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Dehydration

Dehydration

Definition

Dehydration is the loss of water and salts that are essential for normal body function.

Description

Dehydration occurs when the body loses more fluid than it takes in. Dehydration can upset the delicate fluid-salt balance needed to maintain healthy cells and tissues. The human body is generally over 60 percent water. The body works to maintain water balance through mechanisms such as the thirst sensation. When the body requires more water, the brain stimulates nerve centers to encourage a person to drink in order to replenish the water stores. Water intake can vary widely on a daily basis, influenced by such factors as access to water, thirst, habit, and cultural factors.

The kidneys are responsible for maintaining water balance through the elimination of waste products and excess water. Water is primarily absorbed through the gastrointestinal tract and excreted by the kidneys as urine. The variation in water volume ingested is dependent on the ability of kidneys to dilute and concentrate the urine as needed.

Children need more water than adults because they expend more energy, and most children who drink when they are thirsty get as much water as their systems require. Dehydration in children usually results from losing large amounts of fluid and not drinking enough water to replace the loss. This condition generally occurs in children who have a stomach flu characterized by vomiting and diarrhea or who cannot or will not take enough fluids to compensate for excessive losses associated with fever and sweating of acute illness. Dehydration can result from illness; a hot, dry climate; prolonged exposure to sun or high temperatures; not drinking enough water; and overuse of diuretics or other medications that increase urination.

Types of dehydration

Dehydration is classified as mild, moderate, or severe based on how much of the body fluid is lost, estimated by loss in bodyweight. Mild dehydration is the loss of no more than 5 to 6 percent loss of body weight. Loss of 7 to 10 percent is considered moderate dehydration. Severe dehydration (loss of over 10 percent of body weight) is a life-threatening condition that requires immediate medical care.

Complications of dehydration

When the body's fluid supply is severely depleted, hypovolemic shock is likely to occur. This condition, which is also called physical collapse, is characterized by pale, cool, clammy skin; rapid heartbeat; and shallow breathing.

Blood pressure sometimes drops so low it cannot be measured, and skin at the knees and elbows may become blotchy. Anxiety , restlessness, and thirst increase. After a child's temperature reaches 107°F (41.7°C) damage to the brain and other vital organs occurs quickly.

Demographics

Dehydration is a major cause of infant illness and death throughout the world. Dehydration is often a result of gastrointestinal disease and diarrhea in children. Among children in the United States, short-term diarrhea results in approximately 200,000 hospitalizations and 300 deaths per year. In developing countries, dehydration from illness is a common cause of death in children under five years of age, accounting for about 2 million deaths per year.

Causes and symptoms

Dehydration is a deficit of body water that results when the output of water exceeds intake. Dehydration stimulates a child's thirst mechanism. Causes of dehydration may include the following:

  • decreased water or fluid intake
  • diarrhea
  • vomiting
  • excessive heat
  • excessive sweating
  • fever
  • excessive urination (polyuria)
  • diuretics or other medication that increase fluid loss
  • caffeine or alcohol consumption

Sweating and the output of urine both decrease during dehydration. If water intake continues to fall short of water loss, dehydration worsens and a child may become critically ill.

Reduced fluid intake may be a result of the following:

  • appetite loss associated with acute illness
  • nausea
  • bacterial or viral infection or inflammation of the pharynx (pharyngitis)
  • inflammation of the mouth caused by illness, infection, irritation, canker sores , or vitamin deficiency

Other conditions that can lead to dehydration include the following:

  • disease of the adrenal glands, which regulate the body's water and salt balance and the function of many organ systems
  • diabetes mellitus
  • eating disorders
  • kidney disease
  • chronic lung disease

With mild dehydration, increased thirst and restlessness are usually the only apparent symptoms. In moderately dehydrated children, eyes are somewhat sunken, and the mouth and tongue are dry. Thirst is increased: an older child asks for water, and a younger child drinks eagerly when offered a cup or spoon of water. The skin is less elastic than it should be and is slow to return to its normal position after being pinched. The radial pulse (wrist area) is detectable, but rapid. The soft spot on a baby's head (fontanelle) is somewhat sunken. Two of the following symptoms usually indicate some degree of dehydration: drinks eagerly, thirsty, restless, irritable, sunken eyes, or skin pinch goes back slowly.

Children with severe dehydration are usually lethargic, in a stupor, or even in a coma. Symptoms are even more apparent (deeply sunken eyes without tears, very dry mouth and tongue, rapid and deep breathing). A skin pinch retracts very slowly (over two seconds). Children who are awake are very thirsty, although a child may drink poorly if in a stupor. A child may not have urinated for six hours or longer. When in hypovolemic shock, systolic blood pressure taken in the arm is low or not detectable, the arms and legs are cool, and the nail beds may have a bluish or purplish discoloration. Two of the following symptoms indicate severe dehydration: lethargic or unconscious, very slow skin pinch, sunken eyes, and not able to drink or drinking poorly.

Dehydration can cause confusion, constipation , discomfort, drowsiness, and fever. The skin turns pale and cold, the mucous membranes lining the mouth and nose lose their natural moisture. The pulse sometimes races and breathing becomes rapid. Significant fluid loss can cause serious neurological problems or death.

When to call the doctor

A doctor should be notified whenever an infant or child exhibits signs of dehydration or a parent is concerned that a stomach virus or other acute illness may lead to dehydration.

A doctor should also be notified if any of the following is the case:

  • Symptoms of dehydration worsen.
  • A breast-fed or bottle-fed infant is unable to feed or feeds poorly.
  • An infant or child urinates very sparingly or does not urinate at all during a eight-hour period.
  • An infant younger than two months of age has diarrhea or is vomiting.
  • Dizziness, listlessness, or excessive thirst occurs.
  • The child's heart is beating fast.
  • The child has dry eyes, sunken eyes, a dry mouth, or is not producing tears.
  • There is blood in the stool or vomit.

An infant can become dehydrated within hours after the onset of illness. In general, the smaller the child, the lower the threshold should be for healthcare intervention if dehydration is suspected.

Diagnosis

A child's symptoms and medical history alone usually suggest dehydration. Physical symptoms are usually all that is necessary for diagnosing dehydration, although laboratory tests may be ordered by the physician. Physical examination may reveal shock, rapid heart rate, and/or low blood pressure. Laboratory tests, including blood tests (to check electrolyte levels) and urine tests (e.g. urine specific gravity and creatinine), may be used to evaluate the severity of the problem.

Treatment

Increased fluid intake and replacement of lost electrolytes are extremely important for restoring fluid balances in infants and children who are dehydrated. Treatment is given based on severity of dehydration. Treatment should include two phases: a rehydration phase and a maintenance phase. In the rehydration phase, fluid losses are replaced quickly, within three to four hours until normal hydration is achieved. In the maintenance phase, calories and fluids are given. Rapid refeeding should follow rapid rehydration with the goal of returning the child to an unrestricted, age-appropriate diet including solids. Withholding foods to rest the gut is not recommended. Breastfeeding should be continued at all times through both stages of treatment. Full-strength formula is usually tolerated. Changing formula or diluting to half strength are common practices but are usually unnecessary and may even prolong symptoms and delay nutritional recovery.

To replace calories quickly during acute illness, food should be given as soon as the child will tolerate it. During both rehydration and maintenance phases, fluid losses from vomiting and diarrhea should be replaced continuously. Restricting lactose (milk and milk products) is usually not necessary but may be helpful in a child with a severe intestinal disease or diarrhea in a malnourished child.

Children with minimal dehydration weighing less than 10 kilograms (22 pounds) should be given 60 to 120 mL (24 ounces) of an oral rehydration solution (ORS) for each episode of vomiting or diarrheal stool. Those weighing more than 10 kg (22 lbs) should be given 120 to 240 mL (48 ounces). Food should not be restricted. Children with mild to moderate dehydration should be given 50 to 100 mL (roughly 23.5 ounces) of an ORS per kilogram body weight during two to four hours to replace fluid losses. Additional ORS should be administered to replace ongoing losses from vomiting and diarrhea. In a sick child, a teaspoon, syringe, or medicine dropper can be used to offer a small amount at first with amounts increasing as tolerated. If the child appears to want more, more can be given. Severe dehydration is a medical emergency requiring intravenous fluids immediately.

For moderate or severe dehydration, a child should be treated in a medical facility. Moderate dehydration can be treated orally, but severe dehydration requires the child to take fluids intravenously (IV). When treating dehydration, the underlying cause must also be addressed. For example, if dehydration is caused by vomiting, medications may be prescribed to resolve these symptoms. However, anti-diarrheal medications are not recommended in children. A child who is dehydrated due to diabetes, kidney disease, or adrenal gland disorders must receive treatment for these conditions as well as for the resulting dehydration.

For older children who are mildly dehydrated, just drinking plain water may be all the treatment that is needed. For infants and younger children, especially when ill, drinking a commercial ORS should be encouraged. Parents should follow label instructions when giving children Pedialyte or other commercial products recommended for relieving dehydration. Sports drinks are not recommended as they contain a lot of sugar and may worsen diarrhea.

In order to accurately calculate fluid loss, it is important to chart weight changes every day and keep a record of how many times a child vomits or has diarrhea. Parents should note how many times a baby's diaper must be changed.

Alternative treatment

Gelatin water may be substituted for electrolyte-replacement solutions if an ORS is unavailable. It is made by diluting a 3-oz package in a quart of water or by adding one-fourth teaspoon of salt and a tablespoon of sugar to a pint of water. Receiving the right amount of electrolytes is very important, and thus homemade remedies such as gelatin (or adding salt or sugar to water) are not recommended because of the potential for quantity errors when mixing. However, these may be useful if ORS cannot be obtained in an emergency. Parents should keep a can of ORS on hand for emergencies.

Formulas containing soy fiber have been reported to reduce liquid stools.

Prognosis

Mild dehydration rarely results in complications. If the cause is eliminated and lost fluid is replaced, mild dehydration can usually be cured quickly.

Vomiting and diarrhea that continue for several days without adequate fluid replacement can be fatal. However, dehydration that is rapidly recognized and treated has a good outcome.

Prevention

Ensuring that children always drink adequate fluids during an illness helps to prevent dehydration. Parents can prevent dehydration in infants and children who are vomiting or who have diarrhea by increasing fluids to compensate for losses. Infants and children with diarrhea and vomiting should be given ORS such as Pedialyte immediately to help prevent dehydration.

Children who are not ill can maintain proper fluid balance by drinking water or fluids even before they are thirsty. Children should drink fluids before going outside to exercise or play (especially on a hot day). Dehydration can usually be prevented by drinking enough fluid for urine to remain the color of pale straw. Water in foods, especially fruits and vegetables, is a great source of fluid. Fruits and vegetables can contain up to 95 percent water, so a well-balanced diet is a good way to stay hydrated.

Parents should know whether any medication their child is taking can cause dehydration and should get prompt medical care to correct any underlying condition that increases the risk of dehydration.

Other methods of preventing dehydration and ensuring adequate fluid intake are as follows:

  • eating more soup at mealtime
  • drinking plenty of water and juice at mealtime and between meals
  • keeping a glass of water nearby

Children should not be given coffee or tea, because they increase body temperature and water loss. Avoiding caffeinated soft drinks may also reduce the risk of dehydration. These beverages are all diuretics (substances that increase fluid loss).

KEY TERMS

Diuretic A group of drugs that helps remove excess water from the body by increasing the amount lost by urination.

Electrolytes Salts and minerals that produce electrically charged particles (ions) in body fluids. Common human electrolytes are sodium chloride, potassium, calcium, and sodium bicarbonate. Electrolytes control the fluid balance of the body and are important in muscle contraction, energy generation, and almost all major biochemical reactions in the body.

Resources

BOOKS

Batmanghelidj, F. Water: For Health, For Healing, For Life: You're Not Sick, You're Thirsty! New York: Warner Books, 2003.

Kleinman, Ronald E., and the American Academy of Pediatrics Committee on Nutrition. Pediatric Nutrition Handbook, 5th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2003.

Physicians Committee for Responsible Medicine. Healthy Eating for Life for Children. Hoboken, NJ: Wiley, 2002.

Speakman, Elizabeth, and Norma Jean Weldy. Body Fluids and Electrolytes, 8th ed. London: Mosby Incorporated, 2001.

Willett, Walter C., and P. J. Skerrett. Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating. New York: Simon & Schuster Source, 2002.

Workman, M. Linda. Introduction to Fluids, Electrolytes and Acid-Base Balance. London: Saunders, 2001.

PERIODICALS

Steiner, M. J., et al. "Is this child dehydrated?" Journal of the American Medical Association 291, no. 22 (June 2004): 274654.

ORGANIZATIONS

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 600071098. Web site: <www.aap.org>.

American College of Emergency Physicians. 1125 Executive Circle, Irving, TX 750382522. Web site: <www.acep.org>.

WEB SITES

Rehydration Project. Available online at <www.rehydrate.org> (accessed November 16, 2004).

"Why Is Dehydration so Dangerous?" Rehydration Project. Available online at <www.rehydrate.org/dehydration/index.html> (accessed November 16, 2004).

Crystal Heather Kaczkowski, MSc. Maureen Haggerty

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Dehydration

Dehydration

Definition

Dehydration is the loss of water and salts essential for normal body function.

Description

Dehydration occurs when the body loses more fluid than it takes in. This condition can result from illness; a hot, dry climate; prolonged exposure to sun or high temperatures; not drinking enough water; and overuse of diuretics or other medications that increase urination. Dehydration can upset the delicate fluid-salt balance needed to maintain healthy cells and tissues.

Water accounts for about 60% of a man's body weight. It represents about 50% of a woman's weight. Young and middle-aged adults who drink when they're thirsty do not generally have to do anything more to maintain their body's fluid balance. Children need more water because they expend more energy, but most children who drink when they are thirsty get as much water as their systems require.

Age and dehydration

Adults over the age of 60 who drink only when they are thirsty probably get only about 90% of the fluid they need. Developing a habit of drinking only in response to the body's thirst signals raises an older person's risk of becoming dehydrated. Seniors who have relocated to areas where the weather is warmer or dryer than the climate they are accustomed to are even likelier to become dehydrated unless they make it a practice to drink even when they are not thirsty.

Dehydration in children usually results from losing large amounts of fluid and not drinking enough water to replace the loss. This condition generally occurs in children who have stomach flu characterized by vomiting and diarrhea, or who can not or will not take enough fluids to compensate for excessive losses associated with fever and sweating of acute illness. An infant can become dehydrated only hours after becoming ill. Dehydration is a major cause of infant illness and death throughout the world.

Types of dehydration

Mild dehydration is the 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 that requires immediate medical care.

Complications of dehydration

When the body's fluid supply is severely depleted, hypovolemic shock is likely to occur. This condition, which is also called physical collapse, is characterized by pale, cool, clammy skin; rapid heartbeat; and shallow breathing.

Blood pressure sometimes drops so low it can not be measured, and skin at the knees and elbows may become blotchy. Anxiety, restlessness, and thirst increase. After the patient's temperature reaches 107 °F (41.7 °C) damage to the brain and other vital organs occurs quickly.

Causes and symptoms

Strenuous activity, excessive sweating, high fever, and prolonged vomiting or diarrhea are common causes of dehydration. So are staying in the sun too long, not drinking enough fluids, and visiting or moving to a warm region where it doesn't often rain. Alcohol, caffeine, and diuretics or other medications that increase the amount of fluid excreted can cause dehydration.

Reduced fluid intake can be a result of:

  • appetite loss associated with acute illness
  • excessive urination (polyuria)
  • nausea
  • bacterial or viral infection or inflammation of the pharynx (pharyngitis)
  • inflammation of the mouth caused by illness, infection, irritation, or vitamin deficiency (stomatitis)

Other conditions that can lead to dehydration include:

  • disease of the adrenal glands, which regulate the body's water and salt balance and the function of many organ systems
  • diabetes mellitus
  • eating disorders
  • kidney disease
  • chronic lung disease.

An infant who does not wet a diaper in an eight-hour period is dehydrated. The soft spot on the baby's head (fontanel) may be depressed. Symptoms of dehydration at any age include cracked lips, dry or sticky mouth, lethargy, and sunken eyes. A person who is dehydrated cries without shedding tears and does not urinate very often. The skin is less elastic than it should be and is slow to return to its normal position after being pinched.

Dehydration can cause confusion, constipation, discomfort, drowsiness, fever, and thirst. The skin turns pale and cold, the mucous membranes lining the mouth and nose lose their natural moisture. The pulse sometimes races and breathing becomes rapid. Significant fluid loss can cause serious neurological problems.

Diagnosis

The patient's symptoms and medical history usually suggest dehydration. Physical examination may reveal shock, rapid heart rate, and/or low blood pressure. Laboratory tests, including blood tests (to check electrolyte levels) and urine tests (e.g., urine specific gravity and creatinine), are used to evaluate the severity of the problem. Other laboratory tests may be ordered to determine the underlying condition (such as diabetes or an adrenal gland disorder) causing the dehydration.

Treatment

Increased fluid intake and replacement of lost electrolytes are usually sufficient to restore fluid balances in patients who are mildly or moderately dehydrated. For individuals who are mildly dehydrated, just drinking plain water may be all the treatment that is needed. Adults who need to replace lost electrolytes may drink sports beverages (e.g., Gatorade or Recharge) or consume a little additional salt. Parents should follow label instructions when giving children Pedialyte or other commercial products recommended to relieve dehydration. Children who are dehydrated should receive only clear fluids for the first 24 hours.

A child who is vomiting should sip one or two teaspoons of liquid every 10 minutes. A child who is less than a year old and who is not vomiting should be given one tablespoon of liquid every 20 minutes. A child who is more than one year old and who is not vomiting should take two tablespoons of liquid every 30 minutes. A baby who is being breast-fed should be given clear liquids for two consecutive feedings before breastfeeding is resumed. A bottle-fed baby should be given formula diluted to half its strength for the first 24 hours after developing symptoms of dehydration.

In order to accurately calculate fluid loss, it's important to chart weight changes every day and keep a record of how many times a patient vomits or has diarrhea. Parents should note how many times a baby's diaper must be changed.

Children and adults can gradually return to their normal diet after they have stopped vomiting and no longer have diarrhea. Bland foods should be reintroduced first, with other foods added as the digestive system is able to tolerate them. Milk, ice cream, cheese, and butter should not be eaten until 72 hours after symptoms have disappeared.

Medical care

Severe dehydration can require hospitalization and intravenous fluid replacement. If an individual's blood pressure drops enough to cause or threaten the development of shock, medical treatment is usually required. A doctor should be notified whenever an infant or child exhibits signs of dehydration or a parent is concerned that a stomach virus or other acute illness may lead to dehydration.

a doctor should also be notified if:

  • a child less than three months old develops a fever higher than 100 °F (37.8 °C)
  • a child more than three months old develops a fever higher than 102 °F (38.9 °C)
  • symptoms of dehydration worsen
  • an individual urinates very sparingly or does not urinate at all during a six-hour period
  • dizziness, listlessness, or excessive thirst occur
  • a person who is dieting and using diuretics loses more than 3 lb (1.3 kg) in a day or more than 5 lb (2.3 kg) a week

When treating dehydration, the underlying cause must also be addressed. For example, if dehydration is caused by vomiting or diarrhea, medications may be prescribed to resolve these symptoms. Patients who are dehydrated due to diabetes, kidney disease, or adrenal gland disorders must receive treatment for these conditions as well as for the resulting dehydration.

Alternative treatment

Gelatin water can be substituted for electrolyte-replacement solutions. It is made by diluting a 3-oz package in a quart of water or by adding one-quarter teaspoon of salt and a tablespoon of sugar to a pint of water.

Prognosis

Mild dehydration rarely results in complications. If the cause is eliminated and lost fluid is replaced, mild dehydration can usually be cured in 24-48 hours.

Vomiting and diarrhea that continue for several days without adequate fluid replacement can be fatal. The risk of life-threatening complications is greater for young children and the elderly. However, dehydration that is rapidly recognized and treated has a good outcome.

Prevention

Patients who are vomiting or who have diarrhea can prevent dehydration by drinking enough fluid for their urine to remain the color of pale straw. Ensuring that patients always drink adequate fluids during an illness will help prevent dehydration. Infants and young children with diarrhea and vomiting can be given electrolyte solutions such as Pedialyte to help prevent dehydration. People who are not ill can maintain proper fluid balance by drinking several glasses of water before going outside on a hot day. It is also a good idea to avoid coffee and tea, which increase body temperature and water loss.

Patients should know whether any medication they are taking can cause dehydration and should get prompt medical care to correct any underlying condition that increases the risk of dehydration.

Other methods of preventing dehydration and ensuring adequate fluid intake include:

  • eating more soup at mealtime
  • drinking plenty of water and juice at mealtime and between meals
  • keeping a glass of water nearby when working or relaxing

Resources

OTHER

"HydrationGetting Enough Water." Loyola University Health System. May 13, 1998. http://www.luhs.org.

KEY TERMS

Electrolytes Mineral salts, such as sodium and potassium, dissolved in body fluid.

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Dehydration

Dehydration

Dehydration is the excessive loss of water from the body. Water can be lost through urine, sweat, feces, respiration, and through the skin. Symptoms of dehydration in order of severity are: thirst, nausea , chills, clammy skin, increased heart rate, muscle pain, reduced sweating, dizziness, headache, shortness of breath, dry mouth, fatigue , lack of sweating, hallucinations, fainting, and loss of consciousness. Dehydration can affect mental alertness, renal function, circulation, and total physical capacity.

The following can help to avoid dehydration:

  1. Drink before feeling thirsty
  2. Drink enough fluid to have pale yellow urine
  3. Avoid caffeine and alcohol, which act as diuretics
  4. Drink two to three cups of fluid two hours before exercise or heavy outside work in hot temperatures
  5. Drink one to two cups of fluid every fifteen minutes during exercise or heavy outside work in hot temperatures
  6. Avoid exercising during midday heat, and wear appropriate clothing that allows airflow around the body

Athletes, elderly persons, young children, and those with specific illnesses that affect fluid balance, such as severe diarrhea, are at higher risk for dehydration than the average person.

see also Malnutrition; Oral Rehydration Therapy; Sports Nutrition.

Mindy Benedict

Bibliography

Dorland's Pocket Medical Dictionary, 23d edition (1982). Philadelphia: W. B. Saunders.

Berning, Jacqueline R., and Steen, Suzanne Nelson (1998). Nutrition for Sport and Exercise, 2nd edition. Gaithersburg, MD: Aspen.

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dehydration

dehydration Removal or loss of water from a substance or tissue. Water molecules can be removed by heat, catalysts or a dehydrating agent such as concentrated sulphuric acid. Dehydration is used in food preservation, such as the freeze-drying process of such items as coffee and meat. In medicine, excessive water loss is often a symptom or result of disease or injury.

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dehydration

dehydration Removal of water, especially from a chemical compound by heat, sometimes in the presence of a catalyst or dehydrating agent, e.g. sulphuric acid. Also refers to removal of water from crystals, oil, etc., commercially by distillation, chemicals, or heat. In metamorphism, prograde metamorphic reactions commonly involve dehydration of hydrous minerals.

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dehydration

dehydration The removal of water, especially from a chemical compound by heat, sometimes in the presence of a catalyst or dehydrating agent (e.g. sulphuric acid), or the removal of water from crystals, oil, etc., commercially by distillation, chemicals, or heat.

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dehydration

dehydration (dee-hy-dray-shŏn) n. loss or deficiency of water in body tissues. The condition may result from inadequate water intake and/or from excessive removal of water from the body; for example, by sweating, vomiting, or diarrhoea.

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dehydration

dehydration Drying, normally used for factory‐dried, as distinct from wind‐dried, materials.

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