الفهرس 
DEHYDRATIONOnly 14 pages are availabe for public view
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Abstract
A cute dehydration in pediatric patients is a common and
potentially life-threatening condition encountered
frequently in both primary care and emergency medicine
practice. Unfortunately, individual symptoms and physical
exam findings are often unhelpful in determining the degree of
dehydration in the pediatric patient. In clinical settings, the
assessment of severity of dehydration usually involves taking
into account a group of signs and symptoms, some of which
may be subjective or unreliable.
The combinations of clinical signs and symptoms have
generally low sensitivities and specificities to detect
dehydration grade in children. Laboratory values can also be
used to judge the severity of dehydration in children. It is
generally acknowledged that these also have limited sensitivity
and specificity. There is a need for a noninvasive, rapid, and
objective tool that accurately reflects the volume status in
children with dehydration
Bedside ultrasonography (US) measurement of the inferior
vena cava (IVC) may be useful in objectively assessing children
with suspected dehydration. Since the size and shape of the IVC is
correlated to the central venous pressure and circulating blood
volume. Sonographic evaluation of the IVC is an instantaneous noninvasive
measure of volume status, the closer the collapsibility index is to 0% or 100% the higher the likelihood that patient is volume
overloaded or depleted, respectively.
Even more importantly, US could aid providers in
identifying those children who may not appear overtly ill but
are actually severely dehydrated and require immediate lifesaving
therapy.
This present case control study aimed to evaluate the role
of bedside ultrasound measurement of inferior vena caval
diameter during inspiration and expiration and then calculation
of collapsibility index of inferior vena cava in relation to clinical
evaluation as a useful non-invasive tool for the detection of
children’s hydration status.
This work was conducted on fifty dehydrated children
who were admitted at Children Hospital, Ain Shams University
and were divided as follow: 20 children were mildly
dehydrated, 18 were children moderately dehydrated and 12
children were severely dehydrated, all dehydrated children
were due to GIT causes. Fifty -age and sex matched- apparently
healthy children were included as a control group.
All studied patients were subjected to the following: Full
medical history, general and systemic examination, grading of
dehydration into (mild, moderate and severe) according to the
classification in Table (3), and laboratory investigations
including: complete blood picture, Serum Na and Serum K,
Blood urea nitrogen test (BUN) and Serum creatinine.Both cases and control were subjected to ultrasonography
for measurement of IVC diameter during inspiration and
expiration, and then calculation of IVC collapsibility index was
done according to the equation mentioned in P.44.
Then collected data were reviewed, coded and entered
PC where statistical analysis was done using SPSS (statistical
package for social science) and Microsoft Office, Excel 2010
According to clinical grading mentioned before in table
(3), 20 children were mildly dehydrated (40% of cases), 18
children were moderately dehydrated (36 % of case) and 12
children were severely dehydrated (24 % of case). Current
study reported that the age of dehydrated children (n=50)
ranged from 1 month to 5 years with median 8 months old,
there was a slight male predominance among dehydrated
children (males were 54 % and females were 46 % with male to
female ratio 1.17: 1).
Our results revealed that there was statistically
significant difference between cases group and healthy control
group as regards MCV level.
Moreover, there was highly statistically significant difference
between cases group and healthy control group as regards IVC
diameter during inspiration and IVC collapsibility index.
Our results revealed that there was a highly statistically
significant difference between mild and moderate dehydration
cases (p=0), mild and severe dehydration cases (p=0) and moderate and severe dehydration cases (p=0.01) as regards IVC
collapsibility index and After calculation of area under curve
(AUC), cut off point value of IVC collapsibility index was >41
with sensitivity = 83.33% and specificity = 88%, Positive
predictive value (PPV) was 80.60 and negative predictive value
(NPV) was 89.8.
There was a significant positive correlation between IVC
collapsibility index and frequency of vomiting, MCV, serum
creatinine level and inferior vena caval diameter during
expiration.
In addition, there was negative correlation between IVC
collapsibility index and inferior vena caval diameter during
inspiration.