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Hydration in severe acute asthma
P C Potter1, M Klein, E G Weinberg
1Department of Clinical Science and Immunology, University of Cape Town, South Africa.
Insights
Mild dehydration is common in children with severe acute asthma, with body weight typically near their stable levels. Bedside assessments of dehydration were unreliable in this study.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Nutrition
Background:
- Severe acute asthma in children can lead to dehydration.
- Accurate assessment of dehydration is crucial for effective management.
- Previous studies have not fully characterized dehydration in pediatric asthma exacerbations.
Purpose of the Study:
- To quantify the degree of dehydration in children admitted to the hospital for severe acute asthma.
- To evaluate the reliability of bedside assessments for dehydration.
- To identify clinical indicators correlating with dehydration severity.
Main Methods:
- Studied twenty children during severe acute asthma attacks.
- Measured body weight on admission compared to stable weight (7-10 days post-attack).
- Assessed packed cell volume, serum electrolytes, and osmolality.
- Correlated dehydration indicators with blood pH and peak expiratory flow rate recovery.
Main Results:
- Mean body weight on admission was 97.8% of stable weight; only 3 children <95%.
- Bedside dehydration assessment was unreliable.
- Packed cell volume was significantly higher on admission (0.44 vs 0.42).
- Dehydration correlated best with a fall in blood pH; no association with recovery of peak expiratory flow rate.
Conclusions:
- Mild dehydration is common in severe acute childhood asthma.
- Fluid administration of 50 ml/kg/24 hours was found to be safe and appropriate.
- Further research may be needed to refine dehydration assessment methods in pediatric asthma.
Abstract:
Twenty children were studied during severe attacks of acute asthma to find out how dehydrated they were on admission to hospital. Mean body weight on admission was 97.8% of their reference stable weight seven to 10 days after the attack and in only three children was it less than 95% of the stable weight. Bedside assessment of dehydration was unreliable. The mean packed cell volume was significantly higher on admission than 7-10 days later (0.44 compared with 0.42, difference 0.02 SE 0.01). Serum sodium and potassium concentrations and osmolality on admission were within normal ranges. The degree of dehydration correlated best with a fall in blood pH. There was no association between the degree of dehydration and the recovery of the peak expiratory flow rate during the first 24 hours or thereafter. We conclude that mild dehydration is common in severe acute childhood asthma. Fluid given at a rate of 50 ml/kg/24 hours was safe and appropriate for these children.