Which signs indicate pediatric dehydration requiring urgent assessment?

• A. Altered mental status, dry mucous membranes, sunken fontanelle, delayed capillary refill
• B. Normal mental status with moist mucous membranes
• C. Increased urination with moist mouth
• D. No signs of dehydration

Answer: (A)

Pediatric dehydration requiring urgent assessment is suggested by signs that show poor perfusion and altered mental status. Altered mental status means the child isn’t behaving at baseline and may be lethargic or irritable, signaling possible hypoperfusion. Dry mucous membranes reflect fluid loss, and a sunken fontanelle in infants is a classic sign of significant dehydration. Capillary refill delay, typically longer than about two seconds, indicates reduced peripheral perfusion from decreased circulating volume. When these findings appear together, they point to dehydration at a level that needs urgent evaluation and likely rapid fluid management.

Normal mental status with moist mucous membranes suggests adequate hydration. Increased urination with a moist mouth does not by itself indicate urgent dehydration, and no signs of dehydration means hydration is likely normal.