Non-invasive Assessment of the Current State of Hydration in Children by Ultrasound
Non-invasive Assessment of the Current State of Hydration in Children by Ultrasound
Children with clinical signs of severe dehydration will be examined by ultrasound in a supine
 position during admission. Children aged between 1 and 15years will be divided into three
 weight groups: 10-20kg, 20-30kg, 30-50kg. Early after admission 1st measurement of diameters
 of vena cava inferior (VCImax, VCImin) during breathing cycles and diameters of both venae
 jugulares (VJI dx max, min, VJI sin max, min) before and after passive leg raise maneuver
 will be recorded. After a defined fluid infusion within 60 minutes, a second examination will
 be evaluated and compared with the first one. The investigators considered also
 echocardiography to measure CO changes however they wanted to make it as simple as it might
 be at emergency during the night shift without an experienced cardiologist.
Only children admitted to the hospital with clinically detectable dehydration (weight loss,
 dry skin, sunken eyes, no tears) will be evaluated. Weight, noninvasive blood pressure
 measurement, pulse rate will be recorded. Measurements would be performed with an ultrasound
 probe with a low frequency (2-5 MHz), a curved array transducer will be used. In the supine
 position, the ultrasound probe will be placed in the substernal area, in the longitudinal and
 transversal plane, 1 cm caudal to the confluence of the hepatic veins, and it will be
 operated in M-mode. The largest (VCImax) and smallest (VCImin) diameters will be measured and
 the collapsibility index will be calculated (according to the formula: VCImax - VCI min / VCI
 max x100). Immediately after this examination measurement of the right VJImax, min and the
 left VJImax, min will be measured again in the supine position, then after passive leg raise
 (lifting the lower limbs 45st. for at least 1minute ) VJImax, min. and left VJImax, min will
 be measured. The collapsibility index for right and left VJI would be calculated according to
 the formula: VJImax - VJI min / VJI max x100. After a defined fluid infusion (20ml/kg, but
 the maximum volume will be limited to 500ml, this means that over 25kg weight we would apply
 not more than 500ml) within 60 minutes. A control examination of VCI, right VJI, and left VJI
 will be evaluated the same way as first and compared with the previous one.
Inclusion Criteria:

 -  previously healthy children

 -  history and clinical signs of dehydration (gastroenteritis, diabetic ketoacidosis)

 Exclusion Criteria:

 -  congenital heart diseases

 -  intestinal obstruction

 -  any signs of abdominal hypertension

 -  any illnesses known to affect the volume status