Paediatricscommon
An 11-month-old boy weighing 10 kg has had 36 hours of watery diarrhoea and vomiting. He lies quietly in his mother's arms and opens his eyes when spoken to. His heart rate is 168 beats per minute (105-150 for age), respiratory rate 42 breaths per minute, blood pressure 88/58 mmHg (systolic 70-105 for age) and temperature 36.6 degrees Celsius. His hands and feet are cool to the wrists and ankles and capillary refill is four seconds. Which one of the following best describes his circulatory state?