depend on associated abnormalities, particularly hyponatremia or hypernatremia Clinical Considerations Clinical recognition Concern for volume depletion should be raised in any patient presenting to the ED with a history of increased fluid losses or poor oral intake Young children or children with developmental delay may also be at increased risk due to inability to communicate their needs and lack of access to fluid intake in response to thirst Triage considerations Children with a history or appearance suggestive of hypovolemia should be assessed in a timely manner to evaluate their degree of hypovolemia and potential need for rapid intervention While oral rehydration therapy (ORT) may be appropriate for mild to moderate dehydration, children with severe hypovolemia require rapid resuscitation with IV isotonic crystalloid Clinical assessment The initial assessment of a child with hypovolemia should include a medical history and thorough physical examination A careful history should establish the cause of hypovolemia, duration of illness, and approximate volume and composition of fluid taken in as well as urine output Potential causes of increased insensible losses, such as fever and tachypnea, should be considered The physical assessment should include an accurate weight A change in weight from a recent healthy baseline, if available, would provide the most accurate objective account of the degree of depletion Assessment of intravascular volume should include the pulse quality and rate, blood pressure, hydration of mucous membranes, skin turgor and perfusion, mental status, and activity Mild hypovolemia (3% to 5% volume loss) may be associated with minimal or absent clinical signs Moderate hypovolemia (6% to 9% volume loss) will have clinical signs apparent, which may include tachycardia, orthostatic blood pressure changes, dry mucous membranes, and delayed capillary refill time Several dehydration scores (Gorelick score, WHO score, and clinical dehydration score) have been proposed to aid in estimating degrees of dehydration based on clinical findings, with mixed results A systematic review of published data reported by Steiner et al revealed that the most useful individual signs for predicting 5% hypovolemia in children were delayed capillary refill time,