Emergency Department Management of Dehydration in Pediatric Patients (Pharmacology CME)

Publication Date: January 2026 (Volume 23, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 01/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits, subject to your state and institutional approval.

Authors

Christopher S. Amato, MD, FAAP, FACEP

Professor, Departments of Emergency Medicine & Pediatrics, Sidney Kimmel Medical College, Philadelphia, PA; Thomas Jefferson University, Philadelphia, PA; Director, Pediatric Emergency Medicine Fellowship; Medical Director, Pediatric Advanced Life Support, Atlantic; Attending Physician, Pediatric Emergency Medicine, Morristown Memorial Hospital/Goryeb Children’s Hospital, Morristown, NJ

Peer Reviewers

Nicole Gerber, MD

Director of Clinical Services, Pediatric Emergency Medicine; Assistant Professor of Clinical Emergency Medicine and Pediatrics, New York Presbyterian/Weill Cornell Medicine, New York, NY

Matthew Wilkinson, MD, MPH, FAAP, FACEP

Clinical Associate Professor, Assistant Chair of Clinical Research, Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX

Abstract

Pediatric dehydration is a top concern that leads parents to bring their children into the emergency department for evaluation. Rehydration therapy should be tailored to the severity of illness, available resources, and the child’s clinical status. Although accurately determining the fluid deficit can be challenging, guidance is provided for use of scoring systems to estimate the degree of dehydration. Recommendations are given for first-line oral rehydration therapy, and for rehydration through intravenous, intraosseous, or subcutaneous methods when oral rehydration is not an option. A thoughtful, goal-directed approach that emphasizes timely rehydration, caregiver education, and careful follow-up can improve outcomes.

Case Presentations

CASE 1

A mother presents to the emergency department with her 3 children. The oldest girl is 3 years old, and cannot tolerate oral fluids...

The mother tells you the girl has had profuse, watery, nonbloody diarrhea for the past 4 days.
On examination, the girl is sleepy but arousable to stimulation before falling back to sleep. Her capillary refill time is 5 seconds, and she has cool distal extremities. Her vital signs are: temperature, 37.2°C; heart rate, 148 beats/min; blood pressure 72/56 mm Hg, and respiratory rate, 35 breaths/min.
What is the primary goal of initial treatment for this patient?

CASE 2

The second child is an 18-month-old girl with diarrhea and vomiting...

The mother tells you that the girl’s diarrhea has worsened over the past 2 days and is profuse, watery, and nonbloody. The girl had 2 episodes of vomiting.
On examination, the girl is awake and upset. She is making tears during the examination and has warm distal extremities, with a capillary refill time of 3 seconds. Her vital signs are: temperature, 37.6°C; heart rate, 125 beats/min; blood pressure, 87/64 mm Hg; and respiratory rate, 40 breaths/min.
What clinical findings can reassure you about the degree of volume loss in this patient?

CASE 3

The third child is a 6-month-old girl who has had 1 day of diarrhea, which is watery and nonbloody, with no episodes of vomiting...

The girl is awake and crying, but is consolable.
She is making tears during the examination. She has warm distal extremities with a brisk capillary refill. Her vital signs are: temperature, 37.7°C; heart rate, 135 beats/min; blood pressure, 82/58 mm Hg; and respiratory rate, 50 breaths/min.
Does this infant require any treatment while in the emergency department?

Accreditation:

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