A 3-year-old with fever and lethargy has heart rate 168/min, capillary refill 4 seconds, cool knees, pulse pressure narrowed to 18 mmHg, and blood pressure 96/78 mmHg. How should this child be classified?
- A Compensated shock, requiring immediate fluid resuscitation ✓
- B No shock, because blood pressure is normal
- C Decompensated shock with vasoplegic physiology
- D Isolated tachycardia due to fever only
Correct answer: A. Compensated shock, requiring immediate fluid resuscitation
Explanation
In children, hypotension is a late finding because catecholamine-mediated vasoconstriction preserves blood pressure until 25 to 30 percent of circulating volume is lost. Tachycardia, prolonged capillary refill beyond 2 seconds, cold extremities, and narrow pulse pressure define compensated shock and demand immediate 20 mL/kg isotonic crystalloid boluses. Treating the normal blood pressure as reassurance delays resuscitation until irreversible decompensation. Fever alone rarely produces this degree of perfusion abnormality.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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