VALIDITY OF CLINICAL SIGNS AND LABORATORY
ANALYSIS IN THE DIAGNOSIS OF DEHYDRATION IN CHILDREN WITH ACUTE DIARRHEA
Şalk-Vatandaş N,
Yurdakök K, Yalçın SS, Özmert E
Department of Social
Pediatrics, Hacettepe University Institute of Child Health, Ankara, Turkey
Objective: Studies concerning the sensitivity and
specificity of clinical and laboratory findings indicating dehydration are
scarce. This study was aimed to assess the validity of the history,
clinical and laboratory findings in the diagnosis of dehydration.
Methods: 121 children aged 2-24 months, admitted to
Diarrhea Training and Treatment Center with acute diarrhea was taken for
the study. The patients were examined for the clinical findings of
dehydration by three observers. Blood laboratory tests were done for
hemoglobin, electrolytes, pH, bicarbonate and urea. Cases were rehydrated
according to WHO recommendation. Percent weight gain (true weight loss on
admission) was calculated by subtracting weight at resolution of diarrhea
from weight on admission and dividing weight at resolution of diarrhea.
Results: Dehydration was overestimated in 13%of
cases and underestimated in 7% with WHO criteria when compared with percent
weight gain. Dehydrated children had higher frequency of diarrhea, longer anuri
time and higher rate of cows milk intake on admission (p<0.05). In
children with the mean weight loss is ≥ 2 %, thirsty, weakness, sunken
fontanel, sunken eyes, decreased tears, dry mucous membranes and dry lip
were detected. The most valid laboratory findings were low pH (<7.30),
low bicarbonate concentration (<15 mmol/L) and high uric asit level
(>5.8 mg/dL). Interobserver reliability was found to be good to
excellent for all clinical sings. In multivariate analysis, thirsty, dry
mucous membranes, weakness, sunken eyes, hoarse crying and low pH were
found to be significant clinical and laboratory findings that show the loss
of body weight.
Conclusion: In children with acute
diarrhea, last urination time and purging rate should be asked, thirst, dry
mucous membranes, weakness, sunken eyes, hoarse crying should be examined.