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INTRODUCTION

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Sir William MacGregor, MD, at the end of his term as Papua New Guinea’s colonial governor, wrote: “Dysentery causes more deaths than any other disease in tropical countries. No other malady is so universally distributed and of such constant occurrence … [Dysentery has become] the chief agent in the rapid depopulation of the Pacific.”1

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Rehydration does not have the drama of other medical interventions—but it saves more lives than all other disease treatments combined.

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ASSESSMENT

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Diarrhea

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Diarrhea causes most cases of lethal dehydration, especially among infants and children. Acute diarrhea is three or more loose or watery stools per day or a definite decrease in stool consistency and an increase in stool frequency for the individual. The volume of fluid lost through stools can vary from 5 mL/kg body weight/day (approximately normal) to ≥200 mL/kg body weight/day.2 Because of the use of oral rehydration therapy (ORT), the annual worldwide deaths from diarrhea have decreased from >5 million in 1978 to 2.6 million in 2009 (1.1 million people >5 years old and 1.5 million children <5 years old).3

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Pediatric Dehydration

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Assessing a child’s level of dehydration is a clinical diagnosis. This assessment should be no harder in austere situations than in standard practice—except that the confounder of malnutrition may play a big role in a child’s appearance. Laboratory studies, including serum electrolytes, are usually unnecessary.4 Stool cultures are indicated in dysentery, but are not usually indicated in acute, watery diarrhea for an immunocompetent patient.

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Although studies in Africa and the United States have shown dehydration assessment scales to be relatively unreliable, they give clinicians a starting point to evaluate these children. Tables 11-1 and 11-2 are two scales that are easy to use in austere settings and have good inter-rater reliability.5,6

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Table Graphic Jump Location
TABLE 11-1Clinical Pediatric Dehydration Scoring System
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Table Graphic Jump Location
TABLE 11-2WHO Scale for Dehydration in Children 1 Month to 5 Years Old

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