Non-invasive Assessment of the Current State of Hydration in Children by Ultrasound
Condition: Gastroenteritis; Diabetes Mellitus (Ketoacidosis)
MeSH terms: Gastroenteritis; Ketosis
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Intravenous administration of fluids
Intervention type(s): Procedure
Intervention description(s): Intravenous administration of fluids (20ml/kg, but the maximum volume will be limited up to 500ml) within 60 minutes.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: The pediatric patients will be divided into three groups, according to weight: 10-20kg, 20-30kg, 30-50kg.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: children; dehydration; ultrasound; vena cava inferior; vena jugularis; passive leg raise