DHAKA Score for Paediatric Dehydration Assessment
Validated clinical scoring tool for assessing dehydration severity in children with acute diarrhoea. Derived and validated in low-resource settings; simple bedside assessment tool.
Score interpretation
DHAKA 0-1 -- no or minimal dehydration
→ Oral rehydration: continue breastfeeding if applicable; oral rehydration solution (ORS) 10 mL/kg after each loose stool and 2 mL/kg after each vomit; give small amounts frequently (5-10 mL every 5 minutes); normal diet; no restriction on foods; avoid fruit juices and carbonated drinks; discharge with ORS and written advice; return if: not improving in 24 hours, unable to take ORS, worsening symptoms, blood in stool, high fever, or deterioration.
DHAKA 2-5 -- some dehydration; active rehydration required
→ Oral rehydration therapy (ORT): ORS 50-100 mL/kg over 3-4 hours; give 5 mL every 5 minutes initially if vomiting; ondansetron 0.15 mg/kg oral/IV (max 4 mg/dose) for vomiting if aged >= 6 months; reassess dehydration status after ORT; if tolerating ORS and improving: continue ORT and discharge with plan; if unable to tolerate oral fluids: NG rehydration 10 mL/kg/hour; IV access if NGT fails; blood glucose monitoring; weight on admission; document vital signs and hydration status hourly.
DHAKA 6-8 -- severe dehydration; urgent IV fluid resuscitation required
→ Immediate IV/IO access; IV fluid bolus: 0.9% saline or Hartmanns 20 mL/kg over 15-20 minutes; repeat up to 40-60 mL/kg if haemodynamically compromised; blood glucose -- 10% dextrose 2-5 mL/kg if hypoglycaemic; bloods: U+E, blood glucose, blood gas, FBC; sodium monitoring (correct hypernatraemia slowly -- max 0.5 mmol/L/hour reduction); replacement fluids after resuscitation: deficit + maintenance over 24-48 hours (hypernatraemia: 48-72 hours); PICU referral if no improvement after 60 mL/kg; NG tube if IV access failed; document all fluid balance; weigh twice daily; paediatric senior review within 1 hour.
Interpretation bands for the DHAKA Score. Apply clinical judgement and local guidance.
References
- Levine AC et al. Derivation and internal validation of the DHAKA score: a clinical prediction rule for dehydration severity in children with diarrhoea. Emerg Med J. 2015;32(10):744-749.
- NICE CG84. Diarrhoea and vomiting caused by gastroenteritis in under 5s. NICE. 2009 (updated 2022).
Related
Curated clinical cross-links plus same-class fallbacks.
- Potassium chloride with rice powder, sodium chloride and sodium citrate · Oral rehydration salts
- Disodium hydrogen citrate with glucose, potassium chloride and sodium chloride · Oral rehydration salts (ORS)
- Ibuprofen (Paediatric) · NSAID / Analgesic / Antipyretic
- Paracetamol (Paediatric) · Analgesic / Antipyretic — First-Line Pain and Fever in Children
- Morphine (Paediatric) · Opioid Analgesic — Moderate to Severe Pain in Children
- Diazepam (Paediatric) · Benzodiazepine — Status Epilepticus / Febrile Convulsions (Community)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.