Classification of dehydration
|
SIGNS
|
CLASSIFY AS
|
IDENTIFY TREATMENT
|
|
2 of the following signs
-
Lethargic or unconscious
-
sunken eyes
-
not able to drink or drinking poorly
-
skin pinch goes back very slowly
|
SEVERE DEHYDRATION
|
If child has no other severe classification:
à
Give fluid for severe dehydration (Plan C)
If child also has
another severe classification:
à
Advise mother to continue breastfeeding
à
If child is 2 years or older and there is cholera in
your area, give antibiotic for cholera
|
|
2 of the following signs
-
Restless, irritable
-
Drinks eagerly, thirsty
-
Skin pinch goes back slowly
|
SOME DEHYDRATION
|
Give fluid and food for some dehydration (Plan B)
If child has severe classification:
à
Refer urgently to hospital with mother giving
frequent sips of ORS along the way
à
Advise mother to continue breastfeeding
à
Advise mother when to return immediately
à
Follow up in 5 days if not improving
|
|
Not enough signs to classify as some or severe
dehydration
|
NO DEHYDRATION
|
à
Give fluid and food to treat diarrhea at home (Plan
A)
à
Advise mother when to return immediately
à
Follow up in 5 days if not improving
|
3 rules of home treatment
- give
extra fluids
-
continue feeding
-
inform when to return (when unable to drink or breastfeed becomes sicker, develops fever, blood in stool,
drinks poorly)
Tell the Mother:
(a) Breastfeed frequently and longer for
each feed.
(b) If the child is exclusively breastfed, give ORS or clean
water in addition to breastmilk.
(c) If the child is NOT exclusively
breastfed, give 1 or more of the
following:
*
ORS
*
Food-based fluids
*
Clean Water
Some dehydration
*
Give frequent small sips from a cup
*
If the child vomits, wait 10 minutes. Continue afterwards, but more
slowly
*
Continue giving extra fluids until the diarrhea stops . Inform the
mother how much ORS to administer over the next 4 hours. If less than 2 years
show her to give a spoonful frequently.
*
Reassess after 4 hours and classify the child for dehydration
Some dehydration
*
If the mother must leave before completing treatment
*
Show her how to prepare the ORS solution at home
*
Show her how much to give to finish the 4 hour treatment at home
*
Give her enough ORS packets to complete rehydration
Severe dehydration (Plan C)
Treatment Plan C
To treat severe dehydration (IV fluid : pLRS)
|
Age
|
Initial phase (30 mL/kg)
|
Subsequent phase (70 mL / kg)
|
|
Infants (<12 mos)
|
1 hour **
|
5 hours
|
|
Older children
|
30 minutes **
|
2.5 hours
|
** Repeat once if radial pulse
is still very weak or imperceptible
Severe dehydration
*
Reassess the child every 1 – 2 hours. If hydration status is not
improving, give the IV drip more rapidly
*
Also give ORS (5 ml/kg/hr) as soon as the child can drink
*
Reassess the infant after 6 hours and a child after 3 hours. Classify
dehydration
Severe dehydration – nasogastric tube
*
Start hydration by tube with ORS solution. Give 20 mL/kg/hr for 6 hours
*
Reassess the child every 2 hours
*
If there is repeated vomiting or increasing abdominal distention, give
fluid more slowly
*
If hydration status is not improving after 3 hours send the child in for
IV therapy
*
After 6 hours, reassess the child and classify dehydration. If possible
observe the child at least 6 hours after rehydration to be sure the mother can
maintain hydration giving the child ORS solution by mouth
Classification table for persistent diarrhea
|
Signs
|
Classify as
|
Identify treatment
|
|
Dehydration present
|
SEVERE PERSISTENT DIARRHEA
|
Treat dehydration before referral unless the child
has another severe classification
REFER TO HOSPITAL
|
|
No dehydration
|
PERSISTENT DIARRHEA
(diarrhea 14 days or more and also has no signs of severe dehydration)
|
Advise the mother on feeding a child who has
persistent diarrhea
Follow up in 5 days
|
Persistent diarrhea
*
After 5 days, ask:
*
If the diarrhea has not stopped (3 or more stools), do a full
reassessment and give treatment, then refer immediately to the hospital
*
If the diarrhea has stopped (<3 stools per day), tell the mother to
follow the usual feeding recommendations for the child’s age
*
Breastfeed more frequently, longer time
*
Use of nutritious and appetizing food
Dysentery
|
Signs
|
Classify as
|
Identify treatment
|
|
Blood in stool
|
DYSENTERY
|
Treat for 5 days with an oral antibiotic recommended
for shigella in your area
Follow up in two days
|
Follow up for dysentery treatment
*
Assess the child for diarrhea
*
Ask
*
Are there fewer stools?
*
Is there less blood in stool?
*
Is there less fever?
*
Is there less abdominal pain?
*
Is the child eating better?
