Dehydration

What is Dehydration?

A dehydration reaction is a process in which you tend to lose more bodily fluids (mostly water) than its intake [1]. During dehydration, the total amount of water lost by our body is greater than the amount that we drink throughout the day. Chronic dehydration lasts longer than acute dehydration and usually persists for a day. A person might die if he/she loses fluids exceeding 10% of the body weight.

Medical Definition of Dehydration

Dehydration is derived from the Latin word ‘de’ (removal) and ‘Greek hydros (water) and therefore stands for ‘loss of water’. When you lose water that is roughly equivalent to 1% of your weight, you are said to be clinically dehydrated [2]. Loss of a lesser amount is regarded as routine variation in the bodily fluid content.

Types of Dehydration

Depending on how dehydration influences the osmotic pressure of the interstitial fluids, it can be classified into the following types:

  • Isotonic dehydration: This happens when your body loses water and sodium in equal proportion. In such an eventuality, the volume or mass of sodium in the bodily fluid and therefore its tonicity remains stable. 80% of dehydration cases tend to be isotonic [3].
  • Hypertonic dehydration: When the proportion of sodium lost by the body is less than water, naturally occurring sodium concentration in the extracellular fluid increases creating a misbalance known as hypertonicity. In such a scenario, fluid will be drawn from intracellular cells to compensate for the deficiency that will result in shrinkage of cells ultimately leading to brain contraction [4].
  • Hypotonic dehydration: Hypotonic dehydration occurs when a higher proportion of sodium (compared to water) is lost. Since the tonicity of the extracellular fluid is less than that of the intracellular fluid, water drains into the cells causing them to swell resulting in cerebral edema.

    Causes of Dehydration in Children & Infants

  • Viral gastroenteritis that results in diarrhea [5]
  • The infant being unwell doesn’t want to drink
  • Persistent regurgitations [6]
  • Fever with excessive sweating
  • Gastroenteritis

Causes of Dehydration in Adults

  • Excessive workouts, fever, and undue exposure to heat
  • Any infection that causes diarrhea, vomiting, and frequent urination
  • Diseases like gastroenteritis, hypertension or diabetes
  • Consistent incapability to have food and water owing to some disability [7]
  • Ability to drink normally is compromised (when in coma)
  • Safe potable water is inaccessible
  • Serious skin injuries or diseases

Symptoms of Dehydration in Adults

Symptoms of Dehydration
  • Confusion
  • Decreased urine output
  • Dizziness
  • Dry mouth and swollen tongue
  • Fainting
  • Inability to sweat
  • Increased thirst
  • Palpitations (feeling that the heart is jumping or pounding) [8]
  • Sluggishness fainting
  • Weakness

Dehydration Complications

Dehydration causes severe complications like:-

  • Injuries from heat: Not drinking sufficient fluids while exercising strenuously (that leads to water loss from heavy sweating) may cause heat injury. Heat injuries range from mild spasms to estrus or sunstrokes that can be fatal.
  • Kidney and urinary issues: Consistent spells of or lingering dehydration can cause nephrolithiasis (kidney stones), UTI, and possibly even renal failure.
  • Seizures: Electrolytes like sodium, calcium, and potassium are crucial for transmitting electrical messages from one cell to another. The electrolytic imbalance will hamper the normal process of conveying these electrical signals and the messages get jumbled eventually resulting in involuntary or spontaneous muscular spasms thereby causing paralytic seizures [9].
  • Low Blood Volume Shock: One possible complication arising out of dehydration is low blood volume or ‘hypovolemic’ shock which could be critical sometimes. Hypovolemia occurs when the amount of blood circulating in the body decreases abnormally leading to hypotension and hypoxia (low blood pressure and abysmally low oxygen levels respectively).

Dehydration Test

In order to diagnose any of these dehydration problems, a doctor will conduct a series of clinical examinations of urine and/or blood samples or send the same to a diagnostic laboratory.

Dehydration and Blood Pressure

  • Reduced blood pressure, faster respiration, fever, and enhanced heart rate are potential indicators of dehydration as well as other diseases
  • Checking the blood pressure followed by pulse first when the individual is supine and thereafter standing up for 1 and 3 minutes respectively can help establish the extent of dehydration. Usually, your blood pressure plummets a bit when you lie down on your back. Afterward when you stand up, your heart beats faster and the pressure returns to normalcy [10].

However, if you’re dehydrated, blood supply to the brain will be affected owing to deficiency of fluid in the bloodstream eventually speeding up your heart beat rate. The heart rate goes up as your brain realizes this anomaly thus making you feel lightheaded and you may even faint if you keep standing for long.

Urine Tests

  • Urine color, clarity, specific gravity (volume of urine contrasted with equal mass of distilled water), and the existence of ketones can help diagnose dehydration level
  • Enhanced glucose levels in urine that helps to diagnose diabetes could also be a causative factor for dehydration
  • Excessive presence of proteins in urine could be an indicator of dehydration and kidneys problems.
  • Examination of the urine could help in determining symptoms of several other diseases like liver disease

Blood Tests

  • The concentration of sugar and salts like sodium and calcium together with kidney function pointers including creatinine and BUN could be crucial in determining the level of dehydration as well as the likely causes [11].
  • If your doctor strongly feels that a deep-seated malaise or infection could be the cause, then he may conduct a CBC. Going for an LFT could also help pinpoint dehydration symptoms.

Medical Treatments for Dehydration & Home Remedies

Home Remedies

Dehydrated individuals should be encouraged to drink fluids, including water, in the ways mentioned hereunder:

  • Take water in small sips
  • Sip drinks containing electrolyte salts and carbohydrates, for instance, Gatorade, a sports drink or Pedialyte, an effective oral electrolyte solution
  • Sucking on ice pops reinforced with sports drinks or fruit juices
  • Using a drinking straw (ideal for those recuperating from maxillae or mandible surgery or suffering from mouth sores)

If the person is suffering from high fever due to excessive heat exposure, he’ll feel relieved when:-

  • He lightens himself by wearing loose-fitting clothes
  • He’s shifted to a temperature-controlled area for restoring the normal body temperature as well as for breaking the heat exposure cycle. In the case of unavailability of air-conditioned areas, the person can be cooled down by placing a fan near him or making him lie down in shade when outside. Wrapping the individual in a moistened towel also helps [12].
  • If possible, spray lukewarm water on the epidermis (via an aerosol) which will cool the skin once the water evaporates
  • Ice cold water or ice packs should never be used. Ice packs could result in the constriction and shrinkage of blood vessels in the exposed part of the skin that’ll impede heat loss instead of expediting it. Treating the skin to too much cold could make the person shiver leading to increased temperature and worsening dehydration symptoms.

Dehydration Treatment

ER (emergency room) treatment primarily starts with attempting to reinstate fluid concentration and electrolyte balance followed by management of critical symptoms that could be life-threatening. At the same time, tests are conducted to pinpoint causes that led to dehydration in the first place.

If doctors see that the internal body temperature of the dehydrated individual is over 40˚C (or 104˚F), they’ll try to cool him down by placing him near a mist fan or wrapping a cool blanket or giving him a bath.

Fluid Replacement

  • Fluid replacement would be perfect for moderately dehydrated individuals without any vomiting or nausea symptoms. Patients are recommended to sip electrolyte-based drinks, besides water [13].
  • In case the dehydration is moderate or severe, fluids are administered intravenously

Disposition

  • If most of the symptoms disappear while receiving treatment in ER and the patient feels better, he may leave for home where he will be able to recuperate faster in the company of family members and friends. Many mildly dehydrated patients ushered into an ER are discharged once the symptoms stop.
  • Alternatively, if symptoms persist and the patient tends to be puzzled or feverish as well as exhibits anomalous vital signs consistently with affliction signs, he’ll probably be hospitalized for undergoing progressive treatment.

Acetaminophen

Medications like Tylenol (an acetaminophen) or Advil (ibuprofen) can be taken orally if the patient is unable to vomit or introduced rectally in case he’s not able to swallow [14].

Prevention

  • Preventing Dehydration in Babies: It can be effectively prevented through habitual breastfeeding and feeding infant formulas. Doctors recommend parents to stay away from anti-diarrheal medications as there is no reliable or concrete evidence that proves their efficacy. Also, intake of anti-diarrheal drugs by children can lead to numerous side-effects [15].
  • Prepare in Advance: Don’t forget to pack several water bottles for carrying to office or for attending an outdoor event especially if you happen to stay in hot climates. Suggest everybody, particularly endurance athletes and individuals who spend the better part of their day outdoors to drink water as well as isotonic drinks at regular intervals. This will ensure that the fluid and electrolyte balance is maintained.
  • Stay Indoors during excessive hot days: Try to stay indoors as long as possible and avoid workouts on days when the temperatures are abnormally high. Stays tuned to weather forecasts and if possible try rescheduling daytime events towards the evening when it’s much cooler.
  • Access to Safe Drinking Water: Make sure that babies, children, and elders have ready access to adequate safe drinking water as well as other healthy fluids. Also, see to it that disabled or handicapped individuals get all the help they need in order to take in sufficient amount of fluids and water.
  • Avoid alcohol: Abstain from consuming alcohol, particularly during the summer season and on days when it’s unbearably hot. Alcohol being desiccative or hygroscopic absorbs water from your body making you intensely dehydrated. Alcohol consumption may also numb your sense of detection whether you are suffering from dehydration [16].
  • Wear the right clothes: Always make it a point to wear clothes that fit somewhat loose and also make sure that the garments are of light colors. Try to keep yourself cool by carrying a personal mist fan.
  • Break Your Exposure: Exposure to hot temperatures need to be broken. It would be advised to find air-conditioned or at least some shady areas in between heat exposures to cool the body. A few hours spent in a cool area can help in the prevention of any cumulative effects due to high heat exposure.

References

  1. http://www.mayoclinic.org/diseases-conditions/dehydration/home/ovc-20261061
  2. http://www.ehealthstar.com/dehydration
  3. https://www.boundless.com/physiology/textbooks/boundless-anatomy-and-physiology-textbook/body-fluids-and-acid-base-balance-26/water-balance-245/water-balance-disorders-1206-10303/
  4. http://www.healthfrom.com/Disease/view-610.html
  5. https://gastrolyte.com.au/dehydration/dehydration-and-gastroenteritis/
  6. http://symptomchecker.webmd.com/multiple-symptoms?symptoms=dry-mouth%7Cregurgitation-of-food-or-liquid&symptomids=85%7C190&locations=7%7C7
  7. http://www.medicalnewstoday.com/articles/153363.php
  8. http://www.health.com/heart-disease/7-weird-things-that-can-mess-with-your-heartbeat-palpitations
  9. http://www.epilepsy.com/connect/forums/medication-issues/dehydration-and-seizures
  10. https://www.drwhitaker.com/determine-the-cause-of-your-high-blood-pressure
  11. https://labtestsonline.org/understanding/conditions/dehydration/start/3
  12. http://www.top10homeremedies.com/home-remedies/home-remedies-for-dehydration.html
  13. http://www.horleys.com/Resources/Resources/Resources%20-%20Dehydration%20%26%20Fluid%20Replacement
  14. http://www.ehealthme.com/ds/acetaminophen/dehydration/
  15. http://www.parents.com/baby/health/sick-baby/baby-dehydrated/
  16. https://gastrolyte.com.au/dehydration/dehydration-and-alcohol/

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