The Rational Clinical Examination
David L. Simel, Drummond Rennie
Hypovolemia, Child
Michael J. Steiner, Darren A. DeWalt, Julie S. Byerley
Four studies evaluated acidosis as a test for dehydration.37,38,40,43 Most patients...
Topics Discussed:
dehydration, diagnostic process, hypovolemia, pediatric discipline, summarizing the evidence
Excerpt:
"Porter et al13 evaluated the agreement between parental
observation of examination signs and the signs elicited by trained
ED nurses. The 
value demonstrated substantial
agreement beyond chance when assessing for a sunken anterior fontanelle
( = 0.73) and presence of cool extremities ( = 0.70).
There was moderate agreement on general appearance ( = 0.46),
presence of sunken eyes ( = 0.49), absence
of tears ( = 0.57), and presence of dry
mouth ( = 0.52).Three studies evaluated the accuracy of history-taking in assessing
dehydration.13,35,37 All 3 of these studies evaluated
history of low urine output as a test for dehydration. In the pooled
analysis, low urine output did not increase the likelihood of 5% dehydration
(LR, 1.3; 95% CI, 0.9-1.9). Porter et al13 showed
that a history of vomiting, diarrhea, decreased oral intake, reported
low urine output, a previous trial of clear liquids, and having
seen another clinician during the illness before presenting to the
ED yielded LRs that lacked utility in the assessment of dehydration.
However, their data did suggest that children who had not been previously
evaluated by a physician during the illness might be less likely
to be dehydrated on presentation (LR, 0.09; 95% CI, 0.01-1.4).
Similarly, parental report of a normal urine output decreases the likelihood of dehydration (Gorelick
et al35 reported an LR of 0.27 [95% CI,
0.14-0.51] and Porter et al13 reported
an LR of 0.16 [95% CI, 0.01-2.5])...."
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