Treatment of hypovolemia (dehydration) in children
- Michael J Somers, MD
Michael J Somers, MD
- Associate Professor of Pediatrics
- Harvard Medical School
Fluid therapy maintains the normal volume and composition of body fluids and, if needed, corrects any existing abnormalities. In children, the most common abnormality requiring fluid therapy is hypovolemia or dehydration, often related to vomiting and diarrhea from gastroenteritis. Clinically, it is useful to divide fluid therapy into repletion therapy and maintenance therapy.
●Repletion therapy replaces any current existing water and electrolyte deficits, replaces any ongoing abnormal losses, and returns the patient to a normal volume and electrolyte status.
●Maintenance therapy replaces the expected ongoing losses of water and electrolytes from normal physiologic processes and maintains normal volume and electrolyte status (calculator 1). (See "Maintenance fluid therapy in children".)
Volume depletion reduces the effective arterial blood volume (also called effective circulating volume [ECV]), which refers to that part of the arterial volume that perfuses the tissues. If severe hypovolemia is not corrected in a timely fashion, ischemic end-organ damage may occur and, with profound or persistent hypovolemia, shock and death may ensue.
The treatment of hypovolemia in children will be reviewed here. The clinical assessment and diagnosis of hypovolemia, and the treatment of hemorrhagic and nonhemorrhagic hypovolemic shock are discussed separately. (See "Clinical assessment and diagnosis of hypovolemia (dehydration) in children" and "Hypovolemic shock in children: Initial evaluation and management".)
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- GENERAL PRINCIPLES
- EMERGENT FLUID REPLETION PHASE
- Severe hypovolemia
- Moderate hypovolemia
- Type of fluid
- - Crystalloid versus colloid
- SECONDARY FLUID REPLETION PHASE
- Oral rehydration therapy
- Intravenous rehydration therapy
- - Therapy according to serum sodium
- - Symptomatic hyponatremia
- - Therapy based on isotonic saline infusion
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS