Diagnosis and treatment protocols for Dehydration in Uganda

Mild Dehydration

Thirsty, alert. Pulse normal. Respiration normal. Systolic BP normal. Skin pinch returns rapidly. Eyes normal. Mucous membranes moist. Urine output normal.

Moderate Dehydration (≥2 signs required)

Thirsty, anxious. Pulse rapid. Respiration deep, may be rapid. Systolic BP normal. Skin pinch returns slowly. Eyes sunken. Tears absent. Mucous membranes dry. Urine reduced, dark.

Severe Dehydration (≥2 signs required)

Pulse rapid, thready, sometimes absent. Respiration deep and rapid. Systolic BP low or immeasurable. Skin pinch returns very slowly (>2 sec). Eyes very sunken. Clammy, cold extremities. Possible cyanosis, muscle cramps. Anuria.

Mild Dehydration

Give oral ORS 25 ml/kg over first 4 hours. Increase or maintain until clinical improvement.

Moderate Dehydration

Give oral ORS 50 ml/kg over first 4 hours.

Severe Dehydration — IV Fluid Regimen

Ringer's Lactate (or Normal Saline 0.9%) IV. First hour: 1 L. Next 3 hours: 2 L. Next 20 hours: 3 L. Give rapidly until radial pulse is felt, then adjust rate. Re-evaluate vitals after 4 hours.

After Rehydration (Severe)

Once signs of dehydration resolve (do not stop early), start fluid maintenance: alternate ORS and water to avoid hypernatraemia. Continue as long as cause persists.

Notes

Volumes are guidelines only — may increase or maintain high rate until clinical improvement. Adults can take up to 750 ml ORS/hour. Continued nutrition is important — food should be continued during treatment. Avoid artificially sweetened juices.

Prevention

Encourage prompt use of ORS at home if the person is vomiting and/or having diarrhoea.