I had a patient admitted to the ward dry as a crisp.

Charlie had literally gotten off an 8-hour flight from a holiday abroad. Prior to that, he had had about 5-7 days' florid diarrhoea (whilst abroad), as had other members of the family.

The problem? Charlie is only like 5 years old. Children tolerate dehydration pretty... badly. Because they have a greater percentage of water in their body than adults. Their 10% dehydration is a bigger issue than the same % in an adult.

When dehydrated, your kidneys have to work extra hard as they get less blood flow (dehydration = less blood) and they have to concentrate your urine to stop you losing more water.

Charlie has a congenital heart condition, meaning he is on an ACE inhibitor. ACEI is great for preserving cardiac function in the long-term, but if you become dehydrated whilst on it, you should stop it for the short term, otherwise, it can kill your kidneys. ACEI reduces kidney blood flow, lowers blood pressure (so it's great if you have high blood pressure), and protects the heart in the long-term if you have heart issues. But coupled with dehydration, it's a baaad combo for the kidneys.

Charlie was admitted to the local hospital abroad but because their care was suboptimal (according to Mum) and their flight home was due, Charlie's mum discharged him against medical advice, wrapped him in a nappy (because of ongoing diarrhoea), and flew pt back. Charlie didn't wake up for the entire flight. When they landed, they came straight here.

Charlie was crispy dry, hypotensive, and still had his cannula in situ.

Throughout all this, I couldn't help but think if Charlie had collapsed or arrested on the flight because of dehydration-induced kidney injury, it would be a disaster because there's no way anyone can get a cannula in that kid (his veins were TINY on admission) in a cramped plane, and it was 8 hours. Nevermind Charlie exposing the entire flight and the airport there and here to whatever viral gastroenteritis he had.

Edit: When I first posted about this elsewhere, someone asked if the mum should be charged for negligence or child endangerment. The answer is, no. Charlie was reviewed by several doctors during his admission (and many, many more in the past due to his cardiac history) and Mum had always been very friendly and cooperative and her interactions with Charlie gave no cause for concern. There was no reason to believe Charlie was in any harm in her care and her rush to discharge him from the foreign hospital so they could get better healthcare and wouldn't miss their flight home was a terribly rash and dangerous decision that could have had disastrous consequences, but it was not done out of malice.

Charlie recovered rapidly after lots of IV fluids and was discharged about 4 days later.