MDCalc

Dehydration: Assessing Kids Accurately (DHAKA) Score

Classifies dehydration in children <5 years with acute diarrhea.

  • This tool is intended for use in children <5 years of age in resource-limited settings.
  • For patients ≥5 years (including adults), the NIRUDAK Score may be more appropriate.

General appearance

Respirations

Skin pinch

Tears

Result:

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Advice

This tool should not replace clinical judgment—flags (e.g., shock, altered mental status) should prompt urgent intervention regardless of the score.

Management

No dehydration (score 0–1):

  • Encourage fluid intake and continue a normal diet.
  • Provide education on warning signs for deterioration.

Some dehydration (score 2–3):

  • Supervised oral rehydration therapy (ORT).
  • Consider short-term observation in a healthcare setting.

Severe dehydration (score ≥4):

  • Initiate IV rehydration immediately.
  • Hospitalize if resources allow.
  • Monitor for complications (e.g., electrolyte abnormalities, worsening dehydration).