Dehydration Clinical Pathway, Emergency Department and Inpatient – History and Physical

Dehydration Clinical Pathway — Emergency Department and Inpatient

History and Physical

Goal

  • Rapidly assess degree of dehydration
  • Identify patients who have other underlying cause for their symptoms
    (surgical, metabolic or CNS disease)

History

Onset of symptoms, presence of fever
Emesis How many, last time, bilious/bloody, worse in the AM
Diarrhea How many, last time, blood/mucous
Intake Type and amount of fluid given
Urination How many times, last time, color/odor
Exposure Ill contacts, new foods, farm animals, foreign travel
Pain Location, quality, radiation, duration
Pre-illness weight If known, weight loss is a sensitive indicator of dehydration

Physical Exam

  • General appearance, VS, Weight
  • Mental status (lethargic, listless, decreased activity)
  • Respiratory status (tachypnea, Kussmaul respirations)
  • Abdominal tenderness, rebound, or guarding
  • Concerns for increased ICP (focal neurologic exam, papilledema)

Consider Alternative Diagnosis

  • Consider alternate diagnoses if any of the following features are present:
    • Duration of symptoms > 7 days
    • Significant electrolyte abnormalities
    • Oliguria despite appropriate rehydration
    • Abnormal neurologic findings
    • Emesis in the absence of diarrhea, awakening child from sleep or occurring consistently upon awakening

Signs of Dehydration

See Dehydration Assessment Tools