, urine output, and mental status all should improve. If improvement is not observed after 60 mL/kg of fluid administration, other etiologies of shock (eg, cardiac [may be more apparent following the initial fluid bolus before reaching 60 mL/kg – evidence of a gallop on examination, rales], anaphylactic, septic) should be considered. Hemodynamic monitoring and inotropic support may be indicated.

Phase 2 focuses on unaddressed deficit replacement after phase 1, provision of maintenance fluids, and replacement of ongoing losses. Maintenance fluid requirements are equal to measured fluid losses (urine, stool) plus insensible fluid losses. Normal insensible fluid loss is approximately 400-500 mL/m2 body surface area and may be increased by factors such as fever and tachypnea.


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