Case Study: Management of Severe Dehydration in a Child with Acute Gastroenteritis

Abstract

This case study discusses a 3-year-old male presenting with acute onset vomiting, profuse watery diarrhea, and lethargy following a viral gastrointestinal illness, leading to severe dehydration. Prompt recognition, rapid intravenous rehydration, and supportive therapy resulted in complete recovery within 48 hours. The case emphasizes early assessment of dehydration severity, evidence-based fluid management, electrolyte monitoring, and caregiver education as vital components in managing acute gastroenteritis in pediatric patients.

Introduction

Acute gastroenteritis remains a leading cause of morbidity and mortality among children under five, particularly in low- and middle-income countries. It is typically caused by viral pathogens such as rotavirus or norovirus, and characterized by diarrhea, vomiting, and risk of dehydration.
Timely rehydration - oral or intravenous depending on severity is the cornerstone of management. Severe dehydration is a medical emergency that can progress rapidly to hypovolemic shock if not corrected. This case illustrates the structured evaluation and stepwise management of severe dehydration due to gastroenteritis in a young child.

Patient Information

Age / Gender: 3-year-old male
Weight: 13 kg
Medical History: No prior major illness; fully immunized including rotavirus vaccine
Family History: Non-contributory
Dietary History: Mixed diet, no recent dietary changes
Social History: Lives with parents in an urban area; attends preschool
Chief Complaints: Repeated vomiting, watery stools, and drowsiness for the past 24 hours

Clinical Findings

Symptoms:

• 10 episodes of watery diarrhea in 12 hours

• 6 episodes of non-bilious vomiting

• Marked thirst, lethargy, and refusal to feed

General Examination:

• Temperature: 99.8°F

• Heart Rate: 160 bpm (tachycardia)

• Respiratory Rate: 34/min

• Blood Pressure: 80/50 mmHg

• Capillary Refill Time: >3 seconds

• Skin Turgor: Very slow recoil

• Eyes: Sunken

• Mucous Membranes: Dry

• Fontanelle: Sunken

• Urine Output: Negligible in the past 6 hours

Assessment:
Clinical features indicated severe dehydration according to WHO classification.

Timeline

• Day 1 Morning: Onset of diarrhea and vomiting; mother administered oral fluids at home.

• Day 1 Evening: Worsening vomiting and refusal to drink; child appeared drowsy.

• Day 2 Early Morning: Brought to emergency department with severe dehydration signs.

• Within 30 Minutes of Admission: Rapid assessment and initiation of IV rehydration.

• Day 2 Evening: Improved alertness, reduced heart rate, and better perfusion.

• Day 3 Morning: Transitioned to oral rehydration solution (ORS).

• Day 3 Evening: Tolerating feeds, adequate urine output, discharged with advice.

Diagnostic Assessment

Laboratory Findings:

• Hemoglobin: 12.4 g/dL

• WBC: 9,800 /µL (normal)

• Serum Sodium: 154 mmol/L (mild hypernatremia)

• Serum Potassium: 3.1 mmol/L (mild hypokalemia)

• Serum Bicarbonate: 16 mmol/L (metabolic acidosis)

• Blood Urea Nitrogen (BUN): 24 mg/dL (elevated due to dehydration)

• Stool Routine: Watery, no blood or mucus; Rotavirus antigen positive

Interpretation:
Findings confirmed severe dehydration with mild electrolyte imbalance secondary to viral gastroenteritis.

Therapeutic Intervention

Step 1 – Emergency Fluid Resuscitation:

• Administered 20 mL/kg isotonic saline (0.9% NaCl) over 30 minutes.

• Reassessed perfusion; two boluses were required to restore capillary refill and improve consciousness.

Step 2 – Ongoing Fluid Replacement:

• Transitioned to Ringer’s Lactate at 100 mL/kg over the next 6 hours as per WHO Plan C protocol.

• Monitored urine output, heart rate, and level of consciousness hourly.

• Corrected hypokalemia with oral potassium supplementation once vomiting subsided.

Step 3 – Nutritional and Supportive Care:

• Introduced Oral Rehydration Solution (ORS) after stabilization.

• Continued breastfeeding and age-appropriate soft diet.

• Given zinc sulfate (20 mg/day) for 14 days to reduce recurrence.

• No antibiotics required as there were no signs of bacterial infection.

Step 4 – Monitoring and Parental Counseling:

• Regular monitoring of serum electrolytes and acid-base status.

• Educated caregivers on warning signs (persistent vomiting, bloody stools, decreased urine output) and importance of continued hydration.

Challenges Faced

• Recurrent Vomiting: Initially hindered oral rehydration, necessitating slow IV administration.

• Electrolyte Imbalance: Required cautious potassium supplementation and serial monitoring.

• Parental Anxiety: Addressed through continuous counseling and reassurance about recovery timeline.

Follow-Up and Outcomes

The child was reevaluated at 24-hour intervals post-discharge for the first week.
At the first follow-up visit (Day 7), the child exhibited normal activity, good appetite, and no recurrence of diarrhea.

Serum electrolytes normalized (Na 140 mmol/L, K 4.1 mmol/L, HCO₃ 22 mmol/L).
Weight gain of 300 grams was noted compared to admission, indicating successful rehydration.

At the one-month follow-up, growth parameters were within normal range, and there were no subsequent episodes of diarrhea.
The caregivers were commended for early presentation and adherence to home-based ORS administration.
This case highlights that timely recognition of dehydration severity and systematic management can achieve complete recovery without complications.

Discussion

This case underscores the critical importance of early assessment and prompt fluid therapy in pediatric acute gastroenteritis. According to WHO and Indian Academy of Pediatrics (IAP) guidelines, isotonic solutions such as normal saline or Ringer’s Lactate remain the gold standard for severe dehydration. Rapid volume restoration followed by maintenance fluids prevents hypovolemic shock and renal compromise.

In this patient, effective transition from IV to oral rehydration, electrolyte correction, and caregiver involvement ensured sustained recovery. Routine use of zinc supplementation and continued feeding improved mucosal healing and reduced post-infectious diarrhea risk. The case also demonstrates the necessity of distinguishing between mild, moderate, and severe dehydration through careful clinical evaluation, especially in resource-limited settings where laboratory facilities may be delayed.

Additionally, this case highlights the importance of preventive counseling, including the promotion of safe drinking water, proper hand hygiene, and timely initiation of ORS at home during diarrheal episodes. Early recognition of warning signs by caregivers can drastically reduce the risk of hospitalization and complications. Strengthening community health education, particularly through primary healthcare workers and pediatric outreach programs, remains essential to lowering morbidity from diarrheal illnesses. Overall, a combination of timely medical intervention, nutritional support, and sustained family awareness forms the cornerstone of effective pediatric dehydration management.

Key Takeaways

• Early clinical recognition of dehydration severity is vital in pediatric gastroenteritis.

• IV isotonic fluid resuscitation should be initiated immediately in severe cases.

• Regular monitoring of electrolytes and urine output ensures safe correction.

• Zinc and continued feeding play a pivotal role in recovery and recurrence prevention.

• Parental education on ORS use and hygiene can significantly reduce morbidity.

Patient’s Perspective

“My son was very weak and wouldn’t drink anything. The doctors acted quickly and explained every step. After the drips, he looked better within hours. They taught us how to use ORS at home, now we keep it ready all the time.”

Conclusion

This case highlights the critical importance of early recognition, prompt fluid resuscitation, and ongoing monitoring in the management of severe dehydration secondary to acute gastroenteritis in children. The successful recovery of the patient underscores that timely rehydration therapy guided by clinical assessment and adherence to WHO-recommended protocols, remains the cornerstone of treatment.

Moreover, this case illustrates the value of a multidisciplinary pediatric approach, integrating medical management, nursing vigilance, nutritional rehabilitation, and parental education to prevent recurrence. Ongoing emphasis on oral rehydration therapy (ORT), sanitation, and early feeding helps break the cycle of infection and malnutrition.

From a public health perspective, the case reaffirms the necessity of improving community-level awareness and accessibility to safe drinking water and ORS solutions. Early caregiver intervention can significantly reduce morbidity and mortality associated with diarrheal diseases.

In essence, the case not only demonstrates clinical excellence in acute management but also highlights the preventive and educational aspects vital to sustaining long-term child health outcomes. It reinforces that effective pediatric care extends beyond crisis management encompassing proactive education, prevention, and family empowerment.

References

1. World Health Organization (WHO). Pocket Book of Hospital Care for Children, 2nd Edition, 2013.

2. Indian Academy of Pediatrics (IAP). IAP Textbook of Pediatrics, 6th Edition, 2021.

3. Guarino A, et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Guidelines for Acute Gastroenteritis. J Pediatr Gastroenterol Nutr. 2014.

4. King CK, et al. Managing Acute Gastroenteritis Among Children: Oral Rehydration, Maintenance, and Nutritional Therapy. MMWR Recomm Rep. 2003.

5. UNICEF/WHO. Integrated Management of Childhood Illness (IMCI) Guidelines, 2020.

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