Table 1

Guidelines for management of dehydration for children aged ≥1 month (excluding severe malnutrition)

Classification	Clinical signs	Recommended fluid management
Shock	All of; weak/absent pulse, altered consciousness AVPU*<A, temperature gradient (cold hands), capillary refill>3 s plus sunken eyes and slow skin pinch	Fluid bolus Ringer’s lactate/normal saline 20mL/kg
Severe dehydration	Two or more of; altered consciousness AVPU*<A or lethargy, unable to drink, sunken eyes, return of skin pinch of ≥2 s	Plan C Step 1: 30 mL/kg Ringer’s lactate over 30 min if aged ≥12 months OR over 1 hour if aged <12 months. Step 2: 70 mL/kg Ringer’s lactate over 2.5 hours if aged ≥12 months OR over 5 hours if aged <12 months
Some dehydration	Two or more of; drinks eagerly, sunken eyes, restlessness or irritable, return of skin pinch for 1–2 s	Plan B: 75 mL/kg ORS (Oral Rehydration Solution) over 4 hours
No dehydration	Less than two signs, not enough to classify as some or severe dehydration	Plan A: 10 mL/kg ORS after every loose stool

Adapted from WHO Pocketbook of Hospital Care for Children: Guidelines for the Management of Common Illnesses with Limited Resources (Second Edition, 2013)2 and Kenya Basic Paediatric protocols (January 2016 Edition).5
*AVPU is a scale used to measure and record a patient's level of consciousness.
AVPU, alert, pain, unresponsive, verbal/voice.