Table 1.

Assessment of diarrhoea patients for dehydration

1. Look at:	Conditiona	Well, alert	Restless, irritable	*Lethargic or unconscious; floppy*
	Eyesb	Normal	Sunken	Very sunken and dry
	Tears	Present	Absent	Absent
	Mouth and tonguec	Moist	Dry	Very dry
	Thirst	Drinks normally, not thristy	*Thirsty, drinks eagerly*	*Drinks poorly, or not able to drink*
2. Feel:	Skin pinchd	Goes back quickly	*Goes back slowly	**Goes back very slowly*
3. Decide:		The patient has no signs of	If the patient has two or more signs, including	If the patient has two or more signs,
		dehydration	at least one *sign*, there is some dehydration	including at least one *sign* , there is
			severe dehydration
4. Treat:		Use Treatment Plan A	Weigh the patient, if possible, and use	Weigh the patient and use Treatment
			Treatment Plan B	Plan C urgently

^aBeing lethargic and sleepy are not the same. A lethargic child is not simply asleep: the child’s mental state is dull and the child cannot be fully awa kened; the child may appear to be drifting into unconsciousness.

^bIn some infants and children the eyes normally appear somewhat sunken. It is helpful to ask the mother if the child’s eyes are normal or more sunken th an usual.

^cIt is necessary to look inside the child’s mouth. The mouth may be dry in a child who habitually breaths through the mouth. The mouth may be wet in a dehydrated child owing to recent vomiting or drinking.

^dThe skin pinch is less useful in infants or children with marasmus or kw ashiorkor, or obese children.