![]() The isotonic solution has a sodium concentration similar to plasma. It is controlled by the release of antidiuretic hormone (ADH) from the posterior pituitary causing water retention, and by the thirst mechanism.Īn isotonic solution does not change the volume of a cell. ![]() Tonicity is related to both the impact on a cell of a fluid and the osmolality of the fluid. It is related to its effect on the volume of a cell. Tonicity applies to the concentration of carbohydrates and electrolytes. Ĭhildren vary in required fluid intake due to increased metabolic rates, which cause increased fluid loss. The most useful lab test to determine the degree of dehydration is bicarb less than 17 mEq/L. BUN shows partial linear relation to the degree of dehydration, but overall is non-specific. Value also exists in a patient unable to eat, especially young children, monitoring to determine the need for dextrose as a component of fluids. The measurement of electrolytes to determine the co-derangement of sodium is a notable exception. With a few exceptions, labs possess a limited role in the diagnosis of dehydration. The presence of the following decreases the likelihood of clinically relevant dehydration: normal-appearing, moist mucous membranes, and absence of sunken eyes. A JAMA study revealed three clinical signs clinically helpful in recognizing 5% or greater dehydration: delayed capillary refill, abnormal skin turgor, and an abnormal respiratory pattern. Vital signs and physical exam should be frequently monitored to guide and assess the severity of dehydration. Treatment recommendations are based on the assessment of dehydration severity. Also, children with moderate dehydration manifest with dry mucous membranes, decreased skin turgor, tachycardia with a prolonged capillary refill, and abnormal respiratory pattern. ![]() For example, infants and young children with mild dehydration may present with either minimal or no clinical findings other than reduced urine output. It is difficult to accurately distinguish varying degrees of dehydration based on clinical examination alone. However, this assessment of the extent of volume depletion may be difficult. The assessment of the severity of dehydration is essential, as therapy instituted should be based on its severity. Minimal dehydration is defined as a loss of less than 3% of body weight. ![]()
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