1WHO Clinical Dehydration Matrix
| Clinical Sign | 0 — No Dehydration | 1 — Some Dehydration | 2 — Severe Dehydration |
|---|---|---|---|
| General Appearance | Well, alert, interactive | Restless, irritable | Lethargic, floppy, or unconscious |
| Eyes | Normal, tears present | Sunken appearance | Deeply sunken, dry, no tears |
| Thirst / Oral Intake | Drinks normally; not thirsty | Thirsty; drinks eagerly | Drinks poorly or unable to drink |
| Skin Pinch (Abdomen) | Retracts immediately | Retracts slowly (< 2 seconds) | Retracts very slowly (> 2 seconds) |
2WHO Protocol Treatment Plans (A, B, and C)
WHO Plan A — No / Minimal Dehydration (<5% Deficit)
Home management focusing on preventing dehydration. Give 10 mL/kg of ORS after every loose stool (50–100 mL for children <2 years; 100–200 mL for children ≥2 years). Continue frequent on-demand breastfeeding and regular feeding.
WHO Plan B — Some Dehydration (5%–9% Deficit)
Clinic-supervised oral rehydration. Administer 75 mL/kg of low-osmolarity ORS over 4 hours using a spoon or cup. If vomiting occurs, wait 10 minutes then resume slowly (1 teaspoon every 1–2 minutes). Reassess hydration status at 4 hours. If improved, discharge on Plan A.
WHO Plan C — Severe Dehydration (≥10% Deficit)
Medical emergency requiring urgent intravenous rehydration with Ringer's Lactate (100 mL/kg total):
- Infants (<12 months): 30 mL/kg over 1 hour → 70 mL/kg over 5 hours (total 6 hours).
- Children ≥12 months & Adults: 30 mL/kg over 30 minutes → 70 mL/kg over 2.5 hours (total 3 hours).
3Zinc Supplementation (IAP & WHO Protocol)
Zinc supplementation is an indispensable co-therapy alongside oral rehydration for all children with acute watery diarrhea:
• Infants under 6 months: 10 mg elemental zinc once daily for 14 days
• Children 6 months to 5 years: 20 mg elemental zinc once daily for 14 days
Mechanism: Enhances enterocyte regeneration, stimulates brush-border enzymatic transport, reduces stool frequency, and provides protection against subsequent episodes for up to 3 months.
4Red Flags Requiring Inpatient Admission
- Lethargy or Unconsciousness: Inability to drink safely carries a high aspiration hazard.
- Persistent Emesis: Vomiting repeatedly (>3–4 times/hour) preventing successful oral rehydration.
- Macroscopic Dysentery: Stools containing fresh blood or mucus (requires targeted antimicrobial therapy).
- Young Infants (<3 months): Higher baseline risk of rapid fluid shifts, hypoglycemia, and occult sepsis.
- Abdominal Distention or Absent Bowel Sounds: Suggestive of paralytic ileus or hypokalemia.
5Frequently Asked Questions
What makes Ringer's Lactate superior to 0.9% Normal Saline for Plan C?+
Ringer's Lactate has a physiological chloride content (109 mEq/L) compared to 0.9% saline (154 mEq/L). Large-volume rehydration with normal saline frequently induces hyperchloremic metabolic acidosis. Furthermore, the lactate in Ringer's is metabolized in the liver to bicarbonate, helping correct base deficits caused by intestinal bicarbonate losses.
How do you recognize hypernatremic dehydration?+
Hypernatremic dehydration (Serum Na >150 mEq/L) presents with a characteristically "doughy" skin turgor, extreme irritability, a high-pitched cry, and prominent thirst out of proportion to skin signs. Because intravascular volume is relatively preserved, standard dehydration signs may be masked. It requires slow, controlled rehydration over 48 hours to prevent cerebral edema.
Should feeding be stopped while oral rehydration is underway?+
No. Breastfeeding should never be interrupted. In Plan B, resume age-appropriate solid and semi-solid food (khichdi, bananas, curd, rice) as soon as the initial 4-hour rehydration period is completed. "Bowel rest" starves enterocytes, delays mucosal repair, and worsens nutritional stunting.
Medical Disclaimer: This clinical calculator is designed for healthcare professionals. Clinical dehydration assessment requires comprehensive evaluation of all 4 WHO parameters alongside capillary refill time, heart rate, and vital signs. Children exhibiting signs of shock, lethargy, or failure of oral rehydration require immediate emergency hospitalization.