How do you diagnose dehydration in a severely malnourished child?

Signs of dehydration for well-nourished children (slow skin pinch, sunken eyes, dry mouth, absent tears, and weight loss) are likely to be present in severe malnutrition due to tissue loss and changes in the salivary and lachrymal glands, and therefore these signs can be misleading for diagnosing dehydration in malnutrition. Assume dehydration if the child has watery diarrhoea and/or persistent vomiting.

How do you know when a child is rehydrated?

It is often difficult to tell if the child is responding to rehydration fluid as the usual signs of dehydration may remain even when the child is fully rehydrated.

Stop ReSoMal after 12h of rehydration, or earlier if there are:

  • 3 or more hydration signs (e.g. passing urine, faster skin pinch, tears, moist mouth, eyes less sunken, not thirsty) or
  • signs of fluid overload.

Do not wait for the watery stools to end before stopping ReSoMal. Watery stools can continue long after dehydration has been corrected.

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