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Predicts clinically important dehydration (≥ 5% body weight) in children with gastroenteritis using the validated 4-item Gorelick scale: capillary refill > 2 seconds, dry mucous membranes, absent tears, and ill/toxic appearance. Three or more of four findings predicts ≥ 5% dehydration.
Dehydration score = capillary refill > 2 s + dry mucous membranes + absent tears + ill appearance (each present = 1) → total 0–4. ≥ 3 of 4 predicts ≥ 5% dehydration.
0–2 findings = estimated < 5% dehydration (mild); ≥ 3 findings = estimated ≥ 5% dehydration (moderate-to-severe, likely to need intravenous rehydration).
The Gorelick dehydration scale (1997) was derived from a cohort of children with acute gastroenteritis to predict dehydration ≥ 5% of body weight using bedside clinical signs. A 4-item model (capillary refill > 2 seconds, dry mucous membranes, absent tears, ill/toxic appearance) predicted ≥ 5% dehydration with a sensitivity of approximately 0.84 and a specificity of approximately 0.86 when 3 or more findings were present. It is a rapid, practical screening tool for rehydration decisions in emergency and outpatient pediatrics.
Specialty
PediatricsCategory
PediatricsDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-16
Formula
Keywords
Normal Range
0–2 findings = estimated < 5% dehydration (mild); ≥ 3 findings = estimated ≥ 5% dehydration (moderate-to-severe, likely to need intravenous rehydration).
| Classification | Range |
|---|---|
Mild (< 5%) Oral rehydration generally sufficient | 0–2 of 4 |
Moderate-to-severe (≥ 5%) Intravenous rehydration typically indicated | 3–4 of 4 |
Predicts clinically important dehydration (≥ 5% of body weight) in children with gastroenteritis using the validated 4-item Gorelick scale (1997): capillary refill > 2 seconds, dry mucous membranes, absent tears, and ill/toxic appearance.
With fewer than 3 of 4 findings, clinically important dehydration (≥ 5%) is unlikely and oral rehydration is generally appropriate. With 3 or more of 4 findings, dehydration of ≥ 5% is predicted and intravenous or aggressive rehydration is typically indicated.
Rapid, accurate identification of children with significant dehydration guides the choice between oral and intravenous rehydration in gastroenteritis, reducing both under-resuscitation and unnecessary IV placement in a common pediatric emergency presentation.
A 3-year-old with 2 days of diarrhea has capillary refill > 2 seconds and dry mucous membranes, but tears are present and the child appears well.
Inputs:
Gorelick dehydration scale — 2 of 4 findings; argues against ≥ 5% dehydration; oral rehydration and reassessment appropriate.
Three or more of the four signs (prolonged capillary refill, dry mucous membranes, absent tears, ill appearance) predict ≥ 5% dehydration, which usually warrants intravenous rehydration.
Yes — the scale is a screening tool, not a perfect test. Weigh the child, track urine output, and combine the score with clinical judgment.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. Combine the score with weight change, urine output, and clinical judgment; never delay resuscitation of a shocked child to complete scoring.
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