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.

 
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