CLINICAL AND LABORATORY ASSESSMRENT OF DEHYDRATION SEVERITY IN CHILDREN WITH ACUTE GASTROENTERITIS

Background: Acute gastroenteritis is a common cause of morbidity in children, and dehydration is one of its most important complications. Early and accurate assessment of dehydration severity is essential for appropriate management and prevention of complications. This study aimed to identify clinical and laboratory predictors associated with dehydration severity in children with acute gastroenteritis. Objectives: To identify the clinical and laboratory predictors associated with the severity of dehydration in children with acute gastroenteritis and to evaluate the diagnostic performance of selected laboratory parameters in predicting severe dehydration. Patients and methods: A cross-sectional study was conducted at Mosul General Hospital, Nineveh Governorate, Iraq, from March 2025 to April 2026. The study included 133 children aged 1 month to 15 years who presented with acute gastroenteritis and clinical evidence of dehydration. Demographic characteristics, clinical manifestations, signs of dehydration, and laboratory parameters were assessed. Data were analyzed using SPSS version 31. Associations between variables and dehydration severity were evaluated, followed by multivariable logistic regression and receiver operating characteristic curve analysis. Results: Of the 133 children, 48 (36.1%) had mild dehydration, 57 (42.9%) had moderate dehydration, and 28 (21.1%) had severe dehydration. Severe dehydration was significantly associated with vomiting, poor oral intake, reduced urine output, prolonged duration and frequency of diarrhea, tachycardia, dry mucous membranes, sunken eyes, reduced skin turgor, prolonged capillary refill, and inability or refusal to drink. Serum bicarbonate progressively decreased with increasing dehydration severity, while urea and creatinine increased significantly. Multivariable analysis identified poor oral intake, reduced urine output, tachycardia, prolonged capillary refill, inability or refusal to drink, bicarbonate ≤16 mmol/L, urea >10 mmol/L, and elevated creatinine as independent predictors of severe dehydration. Bicarbonate demonstrated the highest diagnostic performance (AUC=0.847), followed by urea (AUC=0.811) and creatinine (AUC=0.746), whereas sodium showed limited predictive performance. Conclusions: Several clinical and laboratory parameters were significantly associated with dehydration severity in children with acute gastroenteritis. Clinical indicators of impaired perfusion and inadequate fluid intake, together with low serum bicarbonate and elevated urea and creatinine, may help identify children at increased risk of severe dehydration. An integrated clinical and laboratory approach may improve early recognition and appropriate management of severe dehydration.