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Dehydration Treatment Plans
Why is Dehydration so Dangerous?
Acute diarrhoeal diseases are among the leading causes of mortality in infants
and young children in many developing countries. In most cases, death is
caused by dehydration. Dehydration from diarrhoea can be prevented by giving
extra fluids at home, or it can be treated simply, effectively, and cheaply in
all age-groups and in all but the most severe cases by giving patients by
mouth an adequate glucose-electrolyte solution called Oral Rehydration Salts
(ORS) solution.
During diarrhoea there is an increased loss of water and
electrolytes (sodium, chloride, potassium, and bicarbonate) in the liquid
stool. Water and electrolytes are also lost through vomit, sweat, urine and
breathing. Dehydration occurs when these losses are not replaced adequately
and a deficit of water and electrolytes develops. The volume of fluid lost through the stools in 24 hours can vary from 5 ml/kg
(near normal) to 200 ml/kg, or more. The concentrations and amounts of
electrolytes lost also vary. The total body sodium deficit in young children
with severe dehydration due to diarrhoea is usually about 70110 millimoles per
litre of water deficit. Potassium and chloride losses are in a similar range.
Deficits of this magnitude can occur with acute diarrhoea of any etiology. The
most common causes of dehydration are rotavirus, enterotoxigenic Escherichia coli
(ETEC) and, during epidemics, Vibrio cholerae
O1 or O139. Dehydration is the loss of water and salts from the body. The human body needs water to maintain enough blood and other fluids to
function properly. Along with the fluids, the body also needs
electrolytes, which are salts normally found in blood, other fluids, and
cells. The body may lose fluids in a variety of ways:
- when urinating
- when you vomit or have diarrhoea
- when sweating
- from the lungs during normal breathing.
If the body loses a substantial amount of fluids and salts
and they are not quickly replaced; for example: by drinking, the body starts
to "dry up" or get dehydrated. Severe dehydration can cause death. The usual causes of dehydration are a lot of diarrhoea
and vomiting. Dehydration can also occur if you do not eat or drink much
during an illness or if you do not drink enough during or after strenuous
exercise. Medications that cause fluid loss to control excess body fluid
(diuretics) are a common long-term cause. Although anyone can become dehydrated, those who become dehydrated the most
easily are:
- babies under 1 year old
- the elderly
- anyone who has a fever
- people in hot climates.
Dehydration caused by diarrhoea is one of the
biggest single killers of children in the modern world and diarrhoea itself is one of the
major causes of nutritional loss and poor growth. This year, about 2.2
million children will die of dehydration caused by diarrhoea -
80% of them in the first two years of their life.
What
are the symptoms of dehydration? The degree of dehydration is graded according to signs and symptoms that
reflect the amount of fluid lost:
In the early stages of dehydration, there are no signs or symptoms. Early features are difficult to detect but include dryness
of mouth and thirst
As dehydration increases, signs and symptoms develop. These
include: thirst, restless or irritable behaviour, decreased skin turgor, dry mucous
membranes, sunken eyes, sunken fontanelle (in infants), and absence of tears when crying
vigorously. Symptoms of early or mild
dehydration include:
- flushed face
- extreme thirst, more than normal or unable to drink
- dry, warm skin
- cannot pass urine or reduced amounts, dark, yellow
- dizziness made worse when you are standing
- weakness
- cramping in the arms and legs
- crying with few or no tears
- sleepy or irritable
- unwell
- headaches
- dry mouth, dry tongue; with thick saliva.
Symptoms of moderate to severe
dehydration include:
- low blood pressure
- fainting
- severe muscle contractions in the arms, legs, stomach, and back
- convulsions
- a bloated stomach
- heart failure
- sunken fontanelle - soft spot on a infants head
- sunken dry eyes, with few or no tears
- skin loses its firmness and looks wrinkled
- lack of elasticity of the skin (when a bit of skin lifted up stays folded
and takes a long time to go back to its normal position)
- rapid and deep breathing - faster than normal
- fast, weak pulse
In severe dehydration, these effects become more pronounced
and the patient may develop evidence of hypovolaemic shock, including: diminished
consciousness, lack of urine output, cool moist extremities, a rapid and feeble pulse (the
radial pulse may be undetectable), low or undetectable blood pressure, and peripheral
cyanosis. Death follows soon if rehydration is not started quickly. |
Dehydration
From Wikipedia, the free encyclopedia
Dehydration (hypohydration) is the removal ofwater (hydor
in ancient
Greek) from an object. Medically,
dehydration is a serious and potentially life-threatening condition in which
the body contains an insufficient volume of water for normal functioning.
The term "volume depletion" is similar to dehydration, but it refers to the
loss of salts as well as water. Also see
Hypovolemia.
Medical causes of dehydration
In humans,
dehydration can be caused by a wide range ofdiseases
and states that impair water
homeostasis in the body. These include:
- External or
stress-related causes
- Other causes of obligate water loss
Symptoms and prognosis
Symptoms
may include
headaches similar to what is experienced as ahangover,
a sudden episode ofvisual
snow, decreased
blood pressure (hypotension),
and
dizziness orfainting
when standing up due to
orthostatic hypotension. Untreated dehydration generally results indelirium,
unconsciousness, anddeath.
Dehydration symptoms generally become noticeable after 2% of one's normal
water volume has been lost. Initially, one experiencesthirst and
discomfort, possibly along with loss ofappetite
and dry skin.Athletes
may suffer a loss of performance of up to 50%, and experience
flushing, low endurance, rapidheart
rates, elevated body temperatures, and rapid onset of
fatigue.
The symptoms become increasingly severe with greater water loss. One's
heart and
respiration rates will increase to compensate for decreased
plasma volume and
blood pressure, while body temperature may rise because of decreased
sweating. Around 5% to 6% water loss, one may become groggy orsleepy,
experience headaches ornausea, and
may feel tingling in one's limbs (paresthesia).
With 10% to 15% fluid loss, muscles may become spastic, skin may shrivel and
wrinkle, vision may dim, urination will be greatly reduced and may become
painful, and delirium may begin. Losses of greater than 15% are usually fatal.
[1]
Treatment
Correction of a dehydrated state is accomplished by the replenishment of
necessary water and electrolytes (rehydration).
Even in the case of serious lack offresh
water (e.g. atsea or in adesert),drinkingseawater
or urine does
not help, nor does the consumption ofalcohol. It
is often thought that the sudden influx ofsalt into the
body from
seawater will cause the
cells to dehydrate and thekidneys to
overload and shut down but it has been calculated that average adult can drink
up to 0.2 liters of seawater per day before the kidneys start to fail.
When dehydrated, unnecessarysweating
should be avoided, as it wastes water. If there is only dry food, it is better
not to eat, as water is necessary fordigestion.
The best treatment for minor dehydration is consumption of an
electrolyte-balanced fluid like a sports drink. For severe cases of
dehydration wherefainting,
unconsciousness, or any other severely inhibiting symptom is present (the
patient is incapable of standing or thinking clearly), emergency attention is
required. Fluids will be given through an IV, and within a few hours, the
patient will return to normal unless a complication occurs.
Avoiding dehydration
A person's body loses, during an average day in atemperateclimate
such as the
United Kingdom, approximately 2.5litres of
water. This can be through thelungs aswater
vapor, through theskin assweat, or
through the
kidneys
urine. Some (a less significant amount, in the absence ofdiarrhea)
is also lost through thebowels.
During vigorous exercise or in a hot environment, it is easy to lose
several times this amount. Heavy exercise in high temperatures could cause the
loss of over 2.5 litres of fluid per hour, which exceeds the body's absorptive
capacity.
Ethical concerns over death by dehydration
Judge Lynch of the
Massachusetts Supreme Judicial Court argued that death by dehydration
symptoms was "cruel and violent" in his opinion on the
1986 Brophy case:
- The mouth would dry out and become caked or coated with thick material.
- The lips would become parched and cracked.
- The tongue would swell, and might crack.
- The eyes would recede back into their orbits and the cheeks would become
hollow.
- The lining of the nose might crack and cause the nose to bleed.
- The skin would hang loose on the body and become dry and scaly.
- The urine would become highly concentrated, leading to burning of the
bladder.
- The lining of the stomach would dry out and the sufferer would
experience dry heaves and vomiting.
- The body temperature would become very high.
- The brain cells would dry out, causing convulsions.
- The respiratory tract would dry out, and the thick secretions that would
result could plug the lungs and cause death.
- At some point within five days to three weeks, the major organs,
including the lungs, heart, and brain, would give out and the patient would
die.
Be advised that death due to dehydration can occur in 3 days (or less in
hot weather) and no one normally lives more than about 5-6 days without water.
External links
See also
References
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updated: 25 March, 2019
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