Volume depletion in children - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Volume depletion is a common condition encountered in pediatric practice. Early signs and symptoms in infants and children are often nonspecific and frequently under-recognized.
Signs and symptoms vary by age and specific etiology but can include generalized irritability, thirst, decreased activity, tachycardia, delayed capillary refill, dry mucous membranes, sunken eyes, decreased skin turgor, and decreased urination. Specific causes of volume depletion such as diabetic ketoacidosis and acute tubular necrosis may present with increased urination. A meticulous general pediatric history and physical exam is the most sensitive means of determining that a child is in a state of volume depletion.
Hypotension is a late sign of volume depletion in children and often heralds overt circulatory collapse.
Initial management of children with mild or moderate volume depletion is with oral rehydration therapy. Regardless of etiology, children with severe hypovolemia and shock should be treated promptly with intravenous isotonic crystalloid solution.
With timely recognition and appropriate intervention, volume depletion in children is readily reversible, with an excellent prognosis.

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Upper limits of normal heart rate by age

Citations

Key Articles

Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022 Nov;23(7):835-56.[Abstract]
World Health Organization. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. Geneva: World Health Organization; 2005.
Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67.[Abstract][Full Text]
Golden DBK, Wang J, Waserman S, et al. Anaphylaxis: a 2023 practice parameter update. Ann Allergy Asthma Immunol. 2024 Feb;132(2):124-76.[Abstract][Full Text]

Other Online Resources

Clinical practice guideline for screening and management of high blood pressure in children and adolescents

Referenced Articles

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