Table 4.6Symptoms and signs of clinical dehydration and shock

Interpret symptoms and signs taking risk factors for dehydration into account. Within the category of ‘clinical dehydration’ there is a spectrum of severity indicated by increasingly numerous and more pronounced symptoms and signs. For clinical shock, one or more of the symptoms and/or signs listed would be expected to be present. Dashes (–) indicate that these clinical features do not specifically indicate shock. Symptoms and sig-ns with red flags ( Image ch4fu1.jpg) may help to identify children at increased risk of progression to shock. If in doubt, manage as if there are symptoms and/or signs with red flags.

Increasing severity of dehydration
Image ch4fu2.jpg
No clinically detectable dehydrationClinical dehydrationClinical shock
Symptoms (remote and face-to-face assessments)Appears well Image ch4fu1.jpgAppears to be unwell or deteriorating
Alert and responsive Image ch4fu1.jpgAltered responsiveness (for example, irritable, lethargic)Decreased level of consciousness
Normal urine outputDecreased urine output
Skin colour unchangedSkin colour unchangedPale or mottled skin
Warm extremitiesWarm extremitiesCold extremities
Signs (face-to-face assessments)Alert and responsive Image ch4fu1.jpgAltered responsiveness (for example, irritable, lethargic)Decreased level of consciousness
Skin colour unchangedSkin colour unchangedPale or mottled skin
Warm extremitiesWarm extremitiesCold extremities
Eyes not sunken Image ch4fu1.jpgSunken eyes
Moist mucous membranes (except after a drink)Dry mucous membranes (except for ‘mouth breather’)
Normal heart rate Image ch4fu1.jpgTachycardiaTachycardia
Normal breathing pattern Image ch4fu1.jpgTachypnoeaTachypnoea
Normal peripheral pulsesNormal peripheral pulsesWeak peripheral pulses
Normal capillary refill timeNormal capillary refill timeProlonged capillary refill time
Normal skin turgor Image ch4fu1.jpgReduced skin turgor
Normal blood pressureNormal blood pressureHypotension (decompensated shock)

From: 4, Assessing dehydration and shock

Cover of Diarrhoea and Vomiting Caused by Gastroenteritis
Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years.
NICE Clinical Guidelines, No. 84.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2009 Apr.
Copyright © 2009, National Collaborating Centre for Women’s and Children’s Health.

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