💧 Dehydration · Pediatric Severity & Rehydration Tool

Schwartz Clinical Handbook — Chapter 25 · Gorelick 4-point score · Oral rehydration · IV fluids · Hypernatremia · Hypoglycemia

Select clinical signs (cap refill, tears, mucous membranes, general appearance) → estimate % dehydration (mild <5%, moderate 5-10%, severe >10%) and guide oral vs IV rehydration.
⚠️ Red flags: lethargy, poor perfusion, sunken fontanelle, hypotension → urgent IV bolus 20 mL/kg normal saline.

📋 Step 1 — Clinical signs of dehydration
📌 Dehydration severity & management
📖 Schwartz Ch 25

Select Gorelick 4 signs: prolonged cap refill (>2 sec), abnormal skin turgor, dry mucous membranes, sunken eyes, absent tears, poor overall appearance → system calculates dehydration percentage and recommends ORT (Pedialyte) vs IV fluids (NS bolus) + maintenance.

✔️ 4‑point score (Gorelick): poor appearance, absent tears, dry mucous membranes, delayed cap refill.
✔️ Score 0 → none; 1 → mild (<5%); 2‑3 → moderate (5‑10%); 4 → severe (>10%).
✔️ Ondansetron facilitates ORT.
📘 Schwartz pearls (Chapter 25)
• 1/3 of moderately dehydrated children are hypoglycemic — check glucose.
• ORT with reduced osmolarity solution (75 mEq/L Na) is first line.
• Rule of 50 to calculate dextrose: 50 / dextrose% = mL/kg for 0.5 g/kg glucose.
• Hypernatremic dehydration: replace deficit slowly over 48h.