Dehydration / Over-hydration.
Learning Objectives:
By the completion of lecture, the student should be able to:
• Define Dehydration?
• How do we classify dehydration?
• What treatment plan should be taken in mild, moderate and
severe dehydration?
• How do we describe rehydration?
• What is the Composition of ORS.
• What other Intravenous solutions can be used as volume
expanders.
Dehydration
Definition:
Dehydration is the loss of water and salts essential for
normal body function.
Description:
• Human body needs water to maintain enough blood and
other fluids to function properly.
• Body also needs electrolytes, which are salts normally
found in blood, other fluids, and cells.
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.
• usual causes of dehydration are a lot of
diarrhoea and vomiting.
Types of dehydration:
• Mild dehydration :
loss of no more than 5% of the body's fluid.
• Loss of 5-10% is considered moderate
dehydration.
• Severe dehydration (loss of 10-15% of body
fluids) is a life-threatening condition.
Symptoms of early or mild dehydration
• 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
• 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.
• 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.
Home drinks to prevent dehydration
• Mothers can use household liquids.
• preferably rice water or carrot soup.
• Ideally these drinks should contain starches and/or sugars as a source of
glucose and energy, some sodium and preferably some potassium.
• A simple salt/sugar solution is also suitable for early oral rehydration therapy.
• 1 level teaspoon (5 ml) of salt should be mixed with 8 level teaspoons of sugar
in a litre of drinking water.
• Do not use too much salt.
• too much salt can, in extreme cases, cause convulsions.
Rehydration:
• Replenishment of water and
electrolytes lost through dehydration.
• Can be performed by mouth (oral
rehydration) or by adding fluid and
electrolytes directly into the blood
stream (intravenous rehydration).
Over Hydration
Definition:
• A condition in which the body contains too
much water.
• Also called water excess or water
intoxication,
Description
Over Hydration
• Overhydration occurs when the body takes in more water than it excretes and
its normal sodium level is diluted.
• Results in digestive problems, behavioral changes, brain damage, seizures, or
coma.
• Most common in patients whose kidney function is impaired and may occur
when doctors, nurses, or other healthcare professionals administer greater
amounts of water-producing fluids and medications than the patient's body can
excrete.
• Overhydration is the most common electrolyte imbalance in hospitals,
occurring in about 2% of all patients.
Causes and symptoms
• The patient may become confused, drowsy, or inattentive.
• Shouting and delirium are common.
• blurred vision, muscle cramps and twitching, paralysis on one side of the body,
poor coordination, nausea and vomiting, rapid breathing, sudden weight gain,
and weakness.
• The patient's complexion is normal or flushed.
• Blood pressure is sometimes higher than normal, but elevations may not be
noticed even when the degree of water intoxication is serious.
• Overhydration can cause acidosis, anemia, cyanosis (a condition that occurs
when oxygen levels in the blood drop sharply), hemorrhage, and shock.
Diagnosis
• Overhydration is characterized by excess water both within and around the
body's cells,
• While excess blood volume occurs when the body has too much sodium and
can not move water to reservoirs within the cells.
• In cases of overhydration, symptoms of fluid accumulation do not usually
occur.
• In cases of excess blood volume, fluid tends to accumulate around cells in the
lower legs, abdomen, and chest.
• Overhydration can occur alone or in conjunction with excess blood volume,
and differentiating between these two conditions may be difficult.
Treatment
• Mild overhydration can be corrected by limiting fluid intake.
• In more serious cases, diuretics may be prescribed to increase urination, although
these drugs tend to be most effective in the treatment of excess blood volume.
• Identifying and treating any underlying condition (such as impaired heart or kidney
function) is a priority, and fluid restrictions are a critical component of every treatment
plan.
• In patients with severe neurologic symptoms:
– A powerful diuretic and fluids to restore normal sodium concentrations are
administered rapidly at first.
– When the patient has absorbed 50% of the therapeutic substances, blood levels are
measured.
– Therapy is continued at a more moderate pace in order to prevent brain damage as
a result of sudden changes in blood chemistry.
ORS Solution
• A special drink for diarrhoea
• ORS (oral rehydration salts) is a special
combination of dry salts that is mixed with
safe water. It can help replace the fluids lost
due to diarrhoea.
When should ORS be
used?
• When a child has three or more loose
stools in a day, begin to give ORS.
How is the ORS drink prepared?
• Put the contents of the ORS packet in a clean container. Check the
packet for directions and add the correct amount of clean water.
Too little water could make the diarrhoea worse.
• Add water only. Do not add ORS to milk, soup, fruit juice or soft
drinks. Do not add sugar.
• Stir well, and feed it to the child from a clean cup. Do not use a
bottle.
How much ORS drink to give?
• Encourage the child to drink as much as possible.
• A child under the age of 2 years needs at least 1/4 to 1/2 of a large
(250-millilitre) cup of the ORS drink after each watery stool.
• A child aged 2 years or older needs at least 1/2 to 1 whole large
(250-millilitre) cup of the ORS drink after each watery stool.
What if ORS is not available?
• Give the child a drink made with 6 level teaspoons of sugar and 1/2
level teaspoon of salt dissolved in 1 litre of clean water.
• Be very careful to mix the correct amounts. Too much sugar can
make the diarrhoea worse. Too much salt can be extremely
harmful to the child.
• Making the mixture a little too diluted (with more than 1 litre of
clean water) is not harmful.
Other Available solutions for Intra venous infusions(Dextrose
water5%, 10 %, 25%, Ringer lactate, Normal saline, amino acids
solutions, Hemaxcel.
• Intravenous therapy may be used to correct electrolyte
imbalances, to deliver medications, for blood transfusion or
as fluid replacement to correct, for example, dehydration.
• Compared with other routes of administration, the
intravenous route is the fastest way to deliver fluids and
medications throughout the body.
Ringer's lactate solution
• A standardized sterile physiologic–ie,
isotonic– 0.9% solution containing
calcium chloride, KCl, NaCl, sodium
lactate; it is used as a topical irrigant
and as a crystalloid solution for
restoring fluid volumes.
Normal Saline Solution
Other Names
• 0.9% Sodium Chloride Solution.
Action
• Normal Saline is a sterile, nonpyrogenic solution for fluid and
electrolyte replenishment.
• contains no antimicrobial agents.
• It contains 9 g/L Sodium Chloride with an osmolarity of 308 mOsmol/L.
Indications
•source of water and electrolytes.
Amino acid solution for
parenteral nutrition:
• Well balanced supply of essential and non-essential amino
acids
• Rapid improvement of nitrogen balance
• High flexibility due to different concentrations
Characteristics
• Provides essential and non-essential amino acids
• 5%; 10%; 12.5% and 15% versions
• With and without electrolytes
HAEMACCEL
• sterile, pyrogen-free and does not contain any preservatives.
• when given intravenously, adapts itself to the blood volume
situation.
INDICATIONS:
Volume-deficiency shock
Loss of blood
Loss of plasma
Exsiccosis
Volume losses during and after surgery.
Also in conjunction with a heart-lung machine, and during
haemodialysis.