A nurse assesses an infant presenting with lethargy, sunken fontanelles, dry mucous membranes, absence of tears when crying, and delayed skin turgor recoil (> 3 seconds). According to WHO clinical dehydration scales, how is this infant categorized, and what is the primary management?

Answer and explanation

Correct answer: B. Severe dehydration; Immediate intravenous fluid resuscitation with isotonic crystalloid

  1. Step 1: Sunken anterior fontanelle, absent tears, dry mucous membranes, lethargy, and skin tenting (> 2-3 seconds) are clinical hallmarks of severe dehydration (fluid deficit > 10% of body weight).
  2. Step 2: Severe dehydration represents a pediatric medical emergency requiring immediate intravenous fluid resuscitation with isotonic crystalloid (e.g., Ringer's Lactate or Normal Saline 20 mL/kg bolus).
Answer
Severe dehydration; Immediate intravenous fluid resuscitation with isotonic crystalloid.
Why not the others: 'Mild dehydration' presents with normal fontanelles, moist membranes, and tears present; 'No dehydration' is contradicted by the extensive clinical deficit signs; 'Hypernatremic fluid overload' is incorrect because the infant is severely hypovolemic, and diuretics would cause fatal circulatory collapse.

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