HOW VALID ARE CLINICAL SIGNS OF DEHYDRATION IN INFANTS

Our objective was to determine the ability of several clinical signs o f dehydration to distinguish among degrees of dehydration in infants w ith acute diarrhea, The design was a prospective cohort study in a ped iatric referral hospital in Cairo, Egypt. infant boys, 3-18 months old , with a history of acute diarrhea (5 or more watery stools per day fo r no more than 7 days) were eligible, except those with frank protein- energy malnutrition, serious nongastrointestinal illness, or being exc lusively breast-fed. Several clinical signs of dehydration were assess ed upon study entry. Subjects were then rehydrated with an oral rehydr ation solution and fed a standardized diet until diarrhea ceased (no w atery or loose stools for 16 h). The main outcome measure was percent body weight gain at rehydration and at resolution of illness. Data fro m 135 subjects were available for analysis. Average (SD) rehydration p hase duration was 5.2 (2.1) h, and average (SD) duration of illness wa s 54.5 (38) h. Multiple regression analysis selected prolonged skinfol d, altered neurologic status, sunken eyes, and dry oral mucosa as the clinical signs that correlated best with percent dehydration (R(2) for model 0.244, p < 0.001), Mean weight gain for the two assessment syst ems was 3.6-3.9% for mild, 4.9-5.3% for moderate, and 9.5-9.8% for sev ere dehydration. The most valid clinical signs of dehydration include prolonged skinfold, altered neurologic status, sunken eyes, and dry or al mucosa, Children with clinical signs of mild or moderate dehydratio n have fluid deficits on the order of 3 or 5% body weight, respectivel y.