A 2-year-old has been vomiting and passing loose stools for 2 days. On examination he is alert but restless, HR is 168/min, capillary refill is 3 seconds, and BP is 92/58 mmHg. What is the earliest and most consistent hemodynamic finding of compensated shock in children?
- A Hypotension
- B Tachycardia ✓
- C Bradycardia
- D Widened pulse pressure with bounding pulses
Correct answer: B. Tachycardia
Explanation
Children maintain blood pressure by vasoconstriction and tachycardia until roughly 25 to 30 percent of circulating volume is lost, so tachycardia is the earliest and most reliable sign of compensated shock. Hypotension is a pre-arrest finding indicating decompensated shock, which makes option A the classic trap: a normal BP never excludes significant hypovolemia in a child.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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