Comparison of clinical signs of dehydration and septic shock in the severely malnourished child

Clinical sign	Some dehydration	Severe dehydration	Incipient septic shock	Developed septic shock
History/observation
Watery diarrhea	Yes	Yes	Yes or no	Yes or no
Thirst	Drinks eagerly	Drinks poorly	No	No
Mental state	Restless, irritable	Lethargic, comatose	Apathetic	Lethargic
Urine flow	Yes	No	Yes	No
Examination
Hypothermia	No	No	Yes or no	Yes or no
Weak or absent radial pulse	No	Yes	Yes	Yes
Elevated heart rate and respiratory rate	No	Yes	Yes	Yes or no
Sunken eyes	Yes^*	Yes^*	No	No
Cold hands and feet	No	Yes	Yes	Yes
Tests
Hypoglycemia	Sometimes	Sometimes	Sometimes	Sometimes

* If confirmed as recent by the caregiver.

Adapted from: Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers, World Health Organization 1999.

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