💧 TOACS FCPS Station · Dehydration due to Acute Gastroenteritis
📷 Clinical Photograph – Dehydration
🔍 Key clinical features of dehydration:
- ✓ Poor skin turgor skin tenting (>2 sec)
- ✓ This child has severe dehydration (>10% body weight loss – a medical emergency
- ✓ Dry mucous membranes – sticky mouth, absent tears
- ✓ Sunken eyes – periorbital hollowing
- ✓ Delayed capillary refill – >2 seconds
- ✓ Lethargy, irritability – poor overall appearance
- ✓ Reduced urine output – <1 mL/kg/hr
📋 Clinical scenario (examiner prompt)
A 15‑month‑old child is brought to the emergency department with a 2‑day history of watery diarrhea and vomiting. The mother reports poor oral intake and decreased urine output (only 2 wet diapers in the past 24 hours). On examination, the child is lethargic and irritable when disturbed. There are sunken eyes, dry mucous membranes, absent tears, and skin turgor returns slowly (>2 seconds). Capillary refill is 3 seconds. Weight is 8 kg (lost 0.6 kg from previous visit).
🧑⚕️ Examiner tasks · TOACS
1. Identify the diagnosis from the clinical image and context.
2. Describe the clinical features (sunken eyes, dry mucous membranes, absent tears, poor skin turgor, delayed cap refill, lethargy).
3. Classify dehydration severity using WHO/IMCI algorithm.
4. Discuss management (IV fluids, ORS, ondansetron, zinc, antibiotics if indicated).
🎯 Expected answers (for examiners)
- • Diagnosis: Severe dehydration due to acute gastroenteritis
- • Clinical features: Sunken eyes, dry mucous membranes, absent tears, poor skin turgor (>2 sec), delayed capillary refill (>2 sec), lethargy, decreased urine output, weight loss >10%
- • Dehydration classification: Severe (>10% body weight loss) – >100 mL/kg deficit
- • IV rehydration: Ringer lactate or normal saline 20 mL/kg bolus, repeat until perfusion restored. Then 70 mL/kg over 2.5-5 hours
- • ORS: Low-osmolarity ORS (245 mOsm/L) – once able to drink, 5-10 mL q5min
- • Ondansetron: For persistent vomiting – oral dissolvable 2 mg (8-15 kg) or 4 mg (>15 kg)
- • Zinc: 20 mg/day (10 mg for infants) for 10-14 days (developing countries)
- • Antibiotics: Not routinely; only for dysentery, cholera, severe bacterial infection, immunocompromised
• No dehydration: <3% – ORS at home
• Some dehydration: 5-9% – ORS 75 mL/kg over 3-4 hours
• Severe dehydration: ≥10% – IV fluids (20 mL/kg bolus) + ORS
• Gorelick signs (4-point): poor appearance, absent tears, dry mucous membranes, delayed cap refill – score 0-4 guides severity
⚡ Quick FCPS‑style MCQ
A 15-month-old with watery diarrhea for 2 days has sunken eyes, absent tears, dry mucous membranes, delayed capillary refill (3 sec), and lethargy. The weight loss is 7%. This child has:
A. No dehydration B. Some dehydration (5-9%) C. Severe dehydration (≥10%) D. Malnutrition📌 Topic summary · Dehydration in Acute Gastroenteritis
Fluid loss >5% body weight
Sunken eyes, dry mucous membranes, ↓ tears, ↓ urine
Lethargy, poor cap refill, shock, absent tears
75 mL/kg over 3-4h for some dehydration
NS bolus 20 mL/kg, then 70 mL/kg over 2.5-5h
Reduces vomiting, facilitates ORS
| Feature | Some Dehydration (5-9%) | Severe Dehydration (≥10%) |
|---|---|---|
| Appearance | Irritable, restless | Lethargic, floppy |
| Eyes | Sunken | Very sunken |
| Tears | Decreased | Absent |
| Mucous membranes | Dry | Very dry |
| Skin turgor | Slow (>2 sec) | Very slow (>2 sec) |
| Capillary refill | Delayed (>2 sec) | Very delayed (>3 sec) or shock |
| Urine output | Decreased | Oliguria/anuria |
| Management | ORS 75 mL/kg over 3-4h | IV NS bolus 20 mL/kg + ORS |