R. SAÇ, Y. DALLAR, E. SARIYILDIZ, Y. Z. ARAL, B. ACAR

Akut gastroenteritli çocuklarda klinikte varsayılan ve gerçek dehidratasyonun karşılaştırılması

Giriş: Çocuklarda akut gastroenteritlere bağlı dehidratasyonlarda hidrasyonun (vücudun sıvı durumunun) değerlendirilmesi tedavi için temeldir. Ancak klinik bulgular dehidratasyonun derecesini belirlemede her zaman güvenilir olmayabilir. Amaç: Akut gastroenterite bağlı dehidratasyon nedeniyle kliniğimizde izlenen çocuklarda ağırlık kaybı yüzdesini tahmin etmede klinik ve laboratuvar bulguların karşılaştırılması, klinikte tahmin edilen ve gerçek dehidratasyon yüzdeleri arasında fark olup olmadığının belirlenmesidir. Gereç ve yöntem: 1 Haziran 2004-1 Aralık 2004 tarihleri arasında akut gastroenterite bağlı dehidratasyon nedeniyle Çocuk Sağlığı ve Hastalıkları Kliniğine yatırılan ve intravenöz sıvı tedavisi gereken, 40 çocuk (2 ay-7yaş) retrospektif olarak çalışmaya alındı. Çocukların tedavi öncesi klinik değerlendirmede tahmin edilen dehidratasyon dereceleri, tedavi tamamlandıktan sonra hesaplanan gerçek dehidratasyon dereceleriyle karşılaştırıldı. Sonuçlar: Çocukların 26'sı (%65) erkek, 14'ü (%35) kız olup en sık fizik muayene bulguları deri turgorunda azalma ve göz yaşı olmaması idi (%90). Dehidratasyonun klinik derecesine göre üre yüksekliği ve asidoz sıklığı karşılaştırıldığında fark bulunmadı (Sırasıyla p=0.80 ve 0.20). Dehidratasyonun klinik derecesine göre sodyum ve potasyum bozukluğu açısından fark bulunmadı (Sırayla p=0.30 ve 0.50). Klinik olarak 30 (%75) çocuk orta derecede dehidrate iken, gerçekte 4 (%10) orta ve 33 (%82.5) çocuk hafif dehidrate olup anlamlı yanılma payı bulundu (p

Comparison of clinical estimation and actual dehydration in children with acute gastroenteritis

Introduction: Assessment of hydration status in dehydrated children with acute gastroenteritis is the mainstay of therapy. However, clinical findings may not always lead to accurate assessment of degree of dehydration. Aim: To compare clinical and laboratory findings in children that were hospitalized in our clinic because of dehydration due to acute gastroenteritis, to determine if there is a difference between clinical and real dehydration rates. Material and Methods: Forty children that were hospitalized in Pediatric Clinic between 1 June 1-December 1, 2004, were included in the study. Results: Twenty six (65%) of children were boys, and 14 (35%) were girls. The most frequent physical findings were abnormal skin turgor and absence of tears (90%). There were no differences in frequencies of blood urea levels, acidosis, sodium and potassium imbalance when compared with degree of dehydration (p=0.80, 0.20, 0.30 and 0.50 respectively). According to clinical assessment 30 (75%) were moderately dehydrated, whereas 4 (10%) were moderately and 33 (82.5%) were mildly dehydrated in real, a significant margin of error was found (p<0.001). Discussion: In this study dehydration degrees of children with acute gastroenteritis were not accurately estimated in clinical practice, however, when compared, there were no significant differences between the degree of dehydration and laboratory values.

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