Emergency treatment of severe dehydration after shock in children

The article is expertly consulted by Master, Resident Doctor Dang Thi Ngoan - Pediatrician - Neonatologist - Department of Pediatrics - Neonatology - Vinmec Ha Long International Hospital.

After the shock period in children, it is necessary to treat severe dehydration with emergency treatment according to the treatment regimen to protect the health and life of the child, avoiding the risk of unwanted complications.

Shock is a state of decreased blood flow and oxygen supply to peripheral organs, leading to impaired metabolic activity of cells and organs. Hypovolemic shock is a state of shock caused by a sudden decrease in circulating volume, leading to tissue hypoperfusion (cytocellular hypoxia) and cellular metabolic disturbances. Prolonged lack of cellular oxygen will lead to damage to the cells of the organs. If late, the patient may die.
The cause of shock is usually severe bleeding. Occasionally, hypovolemic shock can be caused by plasma loss or severe dehydration due to problems with the digestive system (acute diarrhea), kidneys, or skin. The disease may be more severe if the patient has a combined medical condition such as kidney disease, cardiovascular disease, diabetes mellitus, etc.
Symptoms of hypovolemic shock include: Peripheral vasoconstriction (cold and moist skin; cyanosis and cold extremities, lips, ears), tachycardia, lightness, low blood pressure, tachypnea, oliguria (urine output less than 15ml/h), mental status changes (confusion, delirium, lethargy, coma, anesthesia),...
Treatment is early detection and prompt treatment, immediately replenishing the patient's lost water.

After management of shock in a child, emergency management should be performed according to the following protocol to rehydrate severely dehydrated children:
Infuse 70ml/kg Ringer's lactate (Hartmann's) (or normal saline) over 5 hours to the child infants (under 12 months of age) and for 2.5 hours for older children (1 - 5 years). The amount of infusion is as follows: Children under 12 months old: Children under 4kg infusion 40ml/hour, 4-6kg infusion 70ml/hour, 6-10kg infusion 110ml/hour, 10-14kg infusion 170ml/hour; Children 1 - 5 years old: Children 6 - 10 kg infusion 220ml/hour, 10-14kg infusion 340ml/hour, 14-19 kg infusion 480ml/hour; Reassess the child's health every 1-2 hours. If the child's severe dehydration does not improve, more fluid should be given more rapidly; An electrolyte replacement solution (oresol) of about 5ml/kg per hour can be given to the child as soon as the child is able to drink. The amount of oresol water per hour for children is as follows: Children under 4kg drink 15ml, 6-6kg drink 25ml, 6-10kg drink 40ml, 10-14kg drink 60ml and 14-19kg drink 85ml; Reassess after 6 hours for infants and after 3 hours for older children. Next, classify the child's dehydration and continue to choose the following regimens: Treatment of diarrhea at home (sufficient fluid replacement, zinc supplementation, continued breastfeeding and attention for severe signs requiring re-examination), compensation water with oresol solution in the hospital or rapid fluid resuscitation (infusion and oral oresol); If possible, the child should be observed for at least 6 hours after rehydration to ensure adequate hydration by giving oral oresol solution.

Children who are severely dehydrated after shock need immediate emergency treatment to rehydrate the child in time. During the infusion and oral rehydration solution, it is necessary to closely monitor the child's condition to promptly deal with any incidents.