PE24.16 | Severe Dehydration — Summary & Reflection

KEY TAKEAWAYS

Dehydration assessment and management is a core paediatric emergency skill:
• IMNCI classification (two-or-more-signs rule): No dehydration → Plan A; Some dehydration → Plan B (ORS 75 mL/kg over 4 h); Severe dehydration → Plan C (RL IV)
• Four clinical signs: level of consciousness (alert/restless/lethargic), eye appearance (normal/sunken), drinking ability (normal/thirsty/unable), skin pinch (<1s/1–2s/>2s)
• Plan C: RL 100 mL/kg total in two phases:
- Phase 1: 30 mL/kg — infants <12 months over 1 hour; children ≥12 months over 30 minutes
- Phase 2: 70 mL/kg — infants <12 months over 5 hours; children ≥12 months over 2.5 hours
• Reassess after Phase 1 — repeat if still severe; proceed to Phase 2 if improved
• SAM + dehydration: slower IV rate (15 mL/kg/h); skin pinch unreliable; specialist guidance needed
• Preferred IV fluid: Ringer's lactate (not normal saline) — contains lactate buffer for metabolic acidosis

REFLECT

Imagine being a health worker at a primary health centre at 2 AM with a 9-month-old infant who is lethargic, not drinking, eyes sunken, and skin that does not recoil. You have IV fluid and the knowledge from this module. The parents are terrified and looking to you. How confident are you in your ability to perform the skin pinch correctly, calculate the Plan C volumes, and set the right infusion rate for an infant? What concrete step would you take in the next two weeks — during your clinical posting — to build the muscle memory for this assessment so that when that moment comes, the skill is automatic rather than recalled from a page?