طفل عمره ١٨ شهراً عنده إسهال وقيء من يومين. الأم تقول إنه لم يبلل الحفاض من ٨ ساعات. هو خامل، وعيونه غائرة، والفم جاف، ورجوع الجلد بطيء. العلامات الحيوية: النبض ١٦٨، التنفس ٣٦، الحرارة ٣٨٫٤، إعادة الامتلاء الشعري ٤ ثوانٍ. ما تقييم حالته؟

An 18-month-old has had diarrhoea and vomiting for two days. His mother says he has had no wet nappy for 8 hours. He is lethargic with sunken eyes, dry mouth and slow skin recoil. Vitals: HR 168, RR 36, T 38.4 °C, capillary refill 4 seconds. How is his state assessed?

1. Mild dehydration managed with oral rehydration at home
2. Normal with diarrhoea and will settle within a day untreated
3. Severe dehydration needing urgent IV fluids
4. Moderate dehydration managed with plenty of milk and juice

Answer: C) Severe dehydration needing urgent IV fluids. Lethargy, sunken eyes, oliguria, delayed capillary refill and tachycardia indicate severe dehydration approaching shock, needing urgent IV fluids. Sweet juices worsen diarrhoea.