Comparison of clinical associations and laboratory abnormalities in children with moderate and severe dehydration.
OBJECTIVE
To search for possible early clinical associations and laboratory abnormalities in children with severe dehydration in northern Jordan.


METHODS
We prospectively evaluated 251 children with acute gastroenteritis. Dehydration assessment was done following a known clinical scheme. Probable clinical associations and laboratory abnormalities were examined against the preassigned dehydration status.


RESULTS
Children with severe dehydration had significantly more hypernatremia and hyperkalemia, less isonatremia, and higher mean levels of urea, creatinine, and glucose (P < 0.005). Receiver operating characteristic curves showed statistically significant area under the curve values for laboratory variables. These area under the curve values were 0.991 (95% confidence interval [CI] 0.980-1.001) for serum urea, 0.862 (95% CI 0.746-0.978) for sodium, 0.850 (95% CI 0.751-0.949) for creatinine, 0.69 (95% CI 0.555-0.824) for potassium, and 0.684 (95% CI 0.574-0.795) for glucose (P < 0.05 for all). Certain independent serum cutoff levels of urea, creatinine, sodium, glucose, and potassium had high negative predictive value (100%), whereas other cutoff values for each, except potassium, had high positive predictive value (100%) for severe dehydration. Historic clinical characteristics of patients did not correlate to dehydration degree.


CONCLUSIONS
Serum urea, creatinine, sodium, potassium, and glucose were useful independently in augmenting clinical examination to diagnose the degree of dehydration status among children presenting with gastroenteritis. Serum urea performed the best among all. On the contrary, none of the examined historical clinical patterns could be correlated to the dehydration status. Larger and multicenter studies are needed to validate our results and to examine their impact on final outcomes.
Hayajneh
Wail A
WA
Department of Pediatrics, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. wailh@just.edu.jo
Jdaitawi
Hussein
H
Al Shurman
Abdullah
A
Hayajneh
Yaseen A
YA
D000293:Adolescent; D019540:Area Under Curve; D001786:Blood Glucose; D003401:Creatine / Q000097:blood; D003681:Dehydration / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005759:Gastroenteritis / Q000097:blood / Q000150:complications*; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology*; D006955:Hypernatremia / Q000209:etiology*; D007597:Jordan; D008297:Male; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D014511:Uremia / Q000209:etiology*
D001786:Blood Glucose; D012964:Sodium; D003401:Creatine; D011188:Potassium