How can I assess for dehydration in a severely malnourished child?
Assessment of hydration status is difficult because many of the normally-used signs are unreliable. Skin turgor appears poor in children with marasmus owing to the absence of subcutaneous fat; their eyes may also appear sunken. Diminished skin turgor may be masked by oedema in children with kwashiorkor. In both types of malnutrition the child’s irritability or apathy make assessment of the mental state difficult. Signs that remain useful for assessing hydration status include: eagerness to drink (a sign of some dehydration), and lethargy, cool and moist extremities, weak or absent radial pulse, and reduced or absent urine flow (signs of severe dehydration). In children with severe malnutrition it is often impossible to distinguish reliably between some dehydration and severe dehydration. Of equal importance, it is also difficult to distinguish severe dehydration from septic shock, as both conditions reflect hypovolaemia and reduced blood flow to vital organs. An important distinguishin
