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Dehydration

Definition


Disease: Dehydration Dehydration
Category: Endocrine and metabolic diseases

Disease Definition:

Dehydration is a condition in which the body loses more fluids and liquids than it takes in and thus doesn’t have enough water to perform its natural functions.

 

Intense diarrhea, vomiting, fever and excessive sweating are all common causes of dehydration. Also, insufficient incoming water in hot weather or exercise might also cause dehydration. Anyone is apt to have dehydration, but children, older adults and people with serious illnesses are most at risk.

 

By increasing the intake of fluids, people can usually recover from mild and moderate dehydration. However, severe dehydration needs quick medical treatment. The safest of all methods for preventing dehydration is by drinking enough liquids to replace the lost ones and by monitoring fluid loss during hot weather, illness or exercise.
 

Work Group:


Symptoms, Causes

Symptoms:

Mild and moderate dehydration can cause:

 

  • Thirst
  • Headache
  • Dry, sticky mouth
  • Muscle weakness
  • Few or no tears when crying
  • Dizziness or lightheadedness
  • Sleepiness or tiredness; children are likely to be less active than usual
  • Decreased urine output; fewer than 6 wet diapers a day for infants and 8 hours or more without urination for older children and teens.

 

Severe dehydration is a medical emergency that can cause:

 

  • Fever
  • Sunken eyes
  • Extreme thirst
  • Lack of sweating
  • Low blood pressure
  • Rapid heartbeat
  • Very dry mouth, skin and mucous membranes
  • Little or no urination, if there is any urine, its color may be amber or dark yellow
  • Sunken fontanels in infants, which are the soft spots on the top of a baby's head
  • Delirium or unconsciousness in the most serious cases
  • In infants and children, extreme fussiness
  • In adults, confusion and irritability
  • Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold.

 

Thirst, unfortunately, is not a reliable mark of the body’s need for water, especially in children and older adults.
The color of urine is a better indicator; clear or light-colored urine means a person is well hydrated, while dark yellow or amber colored urine means that the person is dehydrated. 

 

Mild and moderate dehydration in adults can be treated by drinking more liquids. However, if someone develops severe signs and symptoms of dehydration, such as no urination for eight hours, confusion, shriveled skin, dizziness and extreme thirst, immediate medical care is necessary.  

 

Older adults and children need greater care. A person should call a doctor in case their child:

 

  • Can't keep fluids down
  • Has had moderate diarrhea for three days or more
  • Has had episodes of vomiting for more than eight hours
  • Is irritable or disoriented and much sleepier or less active than usual
  • Develops severe diarrhea, with or without vomiting or fever
  • Has any of the signs or symptoms of mild or moderate dehydration

 

If someone thinks a child or older adult is severely dehydrated, they should immediately call their local emergency number. Preventing dehydration could be monitored by observing the sick person and giving them fluids after the first sign of diarrhea, vomiting or fever. Children should be encouraged to drink plenty of water before, during and after exercise.
 

Causes:

Water is important to our lives because:

 

  • It aids in eliminating waste
  • It forms the basis for all body fluids including digestive fluids and blood
  • It helps in the absorption and transformation of nutrients.

 

An average adult loses more than 10 cups (2.5 liters) of water daily through sweating, breathing and eliminating wastes. Other elements are also lost like electrolytes which are minerals such as sodium, potassium and calcium, all of which maintain the equilibrium of fluids in the body. Generally, the lost fluids are replenished through foods and drinks, even if the person is active.

 

Dehydration occurs when a person eliminates more water and salts than they can replace, causing their system to dry out.
 Other simple reasons that lead to dehydration occur when someone's ill, busy, unable to access portable water, travelling, camping or hiking.

 

Some of the other causes of dehydration are:

Fever: 

The higher the fever is, the more fluids a person loses. The loss of fluids will be even more in case the fever occurs along with diarrhea and vomiting. 

Diarrhea, vomiting:

Acute diarrhea that comes suddenly and violently could lead to great loss in water and electrolytes in a short period of time. If vomiting accompanies the diarrhea, the person will lose more fluids and minerals. Children and infants are more at risk of dehydration. Worldwide, dehydration is one of the leading causes of death in children. 

Burns: 

Burns are classified according to the depth of injury and degree of tissue damage. 3rd degree burns are the worst simply because they pierce into the 3 layers of the skin and harm the sweat glands, hair follicles and nerve endings. People having 3rd degree burns or extensive 1st or 2nd degree burns undergo intense fluid loss and dehydration that could be fatal.

Excessive sweating:

When a person sweats, he/she loses an amount of their body water. Someone can become dehydrated in case they're occupied in vigorous activity and don't restore lost fluids. The amount of sweat and lost fluids are increased by hot and humid weather. If lost fluids aren't replaced, people can become dehydrated even in winter. Preteens and teenagers are more apt to suffer dehydration because of their body weight, which is lower than adults, and because they don’t know the warning signs of dehydration if they experience it. Their risk of dehydration will increase even more if they participate in sports.

Increased urination:

Diabetes mellitus is the disease that affects the way someone's body uses blood sugar, and it usually causes increased thirst and more frequent urination. In most cases, increased urination is due to undiagnosed or uncontrolled diabetes mellitus.

 

Diabetes insipidus, another type, is marked by extreme thirst and urination. The cause of this is a hormonal disorder that makes the kidneys unable to store water. Medications that make a person urinate or perspire more than normal can also lead to dehydration. Examples of those medications are some psychiatric drugs, diuretics, blood pressure medications and antihistamines.
 

Complications

Complications:

Some serious complications may result from dehydration, such as:

Seizures:

When normal electrical discharges in the brain are disorganized, involuntary contraction of muscles and sometimes even unconsciousness may result.

Cerebral edema:

Usually, the fluids a person loses when they're dehydrated contains the same amount of sodium their blood contains (isotonic dehydration) and in some case a person may lose more sodium than fluids (hypotonic dehydration). The body will produce particles that pull water back into the cells in order to make up for this loss. This will result in the swelling and rupture of those cells in case they absorb too much water during the rehydration process. When brain cells are affected by this, the consequences will be particularly severe.

Heat injury:

Heat injury is caused when the income of fluids is combined by heavy exercise and heavy perspiration. The severity of heat injury ranges from mild heat cramps to heat exhaustion and heatstroke, which could be life-threatening. 

Kidney failure:

When the kidneys are no longer able to remove excess fluids and waste from the blood, this potentially life-threatening condition occurs.

Hypovolemic shock:

When low blood volume causes a drop in blood pressure and a corresponding reduction in the amount of oxygen reaching the person's tissues, hypovolemic shock occurs, which is the most serious complication of dehydration. A person may die in a matter of minutes in case this condition is left untreated.

Coma and death:

Dehydration could be fatal in case it isn't treated quickly and appropriately.
 

Treatments:

Replacing lost fluids and electrolytes is the only helpful treatment for dehydration. This method depends mainly on the person's age, the severity of the case, and its causes.

 

HOW TO TREAT DEHYDRATION IN SICK CHILDREN:

Below are some of the general guidelines for treating dehydration in sick children. But a doctor can offer more specific suggestions.

Using an oral rehydration solution:

For children with fever, diarrhea and vomiting, an oral rehydration solution can be used, unless the doctor advises otherwise. The solution is made of:

 

  • Water and salt in specific proportions to refill both fluids and electrolytes.
  • Glucose and other carbohydrates like rice powder to boost absorption in the intestinal tract.

 

Oral rehydration products are available in most drugstores, and many pharmacies carry their own brands.
Instead of waiting until the situation becomes urgent, fluids should be given early in the course of an illness.

 

Packets of powdered oral rehydration solution are available in most developing countries; they are developed by the World Health Organization in order to treat dehydration and diarrhea in infants who also have cholera. The powder can be reconstituted in water according to the directions on the package. However, the water should be purified first by boiling, filtering or any other proven way. Then, the water should be re-measured and the powdered oral rehydration material should be added to it.

 

In the case of an emergency, if a readymade solution isn't available, a person can make a solution by mixing:

 

  • 1/2 teaspoon baking soda
  • 1/2 teaspoon salt
  • 3 tablespoon sugar
  • 1 liter of safe drinking water

 

Putting all the ingredients in the correct amount is very important. Any inaccurateness can make the solution less efficient or even harmful. The person could also ask someone else to recheck the measurements for accuracy. In case another solution is given to the patient, the person who's giving it should make sure that it is enough. The doctor might suggest a specific amount depending on the child’s age and stage of dehydration, but a general guideline is to give fluids slowly until the urine restores its clear color. If the child is vomiting, parents should try to divide the solution to small measures at different intervals (1 teaspoon every minute). If the child cannot hold it down, they should give it every 30 to 60 minutes. The temperature of the solution should be the same as the room.

 

In the case of breast-feeding children, the mother should continue to breast-feed when the child is sick, but she should also add an oral rehydration solution. Lactose can worsen diarrhea, so if a mother is giving her child formula, she should make sure that it is lactose-free. The formula should never be diluted more than the instruction advises. The doctor might suggest replacing the oral solution with the formula for 12 to 24 hours.

 

Certain foods and drinks should be avoided. Water alone does not provide the essential electrolytes the child needs. The best liquid is an oral rehydration solution.  Sports drinks restore electrolytes lost through sweating but not diarrhea or vomiting. The child should be kept away from salty broths, gelatins, sodas, fruit juices and milk, particularly boiled milk, because these don't relieve dehydration and could even worsen the symptoms. 

 

HOW TO TREAT DEHYDRATION IN SICK ADULTS:

Drinking more water to treat mild to moderate dehydration resulting from vomiting, diarrhea, or fever in adults could be sufficient. Coffee, tea and any other caffeine beverages should be avoided since they increase dehydration for some time. Fruit juices and soda also worsen diarrhea.

 

HOW TO TREAT DEHYDRATION IN ATHLETES OF ALL AGES:

The best way to treat exercise-related dehydration is by drinking cool water.
Also, sports drinks containing electrolytes and carbohydrates can be helpful. Salt tablets are not needed since too much salt can result in hypernatremic dehydration; a situation characterized by body shortage of water and excess of sodium.

 

HOW TO TREAT SEVERE DEHYDRATION:

Children and adults suffering from severe dehydration are taken by emergency personnel arriving in ambulance or taken to hospital emergency room where they can take in the necessary salts and fluids intravenously rather than their mouth. Used in life-threatening situations, intravenous hydration suffices the body with the necessary water and essential nutrients quicker than oral solutions.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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Consultants Corner

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

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Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Dr. Tahsin Martini

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Dr. Faisal Dibsi

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