DEHYDRATION

BY DR AKANKSHA
 WHAT IS DEHYDRATION ?
Dehydration describes a state of negative fluid balance that may be caused by numerous disease
entities i.e. excessive loss of fluid from the body occurring when loss of fluid exceed the fluid intake .

WHY IS DEHYDRATION NEEDFUL TO ASSESS PROPERLY AND TREAT PROMPTLY ??

According to NLM , dehydration due to diarrhoea / fluid loss contributes to second leading cause of
morbidity and mortality among children under 5 worldwide . So , it becomes important to classify and
manage dehydration
 PATHOPHYSIOLOGY OF DEHYDRATION:

1. Excessive fluid loss

2. Reduced fluid intake
3. Third space fluid shift

Pathophysiology :
All these broad classification/causes of dehydration(increased fluid output / low intake / fluid shift ) will
cause reduction in extracellular and intracellular fluid volumes .
Clinical manifestations of dehydration are most closely related to intravascular volume depletion and
physiologic compensation attempts that takes place . As dehydration progresses , hypovolemic shock
ultimately ensues , resulting in end oragn failure and death .
 CLASSIFICATION OF DEHYDRATION :

 1on the basis of osmolarity

 2. on the basis of severity of dehydration

 1. on basis of osmolarity :
 Serum sodium is a good surrogate marker of osmolarity provided patient has normal serum glucose .
 Osmolarity : (2*serum sodium) +(glucose/18)+ (bun/2.8)
 Isonatremic dehydrationn (130-150 meq/l): most common lost fluid sodium conc = blood sodium
con( both intra and extra vascular cvolume depletion is same )
 Hyponatremic dehydration (< 130 meq/l ): lost fluid sodium conc > blood sodium conc(intravascular
volume depletion )
 Hypernatremic dehydration > 150 meq/l : lost fluid sodium conc < blood sodium conc , intravascular
depletion minimized
Hyponatremic and hypernatremic
dehydration may be associated with
neurologic complications because of
fluctuating serum sodium levels .

Severe hyponatremia may lead to seizures

whereas rapid correction (> 2 meq/lhour //
> 10-12 meq/l/hr/day )
CLASSIFICATION ON BASIS OF SEVERITY :
CAUSES OF DEHYDRATION :
 AExcessive fluid loss : B Decreased fluid intake
 Gastroenteritis stomatitis
 Diabetic ketoacidosis pharyngitis
 Burns gi obstruction
 Adrenal insufficiency : CAH reduced appetite
 diabetes insipidus
 Secretory diarrhoea : malignancy (net ) / hormonal imbalance
 Antibiotic use
 Poisoning : og compounds
SHORT IMPORTANT POINTS IN HISTORY :

 1 intake of fluids
 2. urine output ( frequency / concentrated or dilute )
 Stool output / frequency / consistency
 Vomit : frequency / volume
 Underlying disease : renal / diabetes mellitus / cystic fibrosis
 Appetite patterns
 Any antibiotic use .
 Travel history
 Possible ingestions : eg organophosphorus compounds
 CLINICAL EXAMINATION / SIGNS :

1. Hippocraticus face
2. Shrunken eyes
3. Pinched up nose
4. Parched lips
5. Hollowness of temporal fossa
6. Depressed anterior fontanelle (infants )
7. Dry and coated tongue
8. Dry and laxed skin , subcutaneous tissue feels lax
9. Loss of skin turgor
‘ sign of ridge ‘ – if the skin is pinched up by index finger and then released , a ridge is formed which
subsides slowly (in severe dehydration ) instead of it springing back with normal elasticity
 10. hypotension – weak pulse , collapse of jugular veins
 11. decreased urine output – scanty dark concentrated urine
 12 SHOCK : cold and clammy extremeties ; tachycardia ; with thready pulse ;
hypotension with systolic bp < 90 mmhg ; tachypnea ; urine output < 30 ml/hour
13. Delirium : both through fluid overload / dehydration resulting in hypoxemia

Delayed capillary refill / delayed skin turgor / abnormal respiratory pattern : most
reliable
ASSESSING HYDRATION STATUS OF
PATIENT
1. Skin turgor
2. Moistness of tongue
3. Postural hypotension
4. Intraocular tension
5. Peripheral edema ( ankle nad sacral )
6. Ascites
7. Jugular venous pressure
( skin elasticity can be lost in old age and tongue remains dry in mouth braethers )
 WORKUP :
 Serum sodium
 Serum potassium : elevated in renal failure/ marked acidosis / CAH
 Lactic acid :
 Serum glucose
MANAGEMENT :
Some (mild and moderate ) dehydration can be managed by oral fluids intake ,