#NEPHTWEETORIAL #NEPHKIDS2020 LET'S TALK DEHYDRATION!🥵 Welcome to our first tweetorial where we'll be discussing the pathophysiology of dehydration🤯& try and answer the WHAT, WHY, WHERE, WHEN, HOW in management.🤔 -@jpsugumar @IPNA_PedNeph
Our 👫🏽 body resembles the composition of Mother🌎. We're 2/3rd 💦 Let's look at this conceptual classification to understand which compartment of our 👫🏽 are affected the most according to underlying etiology. 
Similar to the droughts affecting our agricultural lands, DEHYDRATION affects our internal mileu resulting in physiological disturbances. 🌱🌾➡️🥀🍂
(from Askew EW. Water. In: Ziegler EE, Liler LJ, eds. Present Knowledge in Nutrition. 7th ed. Washington, DC: ILIS; 1996:98–108)
(from Askew EW. Water. In: Ziegler EE, Liler LJ, eds. Present Knowledge in Nutrition. 7th ed. Washington, DC: ILIS; 1996:98–108)
Dehydration can result in serious CNS symptoms. Have a look at this analogy depicting how dehydration with dyselectrolytemia affects the 🧠 parenchyma. Hyponatremia causes cerebral edema & Hypernatremia can cause brain shrinkage 👇🏾
Moving on from pathophysiology, Let's look at the most common cause of Dehydration in the 👶🏽 age group. You're 👩🏽⚕️receiving this 👶🏽 in ER with h/o diarrhea.
Which classification for dehydration will you follow to classify this child?
Acute diarrheal disease is the most common cause of dehydration in children and is responsible for 8.6% of deaths in the U-5 age group.
doi.org/10.1016/S0140-…
doi.org/10.1016/S0140-…
Despite being an important contributor to mortality, therein lie several inconsistencies across practitioners in the management of Diarrhea & Dehydration.
Let's have a look at the commonly used clinical scales for assessing dehydration 🥵 ROL📚 revealed that neither scales were found to be superior to one another for ruling in dehydration.
Assuming the child has been classified successfully according to one of the scales mentioned above, a subsequent conundrum occurs in the management of the 👶🏽.
Here's WHO's Plan A&B rehydration plan for mild & moderate dehydration at the community level. 🙅🏾♀️ Differences arise in managing the spectrum of children presenting with Moderate dehydration🥵. Will it be ORS 😋 or IVF 💉?
📚 showed that ORT is as effective as IVF in managing dehydration. Despite being more convenient, 1 study showed that 49% of parents would refuse to consider ORT🙅🏾♀️Parental education at the Hospital and Community level is vital here! ncbi.nlm.nih.gov/pmc/articles/P…
Considering IVF management, No change in cell volume occurs when infused with Isotonic solutions and hence they're considered the fluid of choice in the management of Dehydration. doi.org/10.1152/advan.…
Caution⚠️- Fluid therapy should be considered equivalent to drug administration and perform continuous clinical monitoring + intermittent laboratory investigations as required.
👇🏾#NowThis should provide a concise format for assessing and managing dehydration 🥵
Though no single scale is considered superior, integration of PALS with the assessment of Dehydration will be profoundly helpful. 🌟
Address these important questions when 🧒 presents to you with dehydration! 🥵🥵🥵🥵🥵
Here's an example of a "plan of care" for a child weighing 10kg presenting with Moderate Dehydration & Severe Dehydration.
With this, we leave you here at the end of this tweetorial with the concepts we feel will help in better management of Dehydration in children 🌝 Join us for the next tweetorial on Nov 6th ! #NEPHTWEETORIAL #NEPHKIDS2020 @jpsugumar & Dr ST
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