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A. Physical Exam Key Points. Children with hypernatremic dehydration tend to preserve intravascular volume better than patients with other types of dehydration because of water shifts from intravascular to extravascular space.

1. Vital signs. Check for tachycardia (early sign of dehydration) and orthostatic changes.

2. Skin turgor, color, perfusion. Presence of doughy skin in a dehydrated child suggests hypernatremic dehydration. Cyanosis and prolonged capillary refill suggests severe dehydration.

3. Mucous membranes. Dry mucous membranes suggest dehydration.

4. Neurologic findings. Irritability, lethargy, muscle twitching, and seizures may be present. Some infants have a high-pitched cry and hyperpnea. Alert patients are very thirsty; some complain of nausea.

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