Droopy Dani — Infant Dehydration & Gastroenteritis
Sunken fontanel, no tears, < 4 wet diapers/day — weigh-based oral or IV rehydration now
Dani, 7 months old, has had vomiting and watery diarrhea for two days and has not had a wet diaper in over eight hours. Her mother says she is unusually quiet and will not take her bottle.
Dani is an infant with acute viral gastroenteritis causing vomiting and watery diarrhea. Dehydration in infants shows as a sunken anterior fontanel, dry mucous membranes, absent tears, decreased urine output and delayed capillary refill. Weight loss is the most accurate measure of fluid loss. Mild-to-moderate dehydration is treated with oral rehydration solution in small frequent amounts; severe dehydration requires IV isotonic fluids, and undiluted juice or plain water should never replace rehydration solution in infants.
Read Droopy Dani's full story →The story arc
The setup
Dani develops a viral illness with vomiting followed by frequent watery stools, common at daycare this time of year.
The turn
By day two she refuses her bottle, her lips look dry, and she has not produced a wet diaper in eight hours.
The crisis
Her anterior fontanel is visibly sunken, she cries without tears, her capillary refill is over 3 seconds, and she has lost 8% of her body weight since her last well-child visit.
The save
The nurse weighs Dani, starts IV isotonic fluids for her severe dehydration, monitors strict intake and output, and reassesses fontanel, mucous membranes and capillary refill frequently as she rehydrates.
NCLEX study section — Infant Dehydration & Gastroenteritis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pediatrics
Take this chapter into practice questions on the same topic.