A PROSPECTIVE-STUDY OF THE USEFULNESS OF CLINICAL AND LABORATORY PARAMETERS FOR PREDICTING PERCENTAGE OF DEHYDRATION IN CHILDREN

To evaluate the relative utility of clinical and laboratory parameters of dehydration in children for predicting the magnitude of percent lo ss of body weight (PLBW), we studied 97 children who required intraven ous fluids for acute dehydration, After a complete history and physica l examination, the managing physician made a clinical estimation of de hydration for each child, based on a standard clinical scale, Serum el ectrolytes were obtained in all children prior to intravenous hydratio n therapy, PLBW was calculated after recovery from acute dehydration b y comparing the weight on presentation to the emergency department wit h the weight measured at a follow-up visit when the child was judged w ell, Children were classified according to PLBW into three groups whic h reflect the categories in a standard clinical scale: mild = PLBW les s than or equal to 5 (n = 50), moderate = PLBW 6-10 (n = 30), and seve re PLBW > 10 (n = 17), The physician's clinical estimate of dehydratio n compared to PLBW had a sensitivity of 74% (95% confidence interval ( CI): 60-85) for mild dehydration, 33% (95% CI: 17-53) for moderate deh ydration, and 70% (95% CI: 44-89) for severe dehydration, There was a significant difference in the mean serum bicarbonate concentrations (H CO3) between the PLBW groups (P < 0.01). The sensitivity of the HCO3 < 17 mEq/L in predicting PLBW was 77% (95% CI: 58-90) for PLBW 6-10, an d 94% (95% CI: 71-100) for PLBW > 10. The combination of the clinical scale and the serum bicarbonate identified all 17 children with PLBW > 10 and 90% (27 of 30) children with PLBW 6-10, Our data suggest that physicians should not rely solely on clinical assessment to rule out s evere dehydration in children, and that obtaining a serum bicarbonate may improve the accuracy of predicting serious dehydration.