Doctors Revision

IMCI · Age: 2 months - 5 years

Some Dehydration

Classification for a child with diarrhoea who exhibits two or more signs indicating moderate fluid deficit, requiring treatment with Oral Rehydration Salts (ORS) in the clinic (Plan B).

View images for Some Dehydration (Google Images, opens in a new tab)
On this page

Care priority and warning signs

Care priority

Treat at Clinic (Plan B)

Red flags

  • Development of signs of severe dehydration during treatment.
  • Inability to drink ORS adequately.
  • Persistent vomiting.
  • Presence of another severe classification requiring referral.

Assessment

  • Ask: Does the child have diarrhoea?
  • Ask: For how long?
  • Ask: Is there blood in the stool?
  • Look/Feel: Look at the child's general condition. Is the child Restless, irritable?
  • Look/Feel: Look for sunken eyes.
  • Look/Feel: Offer the child fluid. Is the child Drinking eagerly, thirsty?
  • Look/Feel: Pinch the skin of the abdomen. Does it go back Slowly?

Classification

  • Two or more of the following signs: (Restless, irritable) OR (Sunken eyes) OR (Drinks eagerly, thirsty) OR (Skin pinch goes back slowly) -> SOME DEHYDRATION

Key features

  • Requires TWO or more of the following signs: Restless/irritable, Sunken eyes, Drinks eagerly/thirsty, Skin pinch goes back slowly.
  • Absence of signs of severe dehydration.
  • Requires supervised administration of ORS over 4 hours (Plan B).

Management

Non-pharmacological management

  • Supervise administration of ORS in clinic.
  • Continue breastfeeding frequently.
  • After 4 hours, reassess hydration status.

Pharmacological treatment

  • TREAT WITH PLAN B:
  • Give recommended amount of ORS over 4-hour period in the clinic. Amount based on weight or age: <6kg (<6m): 200-450ml; 6-<10kg (6-<12m): 450-800ml; 10-<12kg (12m-<2y): 800-960ml; 12-<20kg (2y-5y): 960-1600ml. (Approximate amount in ml = weight in kg x 75).
  • Show the mother how to give ORS: frequent small sips from a cup.
  • If child vomits, wait 10 minutes, then continue ORS but more slowly.
  • If the child wants more ORS than calculated, give more.
  • If eyelids become puffy, stop ORS and give plain water or breastmilk; resume Plan B when puffiness is gone.
  • After 4 hours: Reassess the child and classify dehydration. Select appropriate plan (A, B, or C) to continue treatment.
  • Begin feeding the child in clinic after 4 hours.
  • Give Zinc Sulphate 20mg dispersible tablet once daily for 10 days. Dose: Age 2m-<6m: 1/2 tablet (10mg). Age 6m-5y: 1 tablet (20mg). Show mother how to dissolve in small amount of expressed breastmilk, ORS or clean water.
  • If child also has a severe classification: Refer URGENTLY to hospital. Give frequent sips of ORS on the way. Advise mother to continue breastfeeding.

Pre-referral treatment

  • If referring due to co-existing severe classification: Give frequent sips of ORS on the way. Keep child warm. Give other needed pre-referral treatments.

Follow-up

  • If hydration improves and child is discharged on Plan A: Follow-up in 5 days if not improving.
  • If Plan B needs to be repeated or other issues arise: Follow-up as needed.
  • Advise mother to return immediately if signs of dehydration worsen or other danger signs appear.

Counselling points

  • Explain that the child needs special fluids (ORS) because of dehydration.
  • Show the mother how much ORS to give over 4 hours.
  • Show how to give ORS (sips from cup, what to do if vomits).
  • Explain the importance of Zinc and show how to give it for 10 days.
  • If mother must leave before 4 hours: Show her how to prepare ORS at home. Show how much ORS to give to finish the 4-hour treatment. Explain the 4 Rules of Home Treatment (Give Extra Fluid, Give Zinc, Continue Feeding, When to Return).
  • Advise mother when to return immediately (signs listed on page 30 - not drinking, sicker, fever; for diarrhoea also: blood in stool, drinking poorly).

Differential diagnosis

  • Severe Dehydration
  • No Dehydration
  • Early sepsis (child may be irritable)

Complications

  • Progression to severe dehydration
  • Electrolyte imbalance (less common if ORS used correctly)
  • Persistent vomiting leading to treatment failure

Prevention

  • Exclusive breastfeeding for 6 months.
  • Use of safe water and sanitation.
  • Handwashing with soap.
  • Appropriate complementary feeding.
  • Measles vaccination.
  • Rotavirus vaccination (if available).
  • Prompt use of ORS and Zinc at the start of diarrhoea.
  • Continued feeding during diarrhoea.

References

IMCI Chart Booklet - Page 3, Page 16 (Plan B, Zinc), Page 30

For learning and professional reference. Use current local guidance and clinical judgement.

Browse imci entries
Scroll to Top