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Dehydration is a particularly critical issue that concerns parents and pediatricians on a daily basis.

Due to summer, it is even more relevant as fluid needs increase and without proper care, hypovolemic shock and dangerous electrolyte disorders can occur. According to the literature, it is a major cause of mortality and morbidity in the pediatric population, especially in the vulnerable group of infants due to the increased basic needs for 24-hour fluids, increased losses through sweating and the inability of infants to express the feeling of thirst. Let us take into account that 1/5 of deaths in childhood are due to dehydration related to gastroenteritis.

In the etiology of dehydration, we could note the following:

• Increased fluid losses
• Increased fluid intake needs
• Both

More specifically: losses from the gastrointestinal system (vomiting, diarrhea), from the renal system (diabetic ketoacidosis), from the skin (increased sweating, burns) and losses in the third space (in the intestinal lumen in case of ileus). Also, reduced fluid intake can occur in mild illnesses, such as pharyngitis, and of course we should not forget that it could also be a sign of neglect.

Simultaneously with the loss of fluids, there is always a loss of electrolytes to some extent, so that particularly significant electrolyte disorders can occur, such as hyponatremia, hypernatremia, hypokalemia or hyperkalemia.

Dehydration is characterized as mild when there is a loss of body weight < 5%, moderate when the loss of body weight is 5-10% and severe when the loss of body weight is > 10%.

Among the signs and symptoms of dehydration, it is worth mentioning: dry skin with reduced elasticity, the child’s lethargy and sick appearance, the absence of tears, dryness of the mucous membranes, acidic breath, tachycardia and reduced diuresis.

Laboratory testing is considered necessary in cases of moderate and severe dehydration where treatment with intravenous fluids may be necessary and of course in cases of hypovolemic shock.

The American Academy of Pediatrics and the World Health Organization (WHO) recommend oral hydration for mild to moderate dehydration. Children with severe dehydration where there are signs of circulatory collapse require intravenous fluids. In children with inability or refusal to take fluids by mouth, we should consider administration via nasogastric catheter or intravenous hydration.

In conclusion, we must be particularly sensitive especially in the summer months and learn to recognize the signs and symptoms of dehydration at a fairly early stage.

We always keep in mind that young children can neglect the feeling of thirst in order to satisfy their need for physical activity and play.

We do not forget to offer regular refreshing drinks, we do not expose young children to the sun during the dangerous midday hours, we pay attention to the child’s good urination and of course, in cases of fever or serious losses with vomiting and diarrhea or abdominal pain, we immediately inform and consult our pediatrician on how to manage and re-administer fluids and electrolytes.