IVC Index in Patient With Diarrhea and Dehydration And How It Affects Its Management
IVC Index in Patient With Diarrhea and Dehydration And How It Affects Its Management
IVC Index in patient with Diarrhea and Dehydration And How It affects its management.
Introduction The world health organization defines dehydration as condition that result from
 excessive loss of body water .the most common cause of dehydration in children are vomiting
 and diarrhea. Dehydration is a major cause of morbidity and mortality in infant and young
 children world wide .most cases due to consequence of acute gastroenteritis.

 Pathophysiology. Dehydration cause decrease in total body water in both intracellular and
 extracellular fluid volume. Volume depletion closely correlate with sign and symptom of
 dehydration .the total body water is higher in infant and children compared to adult.

 In infant, it is 70% of total body weight, whereas it is 65%and 60% respectively in children
 and adult.

 The World Health Organization recommends assessing dehydration in children based on four
 clinical features: general appearance , eyes (whether they appear sunken), history of thirst
 , and skin pinch to assess turgor. However, these clinical signs may be subtle or non
 specific and thus have important limitations if used as independent predictors of
 dehydration. A more objective way to assess for dehydration using urine analysis has been
 implicated.

 Additionally, studies on dehydration have shown urine analysis do not show sufficient
 sensitivity, Specificity or reliability [3, 4] and are typically only useful in children with
 moderate to severe hypovolemia.

 . Bedside ultrasonography is a noninvasive method that can serve as a more objective tool for
 assessing dehydration in both adults and children. Point-of-care ultrasound has the potential
 to reduce unnecessary use of resources such as IV fluids or hospital access, while
 identifying children who are severely dehydrated and need immediate medical attention.
 Previous studies have shown that intravascular volume correlates to the diameters of the
 inferior vena cava.

 -  The normal IVC diameter is 15_ 17mm

 -  small IVC (usually < 12mm) with spontaneous collapse is often seen in the presence of
 intravascular volume depletion.

 Bedside emergency ultrasonography (EUS) is a relatively new imaging modality in
 pediatrics.(8,9) EUS is fast, painless, and noninvasive. In recent years, many new pediatric
 indications for EUS have been developed.

 Ultrasonography (US) assessment of the inferior vena cava (IVC) has been used as a
 noninvasive diagnostic tool for the assessment of intravascular volume and right heart
 function. Specifically, IVC diameter and collapsibility have been used as methods of
 assessing fluid status in dehydrated patients .

 In these studies, contraction of the intravascular volume resulted in measurable decreases in
 IVC diameters. Conversely, research has shown that the diameter of the descending aorta (Ao)
 remains mostly constant, despite intravascular volume depletion.
(Inclusion Criteria):

 -  Patients under 5years old who Presented with acute diarrhea and clinical evidence of
 significant (Moderate and severe) dehydration and sepsis based on blood picture ,high
 grade fever and CRP

 -  Patients under 5 years old with dehydration and non septic condition.

 -  Patients under 5years old have cardiomyopathy previously diagnosed.

 (Exclusion Criteria ):

 -  Patients receiving oral rehydration solution only .

 -  chronic medical conditions, bronchopulmonary dysplasia and renal and liver diseases.

 -  Children with acute blood loss were also excluded.