Dehydration

Dehydration
Nurses encourage a patient to drink an oral rehydration solution to treat the combination of dehydration and hypovolemia secondary to cholera. Cholera leads to GI loss of both excess free water (dehydration) and sodium (hence ECF volume depletion—hypovolemia).
Specialty	Critical care medicine

Dehydration is a deficit of total body water,^[1] with an accompanying disruption of metabolic processes. Most people can tolerate a 3-4% decrease in total body water without adverse effects. A 5-8% decrease can cause fatigue and dizziness. Loss of over ten percent of total body water can cause physical and mental deterioration, accompanied by severe thirst. Death occurs at a loss of between fifteen and twenty-five percent of the body water.^[2] Mild dehydration is characterized by thirst and general discomfort.

It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mild dehydration can also be caused by immersion diuresis, which may increase risk of decompression sickness in divers. Dehydration can cause hypernatremia (high levels of sodium ions in the blood) and is distinct from hypovolemia (loss of blood volume, particularly blood plasma).

People may rehydrate by drinking fluids such as oral rehydration solution. Fluids may also be given into a vein or by subcutaneous injection (sc). In the elderly sc appears to be safer than intravenous but is less effective.^[3]

Signs and symptoms

The hallmarks of dehydration include thirst and neurological changes such as headaches, general discomfort, loss of appetite, decreased urine volume (unless polyuria is the cause of dehydration), confusion, unexplained tiredness, purple fingernails, and seizures. The symptoms of dehydration become increasingly severe with greater total body water loss. A body water loss of 1-2%, considered mild dehydration, is shown to impair cognitive performance.^[4] While in people over age 50, the body's thirst sensation diminishes with age, a study found that there was no difference in fluid intake between young and old people.^[5] Many older people suffer symptoms of dehydration. Dehydration contributes to morbidity in the elderly population, especially during conditions that promote insensible free water losses, such as hot weather. A Cochrane review on this subject defined water-loss dehydration as "people with serum osmolality of 295 mOsm/kg or more" and found that the main symptom in the elderly (people aged over 65) was fatigue.^[6]

Cause

Risk factors for dehydration include but are not limited to: exerting oneself in hot and humid weather, habitation at high altitudes, endurance athletics, elderly adults, infants, children and people living with chronic illnesses.^[7]

Dehydration can also come as a side effect from many different types of drugs and medications.^[8]

In the elderly, blunted response to thirst or inadequate ability to access free water in the face of excess free water losses (especially hyperglycemia related) seem to be the main causes of dehydration.^[9] Excess free water or hypotonic water can leave the body in two ways – sensible loss such as osmotic diuresis, sweating, vomiting and diarrhea, and insensible water loss, occurring mainly through the skin and respiratory tract. In humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the body. These occur primarily through either impaired thirst/water access or sodium excess.^[10]

Diagnosis

Prevention

For routine activities, thirst is normally an adequate guide to maintain proper hydration.^[14] Minimum water intake will vary individually depending on weight, environment, diet, and genetics.^[15] With exercise, exposure to hot environments, or a decreased thirst response, additional water may be required. In athletes in competition, drinking to thirst optimizes performance and safety, despite weight loss, and as of 2010, there was no scientific study showing that it is beneficial to stay ahead of thirst and maintain weight during exercise.^[16]

In warm or humid weather, or during heavy exertion, water loss can increase markedly, because humans have a large and widely variable capacity for sweating. Whole-body sweat losses in men can exceed 2 L/h during competitive sport, with rates of 3–4 L/h observed during short-duration, high-intensity exercise in the heat.^[17] When such large amounts of water are being lost through perspiration, electrolytes, especially sodium, are also being lost.

In most athletes exercising and sweating for 4–5 hours with a sweat sodium concentration of less than 50 mmol/L, the total sodium lost is less than 10% of total body stores (total stores are approximately 2,500 mmol, or 58 g for a 70-kg person).^[18] These losses appear to be well tolerated by most people. The inclusion of sodium in fluid replacement drinks has some theoretical benefits^[18] and poses little or no risk, so long as these fluids are hypotonic (since the mainstay of dehydration prevention is the replacement of free water losses).

Treatment

Urine color chart

The treatment for minor dehydration that is often considered the most effective is drinking water and stopping fluid loss. Plain water restores only the volume of the blood plasma, inhibiting the thirst mechanism before solute levels can be replenished.^[19] Solid foods can contribute to fluid loss from vomiting and diarrhea.^[20] Urine concentration and frequency will return to normal as dehydration resolves.^[21]

In some cases, correction of a dehydrated state is accomplished by the replenishment of necessary water and electrolytes (through oral rehydration therapy, or fluid replacement by intravenous therapy). As oral rehydration is less painful, non invasive, inexpensive, and easier to provide, it is the treatment of choice for mild dehydration. Solutions used for intravenous rehydration must be isotonic or hypertonic. Pure water injected into the veins will cause the breakdown (lysis) of red blood cells (erythrocytes).

When fresh water is unavailable (e.g. at sea or in a desert), seawater or drinks with significant alcohol concentration will worsen dehydration. Urine contains a lower solute concentration than seawater; this requires the kidneys to create more urine to remove the excess salt, causing more water to be lost than was consumed from seawater.^[22] If a person is dehydrated and taken to a medical facility, IVs can also be used.^{[23][24][25][26]}

For severe cases of dehydration where fainting, unconsciousness, or other severely inhibiting symptom is present (the patient is incapable of standing or thinking clearly), emergency attention is required. Fluids containing a proper balance of replacement electrolytes are given orally or intravenously with continuing assessment of electrolyte status; complete resolution is normal in all but the most extreme cases.^[27]

See also

• Hydrational fluids
• Terminal dehydration
• Dryness (medical)
• Oral Rehydration Therapy

References

Further reading

External links

Look up dehydration in Wiktionary, the free dictionary.

• Definition of dehydration by the U.S. National Institutes of Health's MedlinePlus medical encyclopedia Archived July 5, 2016, at the Wayback Machine