Vega R M, Avner J R
Division of General Pediatrics, Jacobi Medical Center, Bronx, NY 10451, USA.
Pediatr Emerg Care. 1997 Jun;13(3):179-82. doi: 10.1097/00006565-199706000-00001.
To evaluate the relative utility of clinical and laboratory parameters of dehydration in children for predicting the magnitude of percent less of body weight (PLBW), we studied 97 children who required intravenous fluids for acute dehydration. After a complete history and physical examination, the managing physician made a clinical estimation of dehydration for each child, based on a standard clinical scale. Serum electrolytes were obtained in all children prior to intravenous hydration therapy. PLBW was calculated after recovery from acute dehydration by comparing the weight on presentation to the emergency department with the weight measured at a follow-up visit when the child was judged well. Children were classified according to PLBW into three groups which reflect the categories in a standard clinical scale: mild = PLBW < or = 5 (n = 50), moderate = PLBW 6-10 (n = 30), and severe = PLBW > 10 (n = 17). The physician's clinical estimate of dehydration compared to PLBW had a sensitivity of 74% (95% confidence interval (CI): 60-85) for mild dehydration, 33% (95% CI: 17-53) for moderate dehydration, and 70% (95% CI: 44-89) for severe dehydration. There was a significant difference in the mean serum bicarbonate concentrations (HCO3) between the PLBW groups (P < 0.01). The sensitivity of the HCO3 < 17 mEq/L in predicting PLBW was 77% (95% CI: 58-90) for PLBW 6-10, and 94% (95% CI: 71-100) for PLBW > 10. The combination of the clinical scale and the serum bicarbonate identified all 17 children with PLBW > 10 and 90% (27 of 30) children with PLBW 6-10. Our data suggest that physicians should not rely solely on clinical assessment to rule out severe dehydration in children, and that obtaining a serum bicarbonate may improve the accuracy of predicting serious dehydration.
为评估儿童脱水的临床和实验室参数对预测体重减轻百分比（PLBW）幅度的相对效用，我们研究了97名因急性脱水需要静脉补液的儿童。在完成病史采集和体格检查后，主治医生根据标准临床量表对每个儿童的脱水情况进行临床评估。在所有儿童进行静脉补液治疗前获取血清电解质。急性脱水恢复后，通过比较患儿到急诊科就诊时的体重与随访时判定患儿状况良好时测得的体重来计算PLBW。根据PLBW将儿童分为三组，这三组反映了标准临床量表中的类别：轻度=PLBW≤5（n=50），中度=PLBW 6 - 10（n=30），重度=PLBW＞10（n=17）。与PLBW相比，医生对脱水的临床评估中，轻度脱水的敏感性为74%（95%置信区间（CI）：60 - 85），中度脱水为33%（95% CI：17 - 53），重度脱水为70%（95% CI：44 - 89）。PLBW组之间的平均血清碳酸氢盐浓度（HCO3）存在显著差异（P＜0.01）。HCO3＜17 mEq/L预测PLBW的敏感性，对于PLBW 6 - 10为77%（95% CI：58 - 90），对于PLBW＞10为94%（95% CI：71 - 100）。临床量表和血清碳酸氢盐的联合应用识别出了所有17名PLBW＞10的儿童以及90%（30名中的27名）PLBW 6 - 10的儿童。我们的数据表明，医生不应仅依靠临床评估来排除儿童的重度脱水，获取血清碳酸氢盐可能会提高预测严重脱水的准确性。
