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488 Unit III Pediatric Care

Manifestations of Mild, Moderate, and Severe Dehydration

CLINICAL ASSESSMENT MILD MODERATE SEVERE
Percent of body weight lost Up to 5% (4050 mL /kg) 69% (6090 mL/kg) 10% or more (100  mL/kg)

Level of consciousness Alert, restless, Irritable or lethargic (infants Lethargic to comatose

thirsty and very young children); (infants and young children);
thirsty, restless (older children often conscious, apprehensive
and adolescents) (older children and adolescents)

Blood pressure Normal Normal or low; postural Low to undetectable

hypotension (older children
and adolescents)

Pulse Normal Rapid Rapid, weak to palpable

Skin turgor Normal Poor Very poor

Mucus membranes Moist Dry Parched

Urine May appear Decreased output (less than Very decreased or absent
normal 1 mL/kg/hour), dark color; output
increased specific gravity

Thirst Slightly increased Moderately increased Greatly increased unless

lethargic

Fontanel Normal Sunken Sunken

Extremities Warm; normal capillary refill Delayed capillary refill Cool, discolored; delayed capillary
(greater than 2 seconds) refill (greater than 34 seconds)

Respirations Normal Normal or rapid Changing rate and pattern

Source: Ball, J. W., & Bindler, R. C. (2003). Pediatric nursing: Caring for children (3rd ed.). Upper Saddle River, NJ: Prentice Hall, p. 314.

BOX 15-1 CULTURAL PULSE POINTS TABLE 15-3

Typical Laboratory Results for Infants and Children
Voluntary Fluid Restrictions
Muslim families require fasting or restriction of food and bever- COMPONENT TESTED NORMAL LABORATORY VALUES
age from sunrise to sunset in the holy month of Ramadan.When Hematocrit Newborn: 4465%; 1 to 3 years old:
a child requires oral rehydration, this tradition may become flex- 2940%; 4 to 10 years old: 3143%
ible. However, the devout Muslim family may have some con-
cerns about disregarding this fast. Urine specific gravity Newborn:1.0011.020; Child:1.0051.030

Blood urea nitrogen Infant:515 mg/dL; Child:520 mg/dL

If it has been determined the child is dehydrated, fluid re- Potassium Infant: 3.65.8 mEq/L; Child: 3.55.5
placement must be started. Oral rehydration is ideal because mEq/L
it is the most natural and least invasive. Box 15-2 high- Sodium Infant: 134150 mEq/L; Child: 135145
lights important information about fluid requirements and mEq/L
oral rehydration amounts by different weights in children.
The nurse and parents will need to be creative in ad- Calcium Newborn: 3.77.0 mEq/L or 7.414.0 mg/
dL; Infant: 5.06.0 mEq/L or 1012 mg/
ministering oral fluids. Children often prefer sweetened dL; Child: 4.55.8 mEq/L or 911.5 mg/dL
flavored solutions such as Popsicles, gelatin, decarbonated
cola, or ginger ale. However, these can make diarrhea worse Blood gases
due to the osmotic effect of the sugar. When used, they pH Child: 7.367.44
PaCO2 Child: 3545 mm Hg
should be diluted by 50%. Commercially prepared oral HCO3 Child: 2226 mEq/L
replacement solutions are preferred because they contain
necessary electrolytes and less sugar. Some choices are Note: Lab values may vary. Consult the laboratory at your health care agency.