Prevalence and fluid management of dehydration in children without diarrhoea admitted to Kenyan hospitals: a
Sylvia Omoke1, Mike English2,3, Jalemba Aluvaala2,4
1Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya somoke@kemri-wellcome.org.
Insights
Dehydration without diarrhea affects 16% of hospitalized children, with many not receiving adequate fluid therapy. Management often mirrors diarrhea protocols, highlighting a need for specific guidelines for non-diarrheal dehydration in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Dehydration is a common reason for hospital admission in children.
- Diarrhea is the most frequent cause of dehydration, but other conditions can also lead to it.
- Understanding the prevalence and management of dehydration without diarrhea is crucial for optimizing pediatric care.
Purpose of the Study:
- To determine the incidence of dehydration in children aged 1-59 months without diarrhea.
- To describe current fluid management strategies for these cases.
- To identify common co-occurring diagnoses and outcomes.
Main Methods:
- A multisite observational study utilizing prospective in-patient data.
- Data collected from 13 county referral hospitals in Kenya between October 2013 and December 2018.
- Inclusion criteria: children aged 1-59 months diagnosed with dehydration, excluding neonates and those with severe acute malnutrition.
Main Results:
- Dehydration without diarrhea occurred in 3.0% of admitted children, representing 15.9% of all dehydration cases.
- Only 55.8% of affected children received any fluid therapy (oral or intravenous).
- Common co-diagnoses included pneumonia (50.6%) and malaria (35.4%), with an overall case fatality rate of 12.9%.
Conclusions:
- A significant proportion of pediatric dehydration cases occur without diarrhea, often associated with other serious illnesses.
- Current fluid management practices for non-diarrheal dehydration are inconsistent and may not be optimal.
- Further research is needed to establish evidence-based guidelines for managing dehydration in children when diarrhea is absent.
Objectives:
To examine the prevalence of dehydration without diarrhoea among admitted children aged 1-59 months and to describe fluid management practices in such cases.
Design:
A multisite observational study that used routine in-patient data collected prospectively between October 2013 and December 2018.
Settings:
Study conducted in 13 county referral hospitals in Kenya.
Participants:
Children aged 1-59 months with admission or discharge diagnosis of dehydration but had no diarrhoea as a symptom or diagnosis. Children aged <28 days and those with severe acute malnutrition were excluded.
Results:
The prevalence of dehydration in children without diarrhoea was 3.0% (2019/68 204) and comprised 15.9% (2019/12 702) of all dehydration cases. Only 55.8% (1127/2019) of affected children received either oral or intravenous fluid therapy. Where fluid treatment was given, the volumes, type of fluid, duration of fluid therapy and route of administration were similar to those used in the treatment of dehydration secondary to diarrhoea. Pneumonia (1021/2019, 50.6%) and malaria (715/2019, 35.4%) were the two most common comorbid diagnoses. Overall case fatality in the study population was 12.9% (260/2019).
Conclusion:
Sixteen per cent of children hospitalised with dehydration do not have diarrhoea but other common illnesses. Two-fifths do not receive fluid therapy; a regimen similar to that used in diarrhoeal cases is used in cases where fluid is administered. Efforts to promote compliance with guidance in routine clinical settings should recognise special circumstances where guidelines do not apply, and further studies on appropriate management for dehydration in the absence of diarrhoea are required.
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Dehydration occurs when the body loses fluids (particularly water).
Causes:
The major causes of dehydration include excessive sweating, fever, vomiting, diarrhea, and diuresis.
Signs and Symptoms:
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