Dehydration in children and early toxicosis with exicosis

Toxicosis with exicosis in early childhood (intestinal toxicosis) is a syndrome complex characterized by dehydration, CNS damage, and hemodynamic disturbances. Toxicosis with exicosis (TE) is the most common type of toxicosis. Dehydration in a child can develop at any age and with various diseases, but it occurs more often and is more severe in infants, especially young ones.

According to some data, more than half of all cases of TE occur in the first year of life. In the first hours of the disease, the severity of the condition depends on the presence of toxicosis and its severity, and not on the nosological form of the disease.

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What causes dehydration in a child?

The rapid development of dehydration in a child "especially at an early age" is facilitated by the peculiarities of the water-salt metabolism of a growing organism. A baby has a higher percentage of water in the body than an adult, but the volume of H2O is significantly less, so its loss is more noticeable. For example, in an adult, the frequency of vomiting must be at least 10-20 times for signs of the disease to appear, and in a baby - only 3-5 times.

The baby's H2O reserves are mainly represented by extracellular fluid, which includes intravascular fluid, the most constant value determining the circulating blood volume (CBV), and interstitial fluid, a more labile indicator. The baby has a higher level of perspiration, which is due to a high respiratory rate and a larger lung surface area per kilogram of body weight (compared to an adult). In addition, the baby has a greater loss of H2O through the gastrointestinal tract, which is associated with a higher frequency of defecation, and through the kidneys (the relatively low concentrating capacity of the kidneys leads to excessive loss of water and salts).

Dehydration in a child develops with significant losses of water and electrolytes, which occur mainly with vomiting and diarrhea. However, it can also occur with an increase in "imperceptible" losses (loss of moisture through the respiratory tract with severe shortness of breath, through the skin with hyperthermia, etc.).

Most often, toxicosis with exicosis develops against the background of infectious diseases, primarily intestinal infections caused by bacteria, viruses, and protozoa. Dehydration in children can develop with pneumonia (due to respiratory failure) and meningitis (due to uncontrollable vomiting). For the development of TE, the etiology of the underlying disease is not of decisive importance.

Dehydration in a child can also be caused by poisoning, obstruction of the gastrointestinal tract (including a congenital anomaly, such as congenital pyloric stenosis), or severe metabolic disorders (adrenogenital syndrome, diabetes mellitus).

Dehydration in a child can also be iatrogenic in nature: with excessive prescription of diuretics, hypertonic solutions and protein preparations (in the form of infusions), and the use of concentrated infant formulas.

In addition, it is necessary to emphasize that the most common cause of the development of dehydration syndrome is intestinal infection.

Pathogenesis

The release of water from the vessels leads to irritation of the baroreceptors and the mobilization of H2O from the interstitium, and then from the cells. The loss of fluid increases blood viscosity and reduces the blood flow rate. Under these conditions, the body reacts by increasing the tone of the sympathetic nervous system and releasing hormones: adrenaline, noradrenaline and acetylcholine. Spasm of precapillary arterioles occurs with simultaneous arteriovenous shunting in the tissues. This process is compensatory in nature and leads to the centralization of blood circulation.

Centralization of blood circulation, in turn, is aimed at maintaining adequate blood supply to vital organs, primarily the brain and heart. In this case, peripheral organs and tissues suffer. Thus, blood flow in the kidneys, adrenal glands, muscles, abdominal organs, skin becomes significantly lower than necessary for their normal functioning. As a result, hypoxia appears and intensifies on the periphery, acidosis develops, vascular permeability increases, detoxification processes are disrupted, and energy deficiency increases. Against the background of increasing adrenal hypoxia, the release of catecholamines increases, which normally lead to spasm of precapillary arterioles and centralization of blood circulation, and under conditions of acidosis, a paradoxical reaction develops: arterioles dilate (spasm is replaced by paresis of precapillaries with persistent spasm of postcapillaries). Decentralization of blood circulation and pathological deposition ("sequestration") of blood occurs. A significant portion of the blood is separated from the main blood flow, which leads to a sharp disruption of the blood supply to vital organs. Under these conditions, the infant develops myocardial ischemia and heart failure; all types of metabolism are disrupted in the liver (glycolysis and glycogenesis, transamination, etc.). As a result of venous congestion, the volume of pulmonary ventilation decreases, the processes of oxygen and carbon dioxide diffusion are disrupted; renal filtration decreases. All these processes can lead to hypovolemic shock (shock due to loss of H2O).

TE syndrome is characterized by dyshydria - extracellular dehydration combined with swelling of brain cells.

Symptoms of dehydration in a child

Clinical symptoms of dehydration in a child develop as a result of pathological water loss (vomiting, diarrhea, prolonged hyperthermia, polyuria, increased perspiration, etc.) and are characterized by disorders of the nervous system and clinical signs.

Changes in the nervous system come to the fore: the infant becomes restless, capricious, and exhibits increased excitability (grade I). In addition, thirst is noted, and sometimes even an increased appetite (the baby is trying to compensate for the loss of fluid). Clinical signs of dehydration in a child are moderate: a slight decrease in tissue turgor, slight dryness of the skin and mucous membranes, a slightly sunken large fontanel. There may be slight tachycardia, blood pressure is usually within the age norm. Moderate blood thickening is observed (hematocrit is at the upper limit of the norm or slightly exceeds it). When studying the acid-base balance of the blood (ABB), compensated metabolic acidosis is detected (pH within physiological limits). These changes are characteristic of the initial stage of dehydration, corresponding to grade I TE.

If water and electrolyte losses with vomiting and/or diarrhea continue, and the body weight deficit exceeds 5% (grade II), then the baby's anxiety is replaced by lethargy and inhibition, and the clinical signs of dehydration in the child become more pronounced. He refuses to drink (as this increases vomiting), dry skin and mucous membranes occur, tissue turgor decreases sharply (if you fold the skin, it straightens out slowly), facial features become sharper (the chin is clearly defined, the eyes are "sunken"), the large fontanelle sinks. In addition, the pulse quickens and the respiratory rate increases, blood pressure in most cases is reduced, heart sounds are muffled, oliguria develops. Hematocrit levels significantly exceed the norm (by 10-20%), the content of erythrocytes and hemoglobin in the peripheral blood is increased by at least 10%, subcompensated metabolic acidosis develops (pH 7.34-7.25).

The most severe clinical signs of dehydration in a child, as well as an unfavorable outcome of TE, are observed at stage III, when the water deficit exceeds 10%. Depression of the central nervous system continues as a result of edema and swelling of brain cells: the baby is indifferent to the environment, adynamic, and seizures may develop. Symptoms of dehydration in a child are sharply expressed: the skin is dry, pale with pronounced cyanosis as a result of venous congestion; sometimes sclerema is detected (the skin with sclerema is cold, waxy, pasty), tissue turgor is sharply reduced, the skin fold almost does not straighten out; the tongue is covered with a white coating and viscous, sticky mucus. In addition, muffled heart sounds are characteristic, bradycardia often develops. Moist (congestive) rales are heard in the lungs, the breathing rhythm is disturbed (from tachypnea to the Cheyne-Stokes and Kussmaul rhythm). Intestinal peristalsis is reduced, up to paresis as a result of severe electrolyte disturbances. Atony and paresis of the bladder, anuria develop. Body temperature is usually reduced, systolic blood pressure is significantly lower than the age norm. Prognostically unfavorable signs: dry cornea (no tears and eyelids do not close), soft eyeballs. Hematocrit and hemoglobin values significantly deviate from the norm. Decompensated metabolic acidosis is observed (pH < 7.25).

In most cases, dehydration in a child can be determined by clinical signs. In this case, the nature of the disease development (whether it begins acutely or gradually), the predominant mechanism of water loss (vomiting or diarrhea), respiratory rate and the severity of the temperature reaction are taken into account.

Features of clinical signs of dehydration in a child

Criteria	Isotonic	Hypotonic	Hypertensive
Nature of the onset of the disease	It may be spicy	Gradual	Spicy
Predominant mechanism of fluid loss	Moderate vomiting and diarrhea or severe diarrhea and increased perspiration	Persistent vomiting, massive diarrhea	Diarrhea, increased perspiration, hyperthermia, vomiting
Weight loss	Moderate (about 5%)	More than 10%	Less than 10%
Thirst	Moderate	Not expressed	Expressed
Temperature	Subfebrile	Normal or subnormal	Tall
Leather	Dry	Relatively damp and cold with a "marbled pattern", acrocyanosis	Dry and warm, hyperemic
Mucous membranes	Dry	May be covered with sticky mucus	Very dry (tongue sticks to the roof of the mouth)
Blood pressure	Normal or reduced	Low	Normal or elevated
Diuresis	Oliguria	Oliguria, anuria	Remains normal for a long time, then - oliguria
Digestive tract	-	Intestinal paresis	-
Eye symptoms	Not expressed	The eyeballs are sunken and soft.	The eyeballs are reduced in size, soft, crying without tears
Condition of the large fontanelle	Moderately sinking	It sinks in	Doesn't sink
Cramps	Not typical	Tonic (no meningeal symptoms)	Clonic-tonic (there is rigidity of the occipital muscles)
Total protein concentration	Increased	Reduced	Increased
Hematocrit	Increased	Significantly increased	Slightly increased
Sodium concentration	Norm	Reduced	Increased
Potassium concentration	Norm	Reduced	Increased
Osmolarity	Norm	Reduced	Increased
Behavior	Lethargy	Lethargy, inhibition, adynamism	Significant concern

Isotonic dehydration in children is observed more often and is considered the mildest type of exsicosis, in which an equivalent amount of water and salts is lost, moderate metabolic disorders occur. However, cases of severe course of this type of pathology with disorders of consciousness and other severe disorders have been described.

External signs of dehydration in a child are pronounced in the hypertonic variant and moderate in the hypotonic variant, despite the fact that weight loss in the hypotonic type of TE is the greatest. It should also be noted that there is a discrepancy between the pronounced dryness of the skin and mucous membranes and the condition of the large fontanelle in patients with hypertonic dehydration. In severe cases, an increase in the osmotic concentration of cerebrospinal fluid can lead to the development of convulsions and coma.

In acute water loss (in which not only the volume of water lost is important, but also the rate of TE) under conditions of rapidly increasing circulatory failure, hypovolemic shock develops. This type of shock is more often observed in patients with hypotonic and isotonic TE and much less often in hypertonic TE. The main symptoms of hypotonic shock are: decreased blood pressure, hypothermia, tachycardia and cyanosis. If timely assistance is not provided, the patient dies.

In addition to water and sodium ions, infants lose vital potassium and calcium ions when they vomit and have diarrhea.

Hypokalemia may develop as a result of insufficient potassium intake with food, due to toxicosis with exsicosis with uncontrollable vomiting, diarrhea, when using diuretics, as well as due to other reasons (long-term use of glucocorticoids, overdose of cardiac glycosides, etc.). Symptoms of hypokalemia:

• CNS depression;
• muscle hypotonia;
• hyporeflexia;
• paresis and paralysis (may develop in severe cases);
• breathing difficulties;
• tachycardia;
• intestinal paresis;
• impaired renal concentration function.

If the potassium concentration drops critically, cardiac arrest may occur (in the systolic phase).

Hyperkalemia is observed with rapidly developing hypertensive dehydration, oliguria and anuria, acidosis, overdose of potassium preparations, etc. Signs of hyperkalemia:

• increased excitability, possible development of convulsions;
• Brad and cardia;
• increased intestinal peristalsis.

Hyperkalemia can also cause cardiac arrest (in the diastolic phase).

Hypocalcemia develops in infants with significant fluid loss, as well as with rickets, hypofunction of the parathyroid glands, renal failure, etc. Manifestations of hypocalcemia:

• convulsive readiness, convulsions;
• bradycardia;
• intestinal paresis;
• renal failure (impaired nitrogen-excreting function of the kidneys).

Hypercalcemia in toxicosis with exsicosis is extremely rare.

Classification

There is no generally accepted classification of toxicosis with exicosis. However, there are 3 degrees (by severity of clinical manifestations) and 3 types (by the ratio of water and salts in the body).

The severity of dehydration in a child is determined by the body weight deficit (as a percentage of its initial value) that develops as a result of fluid loss.

1. I (mild, compensated) develops with a body weight deficit of 3 to 5%. Manifestations of dehydration in a child are minor and reversible. There are no hemodynamic disorders or they are also minor.
2. II (moderate, subcompensated) - body weight deficit is from 5 to 10%. Moderate manifestations of exsicosis are observed. Hemodynamic disorders are compensated.
3. III (severe, decompensated) - body weight deficit exceeds 10%. In case of acute water loss and, as a result, body weight deficit of more than 15%, a fatal outcome occurs. At this level, clinical signs and hemodynamic decompensation are expressed. Patients need emergency medical care in intensive care and resuscitation departments.

It is important to remember that the above percentages of body weight deficit at various degrees are used only for young infants (up to 5 years old), and after 5 years these indicators change towards a decrease.

Water losses at different degrees of dehydration in infants, % of body weight

Age	Degrees of dehydration
	I	II	III
Up to 5 years	3-5	5-10	>10
Over 5 years old	<3	3-5	>6

Types of dehydration in children

View	Serum Naa+ concentration
Isotonic (iso-osmolar, mixed, extracellular)	Within normal limits
Hypotonic (hypoosmolar, salt-deficient, extracellular)	Below normal
Hypertonic (hyperosmolar, water-deficient, intracellular)	Above normal

Serum electrolyte concentrations are normal

Electrolytes	Concentration, mmol/l
Sodium	130-156
Potassium	3.4-5.3
Total calcium	2.3-2.75
Calcium ionized	1.05-1.3
Phosphorus	1.0-2.0
Magnesium	0.7-1.2
Chlorine	96-109

Isotonic dehydration in a child develops with relatively equal losses of water and electrolytes. The concentration of sodium in the blood plasma in this type is within the normal range.

Hypotonic occurs when mainly electrolytes are lost. With this type of dehydration, plasma osmolarity decreases (Na+ is below normal) and water moves from the vascular bed into the cells.

Hypertension is characterized by a relatively greater loss of water, exceeding the loss of electrolytes. General losses, as a rule, do not exceed 10%, however, due to an increase in the osmotic concentration of plasma (Na above normal), cells lose water and intracellular water loss develops.

It should be noted that some authors distinguish 3 periods of TE: prodromal, peak period and period of reverse development. Other authors, in addition to the degrees and types of dehydration, also suggest distinguishing 2 variants - with or without hypovolemic shock.

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Diagnosis of dehydration in a child

The diagnosis of toxicosis with exicosis is made on the basis of clinical signs of dehydration in a child: thirst, dry skin and mucous membranes (oral mucosa and conjunctiva), sunken large fontanelle and eyeballs, decreased turgor and elasticity of subcutaneous tissue, decreased diuresis, changes in the central nervous system (anxiety or lethargy, somnolence, convulsions), decreased blood pressure, hemodynamic disturbances (paleness and cyanosis of the skin, cold extremities), acute weight loss over several hours or days.

The degree and type of dehydration in a child, the severity of electrolyte disturbances help to clarify laboratory tests (it should be noted that it is not always known how much body weight has decreased). The following laboratory indicators are determined:

• hematocrit and hemoglobin concentration (complete blood count);
• concentration of total protein and electrolytes - sodium, potassium, calcium (biochemical blood test);
• Blood acidity test.

At stage I, the hematocrit value is most often at the upper limit of the norm and is 0.35-0.42, at stage II - 0.45-0.50, and at stage III it can exceed 0.55 (however, if dehydration develops in a baby with anemia, the hematocrit value will be significantly lower).

In addition, as TE increases, the concentration of hemoglobin and protein increases.

In most cases, TE is accompanied by metabolic acidosis, the severity of which is assessed by the blood acid-base balance (ABS) parameters: pH, which is normally 7.35-7.45 (in newborns, a shift to the acidic side up to 7.25); excess/deficit of bases BE ±3 mmol/l (in newborns and infants up to +5 mmol/l); HCO3 - 20-25 mmol/l; total concentration of buffer bases 40-60 mmol/l.

If it is impossible to take a blood sample (for technical reasons) for biochemical testing, electrolyte disturbances (and their severity) can be assessed based on ECG changes.

With hypokalemia, the following signs appear on the ECG:

• ST segment depression below the baseline;
• flattened, negative or biphasic T wave;
• increase in P wave amplitude;
• increase in the duration of the QT interval.

Hyperkalemia is accompanied by the following changes:

• high pointed T wave;
• shortening of the QT interval;
• prolongation of the PQ interval.

Hypocalcemia is characterized by:

• prolongation of the QT interval;
• decrease in T wave amplitude;
• shortening of the PQ interval.

Hypercalcemia is rare. With excess calcium, the following is observed:

• shortening of the QT interval;
• change in T wave amplitude;
• increase in the PQ interval.

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Treating Dehydration in Children

For successful treatment of dehydration in a child, it is important to start etiotropic therapy early. Since one of the main causes of toxicosis with exicosis is intestinal infections, antibiotics with activity against gram-negative microflora are indicated for severe bacterial forms of the disease. In most cases, aminoglycosides (gentamicin, amikacin), protected penicillins (amoxicillin + clavulanic acid) and third-generation cephalosporins (ceftriaxone, cefotaxime) are used in age-related doses, the route of administration is parenteral. In moderate and mild cases of the disease, preference should be given to such drugs as probiotics (bifidobacteria bifidum), nitrofuran drugs (furazolidone), specific bacteriophages (salmonella, coliproteus, etc.).

The next important component of the therapy of toxicosis with exicosis is the elimination of diarrhea and vomiting. Children undergo gastric lavage (use Ringer's solution at the rate of 100 ml per 1 month of life up to 1 year and 1.5-2 liters from 1 year to 3 years), a fasting diet is prescribed. The composition and quantity of food, as well as the frequency of its intake depend on the age and severity of the child's condition. The general rule for young infants is "rejuvenation" of the diet, when complementary foods are excluded from the infant's diet, breast milk, liquid fermented milk products ("Agusha 1", "Agusha 2", children's kefir, etc.) and adapted fermented milk mixtures ("NAN", "Nutrilon", etc.) are used. The increase in the volume of food and expansion of the diet are carried out gradually as the baby's condition improves and the symptoms disappear. In addition, metoclopramide (cerucal*) and others are used to normalize peristalsis.

The basis of treating dehydration in a child is rehydration, the main goal of which is to restore the normal amount and composition of body fluids. To properly perform rehydration, it is necessary to determine the volume of water, its composition and the method of administration. In pediatrics, two methods of fluid administration are mainly used - orally and parenterally.

The rehydration method, in which drugs (electrolyte solutions) are administered orally, is usually used in infants with grade I exsicosis and in some cases with grade II. Preference is given to administering fluid orally, since this method is practically safe for the patient and can be carried out on an outpatient basis (the effectiveness will largely depend on how early rehydration therapy is started). There are special rehydration solutions for oral administration (regidron, glucosolan, etc.). For the treatment of acute diarrhea, solutions (for oral administration) with reduced osmolarity are recommended, since a decrease in the osmolarity of solutions leads to a decrease in the volume of stool and the frequency of vomiting; in addition, there is a less frequent need to switch to infusion therapy (IT).

In pediatric practice, “Carrot-rice broth ORS 200” produced by Hipp is also used for oral rehydration, based on an improved electrolyte solution with optimal osmolarity.

Composition of standard rehydration solutions with normal (regidron, glkzhosolan) and reduced osmolarity (gastrolit)

Components of solutions	Regidron	Glucosolan	Gastrolit
Sodium	3.5 (chloride) + 2.9 (citrate)	3.5 (chloride) + 2.5 (bicarbonate)	1.75 (chloride) + 2.5 (bicarbonate)
Potassium chloride	2.5	1.5	1.5
Glucose	10	20	14.5

The baby can also be given 5% glucose solution, dried fruit decoction, tea, mineral and boiled water (the baby often prefers one drink or another, which is determined by the type of dehydration). The use of a standard solution for rehydration (for oral administration) must be combined with the introduction of salt-free solutions; when using solutions with reduced osmolarity, there is no such need. The liquid should be at room temperature (so as not to provoke vomiting), it should be given fractionally (from a spoon or pipette every 5-10 minutes).

Indication for infusion therapy is a severe degree of TE with pronounced electrolyte and metabolic disorders. Colloidal and crystalloid solutions are used for its implementation. The action of colloidal blood substitutes is based on an increase in the colloid-osmotic pressure of the intravascular fluid and, as a result, retention of part of the water in the vascular bed. Albumin of 5 and 10% concentration and rheopolyglucin* are used most often. A single dose of 5% albumin and rheopolyglucin usually does not exceed 10 mg/kg (maximum daily dose 20 mg/kg), for a 10% albumin solution - 5 mg/kg and 10 mg/kg. However, in most cases these volumes are insufficient, so the remaining fluid volume is replenished with 5 or 10% glucose and saline solutions (Ringer's solution*, Trisol*, etc.). Thus, rehydration therapy is carried out using several solutions, and in different quantitative ratios. The choice of the starting solution and the ratio of the number of solutions depend on the type of dehydration and the severity of the condition.

In case of hypertonic dehydration in a child and satisfactory hemodynamics, therapy should be started with a 5% glucose solution, which immediately, practically without lingering in the vascular bed, enters the interstitium, and then the cells (which is what is required for this type of exsicosis). The use of colloids as a starting solution for this type of TE is contraindicated due to the risk of increased intracellular dehydration against the background of increased oncotic pressure.

Selection of solutions for rehydration therapy: the ratio of volumes of glucose solution and sodium-containing solution (colloidal or crystalloid) for infants of different ages

Type of dehydration in a child and starting solution	Newborns	1-6 months	Over 6 months
Isotonic (10% glucose solution)	3:1	2:1	1:1
Hypertonic (5% glucose solution)	4:1	4:1	3:1
Hypotonic (5% albumin solution)	3:1	2:1	1:1

In isotonic dehydration, a glucose solution is also used as a starting solution, but in a higher concentration (10%). In this case, the hyperosmolarity of the solution allows for some time to maintain the BCC, as well as to replenish the intracellular deficit after the solution leaves the vascular bed.

In the hypotonic type with hemodynamic disturbances, treatment should be started with a colloid or crystalloid solution. In most cases, a 5% albumin solution is used, less often - other plasma substitutes. However, the use of rheopolyglucin (a hyperoncotic drug) can increase dehydration due to the transition of interstitial fluid into the vascular bed.

The ratio of glucose solutions to sodium-containing solutions depends on both the type of TE and age. In newborns (due to physiological hypernatremia) and in young infants (due to a tendency to hypernatremia), less sodium-containing solutions are administered. Excessive administration of saline solutions is dangerous due to the risk of developing hyperosmolar conditions.

The volume of fluid required for rehydration therapy can be calculated in several ways. When calculating in one of the ways, the following is taken into account: the need for water (according to age), the volume of water deficit (the difference in body weight before the disease and at the time of examination) and the volume of pathological losses.

Physiological need for water in infants of different ages

Age	Water requirement, ml/(kg h2o)
2-4 weeks	130-160
3 months	140-160
6 months	130-155
9 months	125-145
12 months	120-135
2 years	115-125
4 years	100-110
6 years	90-100

The volume of pathological losses is calculated as follows: 10 ml/(kg x day) for each degree of increase in body temperature above 37 °C, 10-20 ml/(kg x day) with ongoing vomiting and the same with diarrhea (depending on the severity of symptoms). Another method, the most convenient for practical use, is calculating the daily volume of fluid according to the Denis table, which takes into account the degree of dehydration in the child and his age. The younger the age, the more fluid per kilogram of body weight is required for the same degree of ex and goat.

Daily volume of fluid for rehydration therapy depending on age and degree of dehydration (according to Denis), ml/kg

Degree of dehydration	Up to 1 year	1-5 years	5-10 years
I	130-170	100-125	75-100
II	175-200	130-170	110
III	220	175	130

The ratio of the amount of fluid administered orally to the amount administered parenterally may be increased or decreased (if the amount of fluid administered orally is insufficient, the amount administered parenterally must be increased; if the condition improves and the amount of fluid administered orally increases, the amount administered parenterally can be reduced).

In rehydration therapy, which must be carried out from the first hours of development of toxicosis with exicosis, the effectiveness of treatment largely depends on the rate of fluid administration to the patient. If the patient has no signs of hypovolemic shock, then in the first 6-8 hours the volume of fluid is replenished to relieve hypovolemia, and in the following 16-18 hours the final elimination of toxicosis with exicosis is carried out. From the 2nd day of treatment the volume of fluid depends primarily on the current losses.

If the patient is diagnosed with hypovolemic shock, treatment begins with colloidal solutions: 5% albumin or rheopolyglucin. Within 1-2 hours, colloidal solutions are administered at a dose of 15-20 ml/kg under the control of arterial pressure. Then, after its increase, infusion therapy is carried out, guided by general principles.

In addition to replenishing water loss, with TE it is necessary to correct electrolyte imbalances.

Sodium deficiency (mmol) is determined by the formula:

D(Na+) = (Na+norm. - Na+b.) x MT x K,

Where: D(Na+) is the deficit (mmol); Na+norm. is the normal sodium concentration (usually 140 mmol/l is considered normal); Na+б. is the sodium content in the patient's plasma (mmol/l); BM is the body weight (kg); K is the extracellular fluid coefficient (0.5 for newborns, 0.3 for infants, 0.2 for adults). (1 ml of 10% sodium chloride solution contains 1.7 mmol of sodium.)

Hyponatremia often does not require additional administration and can be corrected with the use of a glucose-insulin-potassium mixture, especially in young infants.

The daily physiological requirement for potassium is 1.5-2.0 mmol/kg (for a body weight of up to 15 kg - 2.0 mmol/kg, for a body weight of more than 15 kg - 1.5 mmol/kg), when hypokalemia develops, the calculation of potassium deficiency is carried out using the formula:

DK+= (K+norm. - K+b.) x MT x K,

Where DK+ is the potassium deficiency level, mmol; K+norm. is usually considered to be the normal level of potassium of 5 mmol/l; K+b. is the potassium content in the patient's plasma, mmol/l; MT is body weight, kg; K is the extracellular fluid coefficient. (1 ml of 7.5% potassium chloride solution contains 1 mmol of potassium.)

To eliminate potassium deficiency in the body, potassium chloride solutions (4, 7, 5 and 10%) are used. Potassium chloride solutions are diluted in glucose solution to a concentration of 0.5% (the maximum permissible concentration of potassium chloride in glucose is 1%). Potassium chloride solutions are administered only by drip, at a rate not exceeding 0.4 ml/min. When administering potassium, it is necessary to monitor diuresis.

Correction of metabolic acidosis is usually carried out during treatment of the underlying disease (IT with replenishment of circulating blood volume, correction of electrolyte disturbances). The use of sodium bicarbonate is advisable only if acidosis is pronounced (decompensated), and the acid-base balance indicators reach critical values (pH <7.25; BE <10 mmol/l; HCO3 <18 mmol/l). When used in other cases, there is a risk of developing alkalosis.

The effectiveness of the therapy is assessed by the reduction and elimination of clinical manifestations of dehydration, improvement of the general condition of the baby, weight gain of at least 1-2% per day from the initial data, positive dynamics of laboratory parameters (hematocrit, hemoglobin level, protein and electrolytes, blood acid-base balance).

What is the prognosis for dehydration in a child?

The prognosis depends on the degree of TE, the age of the infant, the time of contact with the doctor, and the nosological form of the disease against which dehydration developed.