Hypertonic dehydration - pediatric oncall

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Gurmeet Singh, Reena Sood Department of Pediatrics and Department of Obstetrics and Gynaecology, Sh...

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Question
Dear sir I meet frequently a lot of cases of diarrhea some of them are hypertonic dehydration we have no investigation facility most of the cases will have repeated fits then died dispite the following regime 1- i.v fluid 1\5 glucose saline 80ml\kg weight slow infusion in two days after combating shock to avoid rapid correction of Na level 2- Ca in drip to avoid fit 3- antibiotic cover 4- antiepelitic measures 5- no investigation in all iraq because of the war what will you do if you are in my place
Answer
One may clinically suspect hypernatremic dehydration if the amount of dehydration is less than the amount of GI losses. In addition skin will be doughy and the child will be irritable. For clinical correction one may need to given maintainence sodium plus deficit of about 2-4meq/kg and fluids as per grade of dehydration. 1/5 glucose slaine may be too hypoosmolar initially as a child with hypernatremic dehydration may have very high serum osmolality. Thus giving such a low osmolar fluid may lead to shift of fluid in the cerebral space and cerebral edema which may be the cause of convulsions and death. Back to All Questions

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