Evaluation of a child's state of hydration is most important. If possible, it is best to determine the degree of fluid loss by comparing the child's current weight to a recent previous weight. When objective measurements are not available, the state of hydration can be assessed by physical examination. Combinations of physical signs, including ill general appearance, capillary refill of longer than 3 s, dry mucous membranes, and absent tears, are good predictors. The presence of two or more signs predicts 5 percent or greater dehydration, whereas three or more signs predict 10 percent or greater dehydration. 7 Severe dehydration accompanied by lethargy, hypotension, and delayed capillary refill requires immediate administration of parenteral fluids. Although capillary refill may be affected by conditions other than dehydration, it should be considered a sign of significant dehydration until proven otherwise. 8 Guidelines for assessing dehydration are listed in Table... .12.2.-2.
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