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WHO data are still documenting high mortality rate due to acute gastroenteritis in children, worldwide. In the last two decades in Romania there were significant improvements in therapeutic management of the most severe cases, with a 10-fold decrease in mortality rate inflicted by acute hypovolemic shock. The present paper is a practical approach of major emergencies related to acute dehydration, according to PALS (Pediatric Advanced Life Support) and RANP (Reanimation Avancee Neonatale et Pediatrique) guidelines. Pathogenetic mechanisms of acute dehydration are discussed and clinical correlations are presented for hyponatremic, izonatremic and hypernatremic dehydration. Vascular access aspects, amount and nature of fluids used during vascular expansion and infusion rates are briefly summarized. [ABSTRACT FROM AUTHOR]