WHO (World Health Organisation) suggested management of dehydration secondary to diarrhoeal illness

Last reviewed 01/2018

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If severe dehydration then excessively rapid rehydration may result in cerebral oedema.

World Health Organization (WHO) scale for dehydration

It is important to determine the degree of dehydration in order to select the appropriate plan to treat or prevent dehydration.

Clinical assessment for degree of dehydration associated with diarrhoea is as follows

• if two or more of the signs in column C are present - the patient has "severe dehydration"
• if two or more signs from column B (and C) are present - the patient has "some dehydration".
• patients who fall under column A -  "no signs of dehydration"

Estimation of fluid deficit (and the requirement) in children with some dehydration or severe dehydration should be carried out by weighing them without clothing. (if weighing is not possible, a child's age may be used to estimate the weight) (1).

Note:

• treatment should never be delayed because a scale is not readily available (1)
• the three most useful predictors of 5% or more dehydration are abnormal capillary refill, abnormal skin turgor, and abnormal respiratory pattern (2)

fluid management following rehydration

Following rehydration, some children may be at risk of recurrence of dehydration. 

Recomendations on fluid management following rehydration:

• encourage breastfeeding and other milk feeds
• encourage fluid intake
• in children at increased risk of dehydration recurring, consider giving 5 ml/kg of ORS solution after each large watery stool. These include:

• children younger than 1 year, particularly those younger than 6 months
• infants who were of low birth weight
• children who have had more than five diarrhoeal stools in the previous 24 hours
• children who have vomited more than twice in the previous 24 hours.

Restart oral rehydration therapy if dehydration recurs after rehydration (3)

Reference:

• (1) World Health Organization. Cholera. Fact Sheet 107. July 2012
• (2) Colletti JE et al. The management of children gastroenteritis and dehydration in the emergency department. with J Emerg Med. 2010;38(5):686-98
• (3) National Institute for Health and Clinical Excellence (NICE) 2009. Diarrhoea and vomiting in children. Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years