Recallab › Question bank › Paediatrics › #50093
Some dehydration: Plan B
A 2-year-old girl weighing 10 kg has had loose stools for two days. She is restless and irritable but drinks eagerly when offered fluid, her eyes are sunken, and a skin pinch goes back slowly. She has no danger signs. What is the correct management?
- correctA. Oral rehydration solution 750 mL over 4 hours, then reassess
- B. Intravenous Ringer lactate 1,000 mL over 6 hours
- C. Home fluids and continued feeding, with zinc
- D. Plain water freely, with antibiotics
Explanation
Key fact
Two of the four signs means 'some dehydration' and Plan B: 75 mL/kg of oral rehydration solution over 4 hours.
750 mL of oral rehydration solution over 4 hours. She has some dehydration, and 75 mL/kg for 10 kg is 750 mL.
How it happens
- Assess the four signs: condition, eyes, thirst, skin pinch.
- She is restless and irritable, has sunken eyes, drinks eagerly, and the pinch is slow.
- Two or more of these, with no danger signs, is some dehydration.
- Some dehydration is treated with Plan B.
- Plan B gives 75 mL/kg of oral rehydration solution over 4 hours.
- 75 x 10 = 750 mL. Reassess at 4 hours and reclassify.
IMNCI classification of dehydration
| Findings | Classification | Plan |
|---|---|---|
| Two or more of: lethargic or unconscious, sunken eyes, unable to drink or drinking poorly, skin pinch goes back very slowly | Severe dehydration | Plan C, intravenous |
| Two or more of: restless or irritable, sunken eyes, drinks eagerly or thirsty, skin pinch goes back slowly | Some dehydration | Plan B, 75 mL/kg over 4 hours |
| Not enough signs for either | No dehydration | Plan A, home fluids |
Two of four signs is Plan B, and Plan B is 75 mL/kg
Why not the others
- B. Intravenous Ringer lactate 1,000 mL over 6 hours — is Plan C, for severe dehydration. She is drinking eagerly and is not lethargic.
- C. Home fluids and continued feeding, with zinc — is Plan A, for no dehydration. She has clear signs, so Plan A undertreats her.
- D. Plain water freely, with antibiotics — is wrong twice: plain water has no sodium or glucose and worsens hyponatraemia, and antibiotics are not indicated in acute watery diarrhoea.
Remember
Drinks eagerly is some; unable to drink is severe. The thirst sign flips at exactly the point intravenous fluid becomes necessary.
Go deeper
Give zinc for 14 days in every case of childhood diarrhoea: 20 mg daily over 6 months of age, 10 mg under 6 months. It shortens the episode and reduces recurrence.
Continue feeding throughout, including breastfeeding. Withholding food prolongs recovery.
Low-osmolarity oral rehydration solution, at 245 mOsm/L, reduces stool output and the need for unscheduled intravenous fluid compared with the old formulation.
Ghai Essential Pediatrics, 10th ed. (CBS Publishers, 2025); Park K. Park's Textbook of Preventive and Social Medicine, 28th ed. (Bhanot, 2025).