Criteria

Commonly used indicators to determine level of volume depletion

Mild to moderate volume depletion

  • Preserved normal mental status

  • Hemodynamic stability

  • Mildly altered vital signs (e.g., minor degree of tachycardia).

Severe volume depletion

  • Altered mental status

  • Hemodynamic instability

WHO: Manual for the management of diarrhea for physicians and senior health workers

Classifies symptoms of volume depletion in children presenting specifically with diarrheal illnesses.[14] Symptoms and signs allow for placement of children into one of two categories according to severity of volume depletion.

Mild to moderate dehydration (5% to 10% loss of total body water)

  • General: restless, irritable

  • Eyes: sunken

  • Thirst: thirsty, drinks eagerly

  • Skin pinch: goes back slowly

Severe dehydration (>10% loss of total body water)

  • General: lethargic or unconscious

  • Eyes: sunken

  • Thirst: drinks poorly or cannot drink

  • Skin pinch: goes back very slowly

American College of Surgeons: Classification of estimated blood loss in children

Classifies estimated blood loss by clinical signs in children.[24] Simplifies presentation to 4 systems in 3 categories (mild, moderate, and severe).

Mild (15% to 30% total blood volume loss)

  • Cardiovascular system (CVS): tachycardic, weak pulses

  • CNS: irritable, confused, agitated

  • Skin: cool, prolonged capillary refill

  • Urine output: minimally decreased

Moderate (30% to 45% total blood volume loss)

  • CVS: tachycardic, thready peripheral pulses, narrow pulse pressure, mild hypotension

  • CNS: lethargic, minimally responsive

  • Skin: cyanotic or pallid, extremely prolonged capillary refill

  • Urine output: minimal

Severe (>45% total blood volume loss)

  • CVS: tachycardic, absent peripheral pulses, hypotensive, late bradycardia

  • CNS: comatose

  • Skin: pale, cold

  • Urine output: none

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