OBJECTIVE: To review, systematically, the physical diagnosis of hypovolemia in adults. METHODS: We searched MEDLINE (January 1966-November 1997), personal files, and bibliographies of textbooks on physical diagnosis and identified 10 studies investigating postural vital signs or the capillary refill time of healthy volunteers, some of whom underwent phlebotomy of up to 1150 mL of blood, and 4 studies of patients presenting to emergency departments with suspected hypovolemia, usually due to vomiting, diarrhea, or decreased oral intake. RESULTS: When clinicians evaluate adults with suspected blood loss, the most helpful physical findings are either severe postural dizziness (preventing measurement of upright vital signs) or a postural pulse increment of 30 beats/min or more. The presence of either finding has a sensitivity for moderate blood loss of only 22% (95% confidence interval [CI], 6%-48%) but a much greater sensitivity for large blood loss of 97% (95% CI, 91%-100%); the corresponding specificity is 98% (95% CI, 97%-99%). Supine hypotension and tachycardia are frequently absent, even after up to 1150 mL of blood loss (sensitivity, 33%; 95% CI, 21%-47%, for supine hypotension). The finding of mild postural dizziness has no proven value. In patients with vomiting, diarrhea, or decreased oral intake, the presence of a dry axilla supports the diagnosis of hypovolemia (positive likelihood ratio, 2.8; 95% CI, 1.4-5.4), and moist mucous membranes and a tongue without furrows argue against it (negative likelihood ratio, 0.3; 95% CI, 0.1-0.6 for both findings). In adults, the capillary refill time and poor skin turgor have no proven diagnostic value. CONCLUSIONS: A large postural pulse change (> or =30 beats/min) or severe postural dizziness is required to clinically diagnose hypovolemia due to blood loss, although these findings are often absent after moderate amounts of blood loss. In patients with vomiting, diarrhea, or decreased oral intake, few findings have proven utility, and clinicians should measure serum electrolytes, serum blood urea nitrogen, and creatinine levels when diagnostic certainty is required.

STUDY OBJECTIVES: We define the predictive value of parents? computer-based report for history and physical signs of dehydration for a primary outcome of percentage of dehydration (fluid deficit) and 2 secondary outcomes: clinically important acidosis and hospital admission. We also sought to compare the reports of physical signs related to dehydration made by parents and nurses. METHODS: We performed a prospective observational trial in an urban pediatric emergency department. A convenience sample of parents completed a computer-based interview covering historical details and physical signs (ill appearance, sunken fontanelle, sunken eyes, decreased tears, dry mouth, cool extremities, and weak cry) related to dehydration. Nurses independently completed an assessment of physical signs for enrolled children. The primary outcome was the degree of dehydration (fluid deficit), which was defined as the percentage difference between initial ED weight and stable final weight after the illness. Secondary outcomes included clinically important acidosis (defined as a serum CO(2) value of </=15 mEq/L) and hospital admission. RESULTS: One hundred thirty-two parent-child dyads comprised the final sample. Parent-reported data manifested higher sensitivity (range 73% to 100%) than specificity (range 0% to 49%) for the prediction of dehydration of 5% or greater. Likelihood ratios (LRs) near zero (<0.1) suggest that a normal history of fluid intake and urine output reduced the likelihood of significant dehydration. Parental report of a normal tearing state reduced the likelihood of significant dehydration and clinically important acidosis (negative LRs of 0.4 and 0.1, respectively). Two physical signs reported by parents, sunken fontanelle and decreased tears, were associated with hospital admission (positive LR of 3.4 and 4.0, respectively). CONCLUSION: Parents? report of history and observations for children captured through computer-based interview demonstrates predictive value for relevant outcomes in dehydration.

Researched study on stress, the causes of stress, its effects on our mental health and alternative stress management techniques.

Your body is about two thirds water. When the water level dips below that level, you could be dehydrated. Read this article to find out what causes...

It’s summer, along with that heat comes illnesses related to overheating Some of them can cause you pain, unconsciousness and even death. They all have one thing in common, and that is dehydration. The biggest concern is that most people just don’t drink enough water daily.

Intravenous Dextrose during Outpatient Rehydration in Pediatric Gastroenteritis Jason A. Levy, MD* and Richard G. Bachur, MD From the Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School (JAL, RGB), Boston, MA * Contact for correspondence and reprints: Jason A. Levy, MD (Email: jason.levy@childrens.harvard.edu). BACKGROUND: Rapid intravenous (IV) rehydration in the emergency department (ED) is required for certain children with acute gastroenteritis (AGE). OBJECTIVES: To determine whether the amount of IV dextrose administered is related to a return visit with admission (RVA) in children with AGE and dehydration, and to determine which clinical, laboratory, and treatment parameters are associated with an RVA. METHODS: The investigators performed a case control study of children aged 6 months to 6 years who presented to an urban ED with AGE and dehydration and who received IV rehydration before discharge from the ED. Dehydration was defined a priori on the basis of parameters used in prior studies. Cases were defined as those patients who had an RVA within 72 hours of an original visit for ongoing symptoms. Controls were defined as those patients who met inclusion criteria who did not have an RVA. The authors studied whether the amount of IV dextrose administered at the initial visit was related to an RVA as well as which other clinical and treatment parameters were associated with an RVA. RESULTS: A total of 56 cases and 112 controls were studied. Patients who had an RVA received significantly less IV dextrose (mean: 399 mg/kg vs. 747 mg/kg, p < 0.001) than those who did not have an RVA. Patients who received no IV dextrose had 3.9 times greater odds of having a return visit with admission than those who received some dextrose. Controlling for fluid volume, the amount of dextrose administered remained statistically significant by logistic regression; for every 500 mg/kg of IV dextrose administered, the patient was 1.9 times less likely to have an RVA. Patients with length of symptoms less than or equal to one day were more likely to have an RVA than were those with symptom length of two or more days. No other historical or physical exam findings or laboratory parameters (including mean serum bicarbonate) were associated with a return visit requiring admission. CONCLUSIONS: Administration of larger amounts of IV dextrose is associated with reduced return visits requiring admission in children with gastroenteritis and dehydration. Key words: gastroenteritis; dehydration; intravenous fluids; dextrose; rehydration

This Article Extract Full Text (PDF) P3Rs: Submit a response Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Cited by other online articles Articles citing this Article Related Collections Gastrointestinal Tract PEDIATRICS Vol. 114 No. 2 August 2004, pp. 507 -------------------------------------------------------------------------------- ENDORSED CLINICAL PRACTICE GUIDELINE Managing Acute Gastroenteritis Among Children: Oral Rehydration, Maintenance, and Nutritional Therapy Centers for Disease Control and Prevention On April 29, 2004, the American Academy of Pediatrics endorsed and accepted as its policy the following guideline: "Managing Acute Gastroenteritis Among Children: Oral Rehydration, Maintenance, and Nutritional Therapy from the Centers for Disease Control and Prevention" (MMWR Recomm Rep. 2003;52(RR-16):1–16. Available at: www.cdc.gov/mmwr/PDF/RR/RR5216.pdf). -------------------------------------------------------------------------------- PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics The following policy statement is retired: Practice Parameter: The Management of Acute Gastroenteritis in Young Children and Pediatrics 97: 424-435.

Department of Endocrinology, Sydney Children's Hospital, Sydney, Australia. kristen.neville@sesiahs.health.nsw.gov.au AIMS: To determine whether the risk of hyponatraemia in children with gastroenteritis receiving intravenous (IV) fluids is decreased by the use of 0.9% saline. METHODS: A prospective randomised study was carried out in a tertiary paediatric hospital. A total of 102 children with gastroenteritis were randomised to receive either 0.9% saline + 2.5% dextrose (NS) or 0.45% saline + 2.5% dextrose (N/2) at a rate determined by their treating physician according to hospital guidelines and clinical judgement. Plasma electrolytes, osmolality, and plasma glucose were measured before (T(0)) and 4 hours after (T(4)) starting IV fluids, and subsequently if clinically indicated. Electrolytes and osmolality were measured in urine samples. Results were analysed according to whether children were hyponatraemic (plasma sodium <135 mmol/l) or normonatraemic at T(0). RESULTS: At T(0), mean (SD) plasma sodium was 135 (3.3) mmol/l (range 124-142), with 37/102 (36%) hyponatraemic. At T(4), mean plasma sodium in children receiving N/2 remained unchanged in those initially hyponatraemic (n = 16), but fell 2.3 (2.2) mmol/l in the normonatraemic group. In contrast, among children receiving NS, mean plasma sodium was 2.4 (2.0) mmol/l higher in those hyponatraemic at baseline (n = 21) and unchanged in the initially normonatraemic children. In 16 children who were still receiving IV fluids at 24 hours, 3/8 receiving N/2 were hyponatraemic compared with 0/8 receiving NS. No child became hypernatraemic. CONCLUSIONS: In gastroenteritis treated with intravenous fluids, normal saline is preferable to hypotonic saline because it protects against hyponatraemia without causing hypernatraemia. PMID: 16352625 [PubMed - indexed for MEDLINE]