Signs, Symptoms, Causes, and Prevention

Dehydration happens when your body doesn’t have as much water as it needs. Without enough, your body can’t function properly. You can have mild, moderate, or severe dehydration depending on how much fluid is missing from your body.

Causes

It’s normal to lose water from your body every day by sweating, breathing, peeing, and pooping, and through tears and saliva (spit). Usually you replace the lost liquid by drinking fluids and eating foods that contain water. If you lose too much water or don’t drink and eat enough, you can get dehydrated.

You can lose more water than usual with:

You may not replace the water you lose because:

• You’re busy and forget to drink enough.
• You don’t realize you’re thirsty.
• You don’t feel like drinking because you have a sore throat or mouth sores, or you’re sick to your stomach.

Symptoms

Signs of mild or moderate dehydration include:

Signs of severe dehydration include:

• Not peeing or having very dark yellow pee
• Very dry skin
• Feeling dizzy
• Rapid heartbeat
• Rapid breathing
• Sunken eyes
• Sleepiness, lack of energy, confusion or irritability
• Fainting

Symptoms for babies and young children can be different than for adults:

• Dry mouth and tongue
• No tears when crying
• Dry diapers for 3 hours
• Sunken eyes, cheeks, soft spot on the top of the skull
• Sleepiness, lack of energy, or irritability

Severe dehydration is a medical emergency and needs to be treated immediately.

Who’s at Risk?

Anyone can get dehydrated, but the odds are higher for some people:

• Babies and young children are the most likely to have severe diarrhea and vomiting, and they lose the most water from a high fever. The youngest can’t tell you they’re thirsty or get their own drink.
• Older adults often don’t realize they’re thirsty. If they can’t get around very well anymore, they may not be able to get a drink easily or may not be able to take in enough fluids due to medical conditions.
• People who are ill with a cold or sore throat may not want to eat or drink.
• People with a chronic disease such as type 1 or type 2 diabetes can pee a lot if the disease is uncontrolled. They also may take medicines such as water pills, which make them go more often.
• People who are active outside in hot and humid weather sometimes can’t cool down effectively because their sweat doesn’t evaporate. This can lead to a higher body temperature and need for more water.

6 Unusual Symptoms of Dehydration and Tips to Stay Hydrated

Becoming extremely dehydrated — defined by the World Health Organization as losing more than 10 percent of your body weight in fluid — can lead to injury or fatal complications, and it requires an ER visit. Seizures, cardiac arrhythmia, or hypovolemic shock can occur because your blood volume is too low.

Yet it rarely comes to that. Most of the time, you can easily replenish your fluid stores and fend off dehydration. The truth is you can lose 3 to 4 percent of your body weight through dehydration without feeling any real symptoms, says Alp Arkun, MD, the chief of service for emergency medicine at the Kaiser Permanente Fontana and Ontario Medical Centers in Southern California. Yet, once you have lost 5 to 6 percent, you’ll start to feel the symptoms of mild dehydration, notes MedlinePlus. Thirst, fatigue, dizziness, or constipation are sure signs it’s time to reach for water or a sports drink that’s low in sugar and high in electrolytes. ­­

RELATED: Thirsty? 9 Refreshing Alternatives to Soda

But the signs of dehydration aren’t always so obvious. Here are six surprising signs and symptoms of dehydration.

1. Bad Breath Is a Possible Warning Sign of Dehydration

Saliva has antibacterial properties, but dehydration can prevent your body from making enough saliva.

“If you’re not producing enough saliva, you can get bacterial overgrowth in the mouth, and one of the side effects of that is bad breath,” says John Higgins, MD, a professor of medicine at the University of Texas in Houston and the chief of cardiology at Lyndon B. Johnson General Hospital in Houston.

It’s the same reason you may wake up with “morning breath”: Saliva production slows down during sleep, notes the Mayo Clinic, leading to an unpleasant taste in the mouth as bacteria grow. So the next time your mouth seems dry and your breath smells less-than-fresh, it may be time to rehydrate.

RELATED: What Is ‘Raw’ Water, and Should You Drink It?

2. Dry or Flushed Skin Could Be a Symptom of Dehydration

“A lot of people think that people who get dehydrated are really sweaty, but in fact, as you go through various stages of dehydration, you get very dry skin,” Dr. Higgins says, adding that skin may appear flushed as well.

Another key skin-related symptom of dehydration is skin that remains “tented” after being pinched and takes some time to return to its normal, flat appearance (more on that below).

RELATED: 10 Surprising Causes of Dry Skin

3. Muscle Cramps Are a Dehydration Symptom, Likely From Heat Illness

When your body loses enough fluid, it’s unable to cool itself off adequately, leading to heat illness, notes OrthoInfo. One symptom to look out for is muscle cramps, which can happen while exercising, particularly in hot weather.

“The hotter you get, the more likely you are to get muscle cramps, and that’s from a pure heat effect on the muscles. As the muscles work harder and harder, they can seize up from the heat itself. Changes in the electrolytes, such as sodium and potassium, can lead to muscle cramping as well,” says Higgins.

Bear in mind that when it comes to rehydration after exercise, all drinks may not be created equal. A study published in March 2019 in the BMJ Open Sport and Exercise Medicine found that when participants rehydrated with a drink containing electrolytes after exercise, they were less likely to develop muscle cramps. Participants who drank plain water, on the other hand, were more likely to have cramps. The study was small, so its findings may not apply to you, but the next time you feel a muscle cramp coming on after exercise, opting for an electrolyte-filled sports drink may help.

Even in cooler weather, dehydration is possible if you don’t drink enough fluids while working out. Higgins says symptoms may be milder or come on slower, but dehydration carries the same risks, regardless of the temperature outside.

4. Fever and Chills Are Symptoms of Heat Illness, Which Causes Dehydration

Other symptoms of heat illness include fever and chills. You may sweat profusely while your skin is cool to the touch.

Fever can worsen dehydration. The higher the fever, the more dehydrated you may become. Unless your body temperature decreases, your skin will lose its cool clamminess and then become hot, flushed, and dry to the touch. At this point, it’s important that you cool yourself down immediately and see a medical professional, the Centers for Disease Control and Prevention (CDC) advises. Applying ice and cool, wet cloths, and moving to a cool area are short-term strategies until you can see a medical professional.

According to the Mayo Clinic, children and infants lose more of their body fluid to fever, and they are more likely to experience severe diarrhea and vomiting from illness. Any fever in an infant or toddler is cause for concern. Ask your pediatrician for guidelines on when to call for help.

The CDC urges adults with fever to seek medical help if their temperature reaches 103 degrees F.

RELATED: 6 Smart Tips for Staying Hydrated Throughout the Day

5. Food Cravings, Especially for Sweets, May Just Mean You’re Thirsty

“When you’re dehydrated, it can be difficult for organs such as the liver, which uses water, to release glycogen [stored glucose] and other components of your energy stores, so you can actually get cravings for food,” Higgins says.

While you can crave anything from chocolate to a salty snack, cravings for sweets are more common because your body may be experiencing difficulty breaking down glycogen to release glucose into the bloodstream to use as fuel, he says.

6. Headaches Could Be a Sign You Need to Drink More Water

As MedlinePlus points out, even mild dehydration can cause a dehydration headache and trigger a migraine headache. Although various factors besides dehydration can cause headaches, drinking a full glass of water and continuing to sip more fluids during the day is an easy way to ease your pain if, in fact, dehydration is a culprit.

RELATED: What Is Alkaline Water and Does It Offer More Benefits Than Plain H₂O?

How to Tell if You’re Dehydrated or if It’s Something Else

If you’re thirsty, you’re already dehydrated. But lack of thirst doesn’t necessarily mean you’re well hydrated. Here are two other ways to check whether your body is dehydrated:

Try this skin test. Use two fingers to pinch up some skin on the back of your hand, and then let the skin go. The skin should spring back to its normal position in less than a couple of seconds. Higgins says that if the skin returns to normal more slowly, you might be dehydrated.

Check your urine. If you’re well hydrated, your urine will be mostly clear with a tinge of yellow (the color of light lemonade before it hits the bowl). Darker yellow or orange are the “warning” colors to watch for, per UC San Diego Health. If you see those colors, start drinking fluids.

RELATED: 8 Foods High in Water That Can Help Prevent Dehydration

Tips for Staying Hydrated

When it comes to daily water intake, hard-and-fast rules are difficult to apply because it depends on so many variables, including your age, gender, whether you’re pregnant or breast-feeding, and whether you have any underlying medical conditions.

Yet 2004 guidelines from the National Academies of Sciences, Engineering, and Medicine — the most recent available — advise that getting 2.7 liters per day for women and 3.7 liters per day for men. You can reach this amount by consuming foods and fluids.

Here are some tips for getting all the fluids you need and avoiding dehydration:

Keep Your Water Bottle Handy at All Times

“If it’s right next to you, you’ll likely get into the habit of sipping it without even realizing it,” says Johannah Sakimura, RD, an outpatient oncology dietitian at Overlook Medical Center in Summit, New Jersey.

RELATED: The Best Water Bottles to Keep You Hydrated

Try Spicing Up Plain Water

“If you don’t love plain water, jazz it up by adding a splash of fruit juice or chunks of fresh or frozen fruit,” says Sakimura. “Or try naturally flavored, calorie-free seltzers — their fizz and fruit flavor makes them more appealing than plain, flat water.”

RELATED: LaCroix Lawsuit: Is Sparkling Water Good or Bad for You?

Turn to Sugar-Free Herbal Tea or Coffee

Sakimura recommends drinking unsweetened teas, which are available in lots of different flavors. “Sip fruity iced teas during the day (with lots of ice if it’s hot out), or cozy up with a mug of hot peppermint or chamomile tea at night — they all count toward your daily fluid goal.” And if your beverage of choice is coffee rather than tea, that works, too: While caffeinated drinks may have a diuretic affect, increasing your need to urinate, one crossover study of 50 men found that there were no significant differences in total hydration when the men drank four cups of coffee daily compared with four cups of water. The results of the study, which were published in the journal PLoS One in January 2014, suggest that coffee hydrates similarly to water when consumed in moderation by regular coffee drinkers.

RELATED: Is Filtered Coffee Healthier Than Unfiltered Coffee?

Swap Your Packaged Snacks for Fresh Options 

“Swap dry snacks, like chips, pretzels, and crackers — which have a very low water content — with refreshing munchies, like fresh or frozen fruit, yogurt, healthy smoothies, celery with peanut butter, and cut veggies with hummus,” recommends Sakimura.

Pile on the Produce 

In the same vein, know that those veggies and fruits are hydrating, just like beverages. “Aim to make half your plate produce at meals. All those vegetable and fruit servings will supply water as well as a hearty dose of vitamins, minerals, and fiber,” says Sakimura. “In fact, some fruits and vegetables are more than 90 percent water — including cantaloupe, strawberries, watermelon (of course), cucumber, celery, lettuce and leafy greens, zucchini, tomatoes, and bell peppers. ”

Sip More Fluid During Meals

“Sipping water with meals will help you eat more slowly, pace your eating, and, of course, stay hydrated,” Sakimura says. Drinking water before eating may furthermore help with weight loss, as it did for participants of a study published in the journal Obesity in August 2015. During a small randomized controlled trial involving 84 subjects, participants who drank 500 milliliters (ml) of water 30 minutes before eating lost an average of 1.3 kilograms (kg) at the 12-week follow-up.

RELATED: 5 Tricks for Getting Enough Fruit and Veggies

A Final Note on the Importance of Preventing Dehydration if You’re Elderly

Elderly people may be at higher risk for dehydration for a number of reasons, per the National Academies of Sciences, Engineering, and Medicine.

Some elderly people become chronically dehydrated if they take certain medicines, such as diuretics, have a diminished sense of thirst, are not able to get themselves a glass of water easily, or forget to drink because of dementia. Chronic dehydration in an elderly person may lead to confusion, low blood pressure, dizziness, and constipation.

If you have an elderly relative with mobility limitations or cognitive problems, be sure to watch him or her for signs of dehydration, or ask their caregivers to do so. Certain prescriptions can be costly, so make sure to know your Medicare coverage options.

As for your own well-being, remember that healthy bodies are composed of at least 60 percent water, notes the U.S. Geological Society. Keep that healthy balance, and drink up!

Additional reporting by Sheryl Huggins Salomon and Laura McArdle.

Dehydration (for Parents) – Nemours Kidshealth

What Is Dehydration?

We all lose some body water every day in our sweat, tears, urine (pee), and stool (poop). Water also evaporates from skin and leaves the body as vapor when we breathe. We usually replace this body fluid and the salts it contains through our regular diet.

Sometimes, kids lose large amounts of water and salts. This can happen when they have a fever, diarrhea, or vomiting, or through long periods of exercise with lots of sweating. And some illnesses can make it hard for them to drink fluids.

If they can’t replace the fluid that’s been lost, kids can become dehydrated.

What Are the Signs and Symptoms of Dehydration?

If your child has a fever, diarrhea, or vomiting, or is sweating a lot on a hot day or during intense physical activity, watch for signs of dehydration. These include:

• a dry or sticky mouth
• few or no tears when crying
• eyes that look sunken
• in babies, the soft spot (fontanelle) on top of the head looks sunken
• peeing less or fewer wet diapers than usual
• dry, cool skin
• irritability
• drowsiness or dizziness

How Is Dehydration Treated?

It’s important to know the early signs of dehydration and to respond quickly if your child has them. The goal in treating dehydration is to replace fluids and restore body fluids to normal levels.

Kids who are mildly dehydrated from lots of activity will probably be thirsty and should drink as much as they want. Plain water is the best option. They should rest in a cool, shaded spot until the lost fluid has been replaced.

Rehydration

Kids with mild to moderate dehydration due to diarrhea from an illness (like gastroenteritis) should have their lost fluids replaced. This is known as rehydration. It’s done by giving a special liquid called an oral rehydration solution (ORS) over the course of 3 to 4 hours.

ORS is available in many grocery stores and drugstores without a prescription. It has the right combination of sugar and salts that dehydrated kids need.

Start the rehydration process by giving your child 1 or 2 teaspoons (5 or 10 milliliters) of an ORS every few minutes. You can use a spoon or an oral syringe. This may not seem like enough fluids to rehydrate your child, but these small amounts can add up to more than a cup (237 milliliters) an hour. If your child does well, you can gradually give bigger sips a little less often.

Even kids who are vomiting can usually be rehydrated this way because the small frequent sips get absorbed in between the vomiting episodes.

A breastfed infant should continue to be nursed, even during rehydration, unless vomiting repeatedly. Give the ORS in between feedings. Stop giving formula to a formula-fed baby during rehydration, and restart as soon as your baby can keep fluids down and isn’t showing signs of dehydration.

Do not give a dehydrated child water, soda, ginger ale, tea, fruit juice, gelatin desserts, or chicken broth. These don’t have the right mix of sugar and salts and can make diarrhea worse. Older kids who are dehydrated can have sports drinks, but oral rehydration solution is best for young children and infants.

When your child is rehydrated, you can serve a normal diet, including breast milk, formula, or milk.

Some dehydrated kids do not improve when given an ORS, especially if they have explosive diarrhea (very frequent BMs that are forceful and very loud) or are vomiting often. When fluid losses can’t be replaced for these or other reasons, a child might need to get intravenous (IV) fluids in the hospital.

If you’re treating your child for dehydration at home and feel that there’s no improvement or that the dehydration is getting worse, call your doctor right away or take your child to the nearest emergency room (ER).

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Can Dehydration Be Prevented?

Making sure kids get plenty of fluids when they’re sick or physically active can help protect them from getting dehydrated.

How to keep them hydrated can depend. For example, a child with a sore throat may become dehydrated because drinking or eating is too painful. Easing the pain with acetaminophen or ibuprofen may help, and cold drinks or popsicles can soothe a burning throat while also giving fluids.

Not all fevers need to be treated, but if your child is uncomfortable and not getting enough fluids, you can give acetaminophen or ibuprofen to help control the fever.

It’s important that kids drink often during hot weather. Those who play sports or are very physically active should drink extra fluids beforehand, and then take regular drink breaks (about every 20 minutes) during the activity. Ideally, sports practices and competitions should be held in the early morning or late afternoon to avoid the hottest part of the day.

Thirst is not a good early sign of dehydration. By the time they feel thirsty, kids might already be dehydrated. That’s why they should start drinking before they feel thirsty and have more fluids even after thirst is quenched.

Dehydration and the “Stomach Flu”

Kids with mild gastroenteritis (also called the “stomach flu”) who aren’t dehydrated should still drink extra fluids to replace those lost from vomiting and diarrhea. Most kids can safely eat their regular diet while they’re sick.

Infants with mild gastroenteritis who aren’t dehydrated should continue getting breast milk or regular-strength formula. Older kids may continue to drink full-strength milk and other fluids.

Foods that are usually well tolerated by kids with gastroenteritis who aren’t dehydrated include: complex carbohydrates (such as rice, wheat, potatoes, bread, and cereals), lean meats, yogurt, fruits, and vegetables. Avoid fatty foods or foods high in sugars (including juices and soft drinks).

If your child is vomiting and isn’t dehydrated, give fluids often, but in small amounts.

Dehydration | Cancer.Net

Dehydration happens when a person does not take in enough fluid or loses too much fluid. Your cells and organs depend on water. Without it, the human body cannot function properly. The water in your body performs many tasks:

• Transports nutrients and oxygen

• Controls heart rate and blood pressure

• Regulates body temperature

• Lubricates joints

• Protects organs and tissue, including the eyes, ears, and heart

• Creates saliva

• Removes waste and toxins

If you are receiving cancer treatment, you may be at a higher risk for dehydration due to side effects, such as diarrhea and vomiting.

What are the signs and symptoms of dehydration?

The longer you go without taking in enough fluid, the more dehydrated you will become. Thirst is one way your body alerts you to drink more fluid. However, sometimes you can become dehydrated without feeling thirsty. Other possible dehydration symptoms include:

• A dry or sticky mouth or a swollen tongue

• Fatigue or weakness

• Irritability

• Dizziness or lightheadedness

• Nausea and vomiting

• Headaches

• Constipation

• Dry skin

• Weight loss

• Dark yellow urine or a decrease in urination

Severe dehydration can be life-threatening and needs immediate medical treatment. It can cause the following symptoms:

• Extreme thirst

• Low blood pressure

• Fever

• Rapid heartbeat

• Lack of urination for more than 8 hours

• Sunken eyes

• Inability to sweat

• Inability to produce tears

• Disorientation or confusion

Talk with your health care team about any new symptoms or change in symptoms that you experience.

What are the causes of dehydration?

You lose water every day through natural body functions. These include breathing, sweating, and going to the bathroom. Most people easily replace that fluid through drinking and eating. But certain conditions affect the body’s ability to stay hydrated. These include:

• Diarrhea, nausea, and vomiting. Cancer treatment, including certain types of chemotherapy, radiation therapy, and surgery, can cause these side effects.

• Fever. A high fever can cause dehydration. People receiving cancer treatment may be at risk for developing infections that can cause fever.

• Age. Infants, children, and older adults are at a greater risk for dehydration. Young children pass water and electrolytes out of the body frequently. Electrolytes are minerals that help regulate the body. As a person gets older, the body slowly loses the ability to conserve water. Older adults also are less likely to sense that they are thirsty. They may not eat or drink enough, especially if they live alone.

• Chronic illness. Many diseases — such as diabetes, cystic fibrosis, and kidney disease — increase dehydration risk and the need for fluids. For example, people with uncontrolled diabetes urinate frequently. Some medications can also cause a person to urinate or sweat more than normal.

• Environment. Living, working, and exercising in a hot or humid environment increase the need for fluids. People living at high altitudes, from 8,000 feet (2,400 meters) to 12,000 feet (3,700 meters) above sea level, also need more fluids. This is because their bodies lose water as they work to take in more oxygen.

• Exercise. Everyone loses water through sweat. Exercise can make you sweat more. Even if you do not see sweat, you are likely sweating. The more you exercise, the more fluid you need to replace.

How is dehydration diagnosed?

Your doctor can diagnose dehydration using several methods:

• Taking your vital signs, such as your blood pressure and pulse

• Testing your blood for factors such as your electrolytes and kidney function

• Testing your urine for the level of dehydration or to find out what may be causing dehydration

How is dehydration treated?

Relieving side effects, also called palliative care or supportive care, is an important part of cancer care and treatment. Treatment for dehydration depends on its severity. For mild dehydration, you might try the following:

• If you are able to drink, take in small amounts of fluid frequently instead of a large amount at one time. Drinking too much at once may cause vomiting.

• Keep a water bottle with you at all times, and sip from it throughout the day.

• Drink a large glass of water before bed and when you wake up each morning.

• Suck on ice chips or popsicles if you have trouble drinking or eating.

• Apply moisturizer to cracked lips and medication to mouth sores. This can make drinking and eating less painful.

• If you have diarrhea, choose drinks that have sodium and potassium to help replace these lost minerals.

• Keep ice and drinks within reach so you do not have to get up as often, if you are tired.

You doctor may recommend an oral rehydration solution if you are not vomiting or experiencing diarrhea. In this case, you may be moderately dehydrated.

Your doctor may prescribe fluids to given directly through a vein, also called intravenous (IV) fluids. In this case, you may be severely dehydrated.

How can dehydration be prevented?

The following tips can help keep your body’s fluid balance in check:

Drink lots of fluids. The amount of fluid needed each day to stay hydrated depends on your health, treatment, and lifestyle. Ask your doctor how much water you should drink. If you dislike plain water, try drinking flavored water or adding a slice of lemon. Other fluids can also help, including milk, low-sugar juice, and caffeine-free tea.

Remember to avoid foods and drinks that may contribute to dehydration. Avoid alcohol. Choose drinks with low sugar and low or no caffeine. Water is often a better choice than fruit juice, soda, or coffee.

Eat foods with high water content. Drinking water is the best way to hydrate. But many foods contain water and can also help replenish lost fluids. Choose foods such as lettuce (95% water), watermelon (92% water), and broccoli (91% water). Soup, popsicles, and yogurt also have high water content.

Manage side effects. Cancer treatment can cause nausea, vomiting, or diarrhea. Talk with your health care team about ways to prevent or reduce these side effects and any concerns you have about dehydration.

Monitor your environment and activity. Do not wait to drink water or other fluids. Make a conscious effort to drink regularly. Drink more often before you exercise and before you go outside in hot weather. During an illness or if you are feeling unwell, be proactive and drink water to stay hydrated in order to help your recovery.

Related Resources

Cancer.Net Podcast: The Importance of Hydration

Side Effects of Chemotherapy

When to Call the Doctor During Cancer Treatment

More Information

MedlinePlus: Dehydration

American Cancer Society: Dehydration and Lack of Fluids

Dehydration | Health Navigator NZ

Dehydration is the loss of water and salts from your body. Most people experience mild dehydration at some time, but if it becomes severe it can lead to death.

Key points about dehydration

1. When you are dehydrated, you don’t have enough body fluids for your body to carry out normal functions easily.
2. Feeling thirsty is a sign you need more fluid.
3. Babies, older adults and people who work outside are most at risk of dehydration.
4. Mild dehydration can be treated by drinking small amounts of water frequently. Electrolyte solutions may also be suitable.
5. Severe dehydration can be a serious problem, especially for babies and young children and older adults – seek urgent medical help or call Healthline 0800 611 116.

If you have a child under the age of 6 months who is vomiting (being sick) or has diarrhoea (runny poos), or you think they might be dehydrated, take them to a doctor right away.
Read more about dehydration in babies and children.

What are the symptoms of dehydration?

For healthy people, the best way to know that you need more fluid is if you feel thirsty. 

In the early stages of dehydration (mild dehydration), symptoms include:

• a dry, sticky mouth and tongue
• feeling lightheaded or dizzy
• weakness
• a headache
• feeling very tired – no energy.

As dehydration becomes worse (moderate or severe dehydration), symptoms include: 

• extreme thirst
• dry mouth and cracked lips
• urinating (peeing) less
• not peeing for 8 hours (a sign of severe dehydration)
• dizziness when you stand up that doesn’t go away after a few seconds
• weakness
• feeling sleepy, tired or confused
• cramping in your arms and legs.

If you have signs of moderate or severe dehydration, see your doctor or an after-hours clinic immediately or call 111 for an ambulance.

What causes dehydration?

Dehydration is when you don’t have enough body fluids for your body to carry out normal functions easily. About 75% (three-quarters) of your body is water. Your bones are 22% water and your blood is nearly all (92%) water. Your body uses water to replace blood and other fluids so it can function properly. 

Along with water, your body also needs electrolytes. These are salts normally found in blood, other fluids and cells. When you are dehydrated, you also lose these salts.

You can survive without food for more than 30 days, but less than a week without water. 

The common causes of dehydration are:

• diarrhoea (runny poos) and vomiting (being sick)
• having a fever (high temperature)
• not eating or drinking while you’re sick
• being outside in very hot conditions
• not drinking enough before, during or after hard exercise or heavy work
• some health conditions such as kidney disease or diabetes – these cause you to urinate (pee) more often
• some medicines such as water pills (diuretics) – these can cause your body to lose water
• even having a cold or sore throat – because you’re less likely to feel like eating or drinking when you’re sick.  

Who is at risk of dehydration?

Although anyone can become dehydrated, those who become dehydrated most easily are babies under 1-year-old, older adults and people who work or exercise outside. 

Babies under 1 year old

Dehydration can quickly become serious in children. If you have a child under the age of 6 months who has vomiting/diarrhoea, or whom you suspect is dehydrated, take them to see a doctor right away. Young children often can’t tell you that they’re thirsty, nor can they get a drink for themselves. The younger the child, the easier it is for them to become dehydrated. Read more about dehydration in babies and children.

Older adults

As you age, your body’s fluid reserve becomes smaller, your ability to retain water is reduced and your sense of thirst becomes less reliable. This is made worse by conditions such as diabetes and dementia, and by certain medicines. Older adults also may have mobility problems that limit their ability to get water easily.

People who work or exercise outside

When it’s hot and humid, your risk of dehydration and heat illness increases. That’s because when the air is humid, sweat can’t evaporate and cool you as quickly as it normally does. This can lead to a higher body temperature and the need for more fluids. Read more about heat stroke and heat exhaustion.

How can I prevent dehydration?

• Always drink plenty of fluids during the day, especially when working or exercising in the sun.
• Where possible, try to do all physical outdoor activities in the cooler parts of the day.
• Drink water before you play sport, during if possible, and after to ensure your body stays hydrated. 
• Drink plenty of fluids if you have diarrhoea, vomiting or fever – see your doctor if you cannot keep fluids down.
• Water is best. Avoid high-sugar, high-calorie drinks such as undiluted fruit juice, fizzy drinks and sports drinks. They are not as hydrating and drinking these regularly is a leading cause of obesity.
• Avoid caffeinated and alcoholic drinks. These can make dehydration worse as they make you pee more.

What is the treatment for dehydration? 

Mild dehydration can be treated by drinking water frequently in small amounts until you are no longer thirsty and your urine (pee) is a light yellow colour. Even if you are vomiting, some of this water will still be absorbed by your body. 

If drinking water is not enough to treat the dehydration, your doctor or pharmacist may recommend electrolyte solutions such as Electral or Pedialyte. You can buy these from your pharmacist. Prepare them according to the instructions on the packet. Read more about oral rehydration solutions. 

Moderate or severe dehydration often needs treatment in hospital and may involve fluids being given by a nasogastric tube (a tube through your nose into your stomach) or intravenously (through a needle into a vein).  

How much water should I drink every day? 

How much water you need depends on many factors, including your health, how active you are and where you live.

It has been recommended we should drink 6 to 8 glasses of water a day. This is a good guide, although there is no research-based evidence to support this. A good guide is the colour of your urine (pee). It should be a very light-coloured yellow. If it is a deep yellow then it is likely you are not drinking enough water.

If you have kidney stones, drinking plenty of water each day can lower your chances of getting another stone. You should also drink extra amounts of water when experiencing any dehydrating conditions (such as hot, humid weather, high altitudes or physical exertion). 

5 easy ways to drink more water

• Carry a water bottle with you.
• Set an alarm or download an app to remind you when to drink more fluids.
• Have a glass of water before and after each meal.
• Replace other drinks with water, especially drinks with sugar, caffeine or alcohol in them.
• In winter, drink warm water with lemon, honey or mint leaves.

Read more about drinking the right amount of water.

Learn more

Dehydration NHS, UK
Dehydration MedlinePlus, US

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Dehydration in children and babies

In children and babies, dehydration is often due to vomiting (being sick) and diarrhoea (runny poos). The younger the child, the easier it is for them to become dehydrated.  This is because their bodies are smaller and they have smaller fluid reserves. 

How can I prevent dehydration in my baby or child?

Dehydration due to vomiting and diarrhoea can be prevented by giving your child fluids. Whichever fluids your child is having, the important thing is to:

• offer small amounts of fluid often rather than giving large amounts
• aim for quarter of a cup every 15 minutes or 1 teaspoon or 5 mls in a syringe every minute
• keep offering your child fluids even if they are vomiting. 

What fluids should I give my baby or child to avoid dehydration?

Babies

• If you are breastfeeding, continue to feed on demand. You may need to increase the frequency of feeds and give extra fluid.
• If your child is on formula, continue to give them formula feeds.
• If your child is over 1 year, you may give them cow’s milk.

Children

• Water is generally the best fluid.

• Offer small amounts of fluid often rather than giving large amounts.
• Aim for ¼ of a cup every 15 minutes or 1 teaspoon or 5 mls in a syringe every minute.
• Keep offering your child fluids even if they are vomiting.
• If your child vomits, wait 5 to 10 minutes and then start giving fluid again, but more slowly ( eg, a spoonful every 2 to 3 minutes). 

You may also give your child the following drinks as long as they are not dehydrated. These drinks MUST be diluted with water as they contain too much sugar (which can make diarrhoea worse):

• cordial – make up to normal drinking strength then add 5 parts of water to 1 part of the diluted cordial
• soup – add 5 parts of water to 1 part of soup
• fruit juice – add 5 parts of water to 1 part of juice.

Your doctor or pharmacist may recommend electrolyte solutions such as Electral or Pedialyte if your child is mildly dehydrated. You can buy these from your pharmacist. Prepare them according to the instructions on the packet. Read more about oral rehydration solutions.

Don’t give your child these drinks

Do not give your child undiluted fizzy drinks, fruit juices, Lucozade, Ribena or sports drinks (such as Powerade or Gatorade). These contain too much sugar and can make your child’s diarrhoea worse.

Also, don’t give them coffee and tea as these can make your child become dehydrated.

Assessment of dehydration in children

From Gastroenteritis Starship Clinical Guideline, NZ, 2017:

• The best way to find out is to measure weight loss, but a recent weight is seldom available. Clinical estimate of the degree of dehydration is unreliable. Doctors usually overestimate the deficit, and may underestimate it if there is hypernatraemia.
• In the management of dehydration, it is much more important to follow a child closely over time, than it is to calculate and replace a hypothetical figure for % dehydration.

Dehydration severity	Symptoms	Physical signs
Mild		None Slightly dry buccal mucosa
Moderate		Dry buccal mucosa, absent tears Sunken eyes & fontanelle Decreased urine output Altered skin elasticity Signs of ketosis (rapid shallow breathing, smell of ketones)
Severe		Drowsiness Shock (tachycardia, poor volume peripheral pulses, cool peripheries) Hypotension is late/ominous sign Skin retraction time > 2 seconds Capillary refill time > 3 seconds
As a rough guide, the child who is mildly dehydrated (≈5%) may be considered to have a 50 ml/kg deficit, and the child who is shocked (≈10 – 15%) may be considered to have at least a 100 ml/kg deficit.

Oral rehydration therapy (ORT) for children

This is the treatment of choice for dehydration from gastroenteritis. It is safer and more effective than IV therapy for all degrees of dehydration except shock. ORT uses Oral Rehydration Solution, which takes advantage of glucose/sodium co-transport mechanisms in the small bowel.

Certain principles must be remembered:

• ORT is intensive. It depends on a lot of input from the child’s caregiver, or the use of a nasogastric tube.
• Pedialyte is the ORS of choice.
• The treatment of gastroenteritis with ORS occurs in two phases: rehydration and maintenance. Except in hypernatraemia, ORT aims for full rehydration within 4 hours.
• The schedule suggested here for the rehydration phase is a standard rate of replacement for all dehydrated children who are not shocked, over 4 hours. The final volume given is determined by clinical assessment of when the child is rehydrated.
• During the rehydration phase, fluid is given at a rate of 5 ml per minute, by teaspoon or syringe. The small volumes decrease the risk of vomiting. The rate (1 teaspoon / minute) is easy to calculate and administer for a parent sitting at the bedside. 25 ml every 5 minutes can also be used. If oral rehydration not successful, then naso-gastric rehydration should be used.
• This rate of replacement is already maximal, and is not supplemented for ongoing losses. If the child’s ongoing losses exceed an intake at this rate, the child will require nasogastric or intravenous fluids. This rate will rehydrate a moderately dehydrated 1 year old in 2 to 4 hours and a 2 year old in 3 to 5 hours (estimating diarrhoea at 0 -10 ml per kg per hour).
• An alternative rate is 25 ml / kg /hr, over 4 hours, in small aliquots frequently.
• There must be frequent review (at least 2 hourly) in the rehydration phase.
• Vomiting is not a contra-indication. Most children with gastroenteritis who vomit, will still absorb a significant percentage of any fluid given by mouth or NG.
• Half strength apple juice has been shown to be a suitable alternative for children with mild gastroenteritis and minimal dehydration.

Clinical resources

Gastroenteritis Starship Clinical Guideline, NZ, 2017
Oral rehydration therapy (ORT) NZ Formulary for Children
Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management NICE Guideline, 2009
Assessment and management of infectious gastroenteritis BPAC, NZ, 2009

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: 

How to interpret symptoms, signs and investigations of dehydration in children with gastroenteritis

Background

Worldwide, it has been estimated that approximately one in five paediatric deaths can be attributed to dehydration related to gastroenteritis. 1 2 The increased fluid losses from vomiting and diarrhoea can result in rapid fluid and electrolyte shifts leading to dysregulation of physiological mechanisms such as thirst. In extremis, this can lead to volume depletion and dangerous electrolyte imbalances.1 An understanding of the symptoms, signs and investigations used to assess and manage dehydration is vital for any clinician caring for acutely unwell children. This interpretation therefore focuses entirely on the management of dehydration in children with an acute gastrointestinal illness. Other, less common, causes of dehydration (eg, diabetic ketoacidosis, renal failure, cardiac failure, liver disease and postoperative care) are not covered.

Throughout this interpretation, dehydration will be described as mild (<5% of weight loss), moderate (5%–10% weight loss) or severe (>10% weight loss).3

What are the symptoms and signs of dehydration in a child?

A number of clinical features were identified from the literature as predictive of dehydration. These are outlined in table 1 and include decreased skin turgor, capillary refill time of >2 s, ill appearance, absent tears, abnormal respiration pattern, dry mucous membranes, sunken eyes, abnormal (weak or feeble) radial pulse, tachycardia and decreased urine output.4–7 The absence of these signs, among children with gastroenteritis, was highly predictive of the child not having dehydration with a negative predictive value (NPV) of over 90%.4–7

Table 1

Summary of studies quantifying the diagnostic performance of clinical signs of dehydration and/or investigating their predictivity of dehydration severity

Table 2

Clinical Dehydration Scale

Unfortunately, the symptoms and signs listed above and in table 1 were not specific for dehydration; that is, the presence of one or more of the symptoms could not be used to accurately confirm dehydration as present. The most specific symptoms and signs of dehydration were reported as prolonged capillary refill time of >2 s (positive predictive value (PPV) 0. 57–0.65) and decreased skin turgor (PPV 0.52–0.57). The remaining symptoms and signs were non-specific for dehydration with a PPV of less than 0.5.4–7

Based on these findings, it is reasonable to assume that, in a child with acute gastroenteritis, if all of the symptoms and signs listed are absent, then dehydration is unlikely. The presence of any of the features listed should alert the clinician to the possibility of dehydration while also being mindful that many of the features are non-specific and may indicate other illnesses.

One approach to rising awareness and to standardise care in this area has been the development of clinical decision tools. One such tool validated for use in children (aged 1 month–3 years) is the Clinical Dehydration Scale (CDS),8 summarised in table 2. Another useful resource is the National Institute for Health and Care Excellence (NICE) clinical guideline 84: ‘Diarrhoea and vomiting caused by gastroenteritis in under 5 s: diagnosis and management’. 9

Which symptoms and signs are best for predicting the severity of dehydration?

Predicting the severity of dehydration is challenging and requires the clinician to interpret and combine a mixture of symptoms and signs. When taking the history, it is important to ask about the number of episodes of diarrhoea and/or vomiting, as well as asking about intake, duration of illness and estimated urine output. Of the reported symptoms, it is the number of episodes of diarrhoea and/or vomiting that correlates best with severity.10

During the examination, it is important to make a global assessment of the child’s health while also specifically examining for skin turgor, capillary refill time, dryness of mucous membranes, appearance of eyes (sunken or not) and the presence of tears. The individual predictive value of these signs has been discussed already (table 1), and the presence of any one feature should alert the clinician to possibility of dehydration.4–7 10–12 The greater the number of features, the greater the likely degree of dehydration. 6

The CDS provides a pragmatic approach to assessing severity (table 2) and can be used to aide decision making.4 8 Similarly, NICE CG84 provides guidance on assessing severity with features of dehydration listed, including five ‘red flag’ signs of ‘reduced responsiveness, reduced skin turgor, tachycardia, tachypnoea and sunken eyes’.9

Can laboratory investigations be used to assess the severity of dehydration?

NICE does not recommend routine blood testing in the assessment of dehydration in children. Blood testing is only recommended for children who require intravenous therapy, have signs of shock or where hyponatraemia/hypernatraemia is suspected.9 When testing is required, NICE only recommends measuring blood sugar, electrolytes, urea, creatinine and a blood gas. This approach is supported by the available evidence summarised in table 3.7 10 12–18

Table 3

Summary of studies investigating predictivity of dehydration severity of laboratory investigations

Measuring serum urea and creatinine levels is helpful when assessing severe dehydration only with very high serum urea values (greater than 16. 7 mmol/L) and creatinine values (greater than 80 μmol/L) reliably predicting severe dehydration.10 13 Unfortunately, urea and creatinine levels are unhelpful in mild and moderate dehydrations.

Of the tests advised by NICE,9 the blood gas (specifically bicarbonate levels) correlates the best with severity, as shown in table 4.12 13 16 17 As a general trend, the lower the venous bicarbonate levels, the greater the severity of dehydration.10

Table 4

Mean±SD of venous bicarbonate and base excess levels in relation to dehydration levels

What about other tests?

There are a number of other tests that have been suggested as helpful in the assessment of dehydration in children. These include urinary testing (sodium and specific gravity) and blood tests (blood urea nitrogen (‘BUN’), BUN to creatinine ratio and uric acid).12–14 17 18

Urinary testing for specific gravity is of almost no value when assessing for dehydration and should not be routinely used.18 Urinary sodium levels may be helpful with a urine sodium of less than 90 mmol/L being shown to be highly sensitive and specific for dehydration. 17 A urinary sodium may therefore be useful in children where the traditional clinical assessment of hydration may be difficult, for example, dehydration in conditions such as nephrotic syndrome.

Blood testing for BUN and BUN/creatinine levels may also be helpful in some. An elevated BUN greater than 45 mg/dL (16 mmol/L) is indicative of at least moderate dehydration,12 whereas a BUN to creatinine ratio of less than 20 is indicative of an absence of dehydration.14

Experimental testing

The digitally measured capillary refill time (DCRT) is an innovative approach for predicting dehydration severity. The test requires use of specific software to analyse ‘frame-by-frame’ the video of one of the child’s fingertips both before and after a light pressure is applied for 5 s. Studies have demonstrated that a DCRT of >0.4 s was 100% sensitive (95% CI 75% to 100%) and had a specificity of 91% (95% CI 82% to 97%) for predicting the presence of at least moderate dehydration.19

Ultrasound (US) scanning has been proposed as a quick method to determine the severity of dehydration in children. Two different US measures (aorta to inferior vena cava (IVC) ratio and IVC inspiratory collapse) have been studied as methods of estimating dehydration in children. The aorta to IVC ratio demonstrated a sensitivity of 93% and specificity of 59% compared with 93% and 35% for IVC inspiratory collapse.20 The use of US remains experimental but could become of greater clinical relevance as point-of-care US becomes more widely available.20

Clinical bottom line

• The assessment of dehydration in children is challenging and requires a detailed history and examination.

• Blood tests should not be performed routinely.

• The greater the number of symptoms and signs, the greater the likelihood of severe dehydration.

• The Clinical Dehydration Scale and National Institute for Health and Care Excellence CG84 are useful tools to help clinicians identify children with dehydration.

How to Prevent, Detect, & Treat Dehydration in Aging Adults

Q: How can we get my older mother to drink more water? She is susceptible to urinary tract infections and seems to be often dehydrated no matter what we do. We were also wondering if coffee and tea are okay, or should they be avoided to reduce dehydration?

A: Dehydration is indeed an important problem for older adults. It can be common even when it’s not hot outside.

Helping an older person increase her fluid intake, as you’re trying to do, is one of the best ways to reduce the risk of dehydration.

Now how to actually do this? Studies — and practical experience — suggest that the best approaches include:

1. Frequently offering the older person a drink, preferably on a schedule,
2. Offering beverages the person seems to prefer,
3. Not expecting older adults to drink a large quantity at a single sitting,
4. Addressing any urinary incontinence issues that might be making the person reluctant to drink often.

But your question brings up other issues in my mind. Has frequent dehydration been confirmed? (Dehydration can be hard to correctly diagnose.) Have you been able to measure how much your mother drinks, and how does this amount compare to the recommended daily fluid intake for older adults?

Also, is the real goal to prevent or manage frequent urinary infections, and is increasing her hydration likely to achieve this?

So let’s review the basics of dehydration in older adults, and what’s known about helping older adults stay hydrated. I will then share some additional tips on helping your mother maintain hydration.

The Basics of Dehydration

What is dehydration and what causes it?

Dehydration means the body doesn’t have as much fluid within the cells and blood vessels as it should.

Normally, the body constantly gains fluid through what we eat and drink, and loses fluid through urination, sweating, and other bodily functions. But if we keep losing more fluid than we take in, we can become dehydrated.

If a person starts to become dehydrated, the body is designed to signal thirst to the brain. The kidneys are also supposed to start concentrating the urine, so that less water is lost that way.

Why are older adults at higher risk for dehydration?

Unfortunately, the body’s mechanisms meant to protect us from dehydration work less well as we age. Older adults have reduced thirst signals and also become less able to concentrate their urine.

Other factors that put older adults at risk include:

• Chronic problems with urinary continence, which can make older adults reluctant to drink a lot of fluids
• Memory problems, which can cause older adults to forget to drink often, or forget to ask others for something to drink
• Mobility problems, which can make it harder for older adults to get something to drink
• Living in nursing homes, because access to fluids often depends on the availability and attentiveness of staff
• Swallowing difficulties

Dehydration can also be brought on by an acute illness or other event. Vomiting, diarrhea, fever, and infection are all problems that can cause people to lose a lot of fluid and become dehydrated. And of course, hot weather always increases the risk of dehydration.

Last but not least, older adults are more likely to be taking medications that increase the risk of dehydration, such as diuretic medications, which are often prescribed to treat high blood pressure or heart failure.

A UK study of older adults in residential care found that 46% had impending or current dehydration, as diagnosed by blood tests.

How is dehydration diagnosed?

For frail older adults, a simple preliminary check, if you’re concerned about dehydration, is to get the older person to drink some fluids and see if they perk up or improve noticeably. (This often happens within 5-10 minutes.)

This is not a clinically-proven method, but it’s easy to try. If drinking some fluids does noticeably improve things, that does suggest that the older person was mildly dehydrated.

For a truly accurate diagnosis in older adults, the most accurate way to diagnose dehydration is through laboratory testing of the blood. Dehydration generally causes abnormal laboratory results such as:

• Elevated plasma serum osmolality: this measurement relates to how concentrated certain particles are in the blood plasma
• Elevated creatinine and blood urea nitrogen: these tests relate to kidney function
• Electrolyte imbalances, such as abnormal levels of blood sodium
• Low urine sodium concentration (unless the person is on diuretics)

(Doctors often sub-classify dehydration based on whether blood sodium levels are high, normal, or low. )

Dehydration can also cause increased concentration of the urine — this is measured as the “specific gravity” on a dipstick urine test. However, this is not an accurate way to test for dehydration in older adults, since we tend to lose the ability to concentrate urine as we get older. This was confirmed by a 2016 study, which found that the diagnostic accuracy of urine dehydration tests in older adults is “too low to be useful.“

There are also a number of physical symptoms associated with dehydration. However, a 2015 study of older adults found that the presence or absence of dehydration symptoms is not an accurate way to diagnose dehydration.

Physical signs of dehydration may include:

• dry mouth and/or dry skin in the armpit
• high heartrate (usually over 100 beats per minute)
• low systolic blood pressure
• dizziness
• weakness
• delirium (new or worse-than-usual confusion)
• sunken eyes
• less frequent urination
• dark-colored urine

But as noted above: the presence or absence of these physical signs are not reliable ways to detect dehydration. Furthermore, the physical symptoms above can easily be caused by health problems other than dehydration.

This study published in 2019 confirmed that commonly used symptoms do not accurately detect dehydration in frail older adults: Signs and Symptoms of Low-Intake Dehydration Do Not Work in Older Care Home Residents—DRIE Diagnostic Accuracy Study.

So if you are concerned about clinically significant dehydration — or about the symptoms above — blood tests results may be needed. A medical evaluation for possible dehydration should also include an interview and a physical examination.

What are the consequences of dehydration?

The consequences depend on how severe the dehydration is, and perhaps also on how long the dehydration has been going on.

In the short-term, dehydration can cause the physical symptoms listed above. Especially in older adults, weakness and dizziness can provoke falls. And in people with Alzheimer’s or other forms of dementia, even mild dehydration can cause noticeable worsening in confusion or thinking skills.

Dehydration also often causes the kidneys to work less well, and in severe cases may even cause acute kidney failure.

The consequences of frequent mild dehydration — meaning dehydration that would show up as abnormal laboratory tests but otherwise doesn’t cause obvious symptoms — are less clear.

Chronic mild dehydration can make constipation worse. Otherwise, a 2012 review found that the only health problem that has been consistently associated with low daily water intake is kidney stones.

A 2013 review on fluid intake and urinary system diseases concluded that it’s plausible that dehydration increases the risk of urinary tract infections, but not definitely proven.

A 2020 review on the effect of increasing fluid intake to prevent UTIs also noted that “Patients with UTI are often advised by clinicians to keep adequately hydrated or drink more fluids. However, the evidence base for this recommendation remains unclear.”

Speaking of urinary tract infections (UTIs), if you are concerned about frequent bacteria in the urine, you should make sure this reflects real UTIs and not simply a sign of the older person’s bladder being colonized with bacteria.

This is a very common condition known as asymptomatic bacteriuria, and incorrectly diagnosing this as a UTI can lead to pointless overtreatment with antibiotics. (More on this issue below, or see Q&A: Why Urine Bacteria Doesn’t Mean a UTI Needs Antibiotics.)

How is dehydration treated?

The treatment of dehydration depends on:

• Whether the dehydration appears to be mild, moderate, or severe
• What type of electrolyte imbalances (such as high/low levels of sodium and potassium) appear on laboratory testing
• If known, the cause of the dehydration

Mild dehydration can usually be treated by having the person take more fluids by mouth. Generally, it’s best to have the person drink something with some electrolytes, such as a commercial rehydration solution, a sports drink, juice, or even bouillon. But in most cases, even drinking water or tea will help.

Mildly dehydrated older adults will often perk up noticeably after they drink some fluids, usually within 5-10 minutes.

Moderate dehydration is often treated with intravenous hydration in urgent care, the emergency room, or even the hospital. Some nursing homes can also treat dehydration with a subcutaneous infusion, which means providing fluid through a small IV needle placed into the skin of the belly or thigh. This is called hypodermoclysis, and this is actually safer and more comfortable for older adults than traditional IV hydration.

Severe dehydration may require additional intervention to support the kidneys, and sometimes even requires short-term dialysis.

How to prevent dehydration in older adults?

Experts generally recommend that older adults consume at least 1.7 liters of fluid per 24 hours. This corresponds to 57.5 fluid ounces, or 7.1 cups.

What are the best fluids to prevent dehydration?

I was unable to find research or guidelines clarifying which fluids are best to drink. This is probably because clinical research hasn’t compared different fluids to each other.

As to whether certain fluids are dehydrating: probably the main fluid to be concerned about in this respect is alcohol, which exerts a definite diuretic effect on people.

The effect of caffeine on causing people to lose excess water is debatable. Technically caffeine is a weak diuretic. But real-world studies suggest that people who are used to drinking coffee don’t experience much diuretic effect.

Now, caffeine may worsen overactive bladder symptoms, so there may be other reasons to be careful about fluids containing caffeine. But as best I can tell, coffee and tea are not proven to be particularly dehydrating in people who drink them regularly.

The safest approach would still be to drink decaffeinated drinks. But if an older person particularly loves her morning cup of (caffeinated) coffee, I’d say to consider accommodating her if at all possible.

How to help older adults to stay hydrated?

A 2015 review of nursing home interventions intended to reduce dehydration risk concluded that “the efficacy of many strategies remains unproven. ” Still, here are some approaches that are reasonable to try:

• Offer fluids often throughout the day; consider doing so on a schedule.
• Offer smaller quantities of fluid more often; older adults may be reluctant to drink larger quantities less often.
• Be sure to provide a beverage that is appealing to the older person.
• See if the older person seems to prefer drinking through a straw.
• Supplement fluids with water-rich fruit (e.g. watermelon) or other foods with high water content.
• Identify any continence concerns that may be making the older person reluctant to drink. Keeping a log of urination and incontinence episodes can help.
• Consider a timed toileting approach, which means helping the older person get to the bathroom on a regular schedule. This can be very helpful for people with memory problems or mobility difficulties.
• Track your efforts in a journal. You’ll want to track how much the person is drinking; be sure to note when you try something new to improve fluid intake.
• Offer extra fluids when it’s hot, or when the person is ill.

Practical tips for family caregivers

Let’s now return to the issues brought up in the question.

Family caregivers are often concerned about whether an older person is drinking enough. Since dehydration is indeed very common among older adults, this concern if very important.

However, before expending a lot of energy trying to get your mother to drink more, I would encourage you to consider these four suggestions:

1.Measure how much your mother is actually drinking most days.

This can require a little extra effort. But it’s very helpful to get at least an estimate of how much the person drinks. This can confirm a family’s — or doctor’s — hunch that the person isn’t taking in enough fluid, and can help the care team figure out how much more fluid is required.

Again, the recommendation for older adults is to consume at least 1.7 liters/day, which corresponds to at least 57. 5 fluid ounces. In the US, where a measuring cup = 8 ounces, this is equivalent to 7.1 cups/day.

Keep a journal to record how much fluid your older parent is drinking. It’s generally important to track anything you want to improve.

2. Confirm that your mother is, in fact, often dehydrated.

As noted above in the section on diagnosing dehydration: physical symptoms and urine tests are not enough to either diagnose dehydration or rule it out.

Instead, consider these two approaches to confirming clinical dehydration. One is to see if her energy and mental state perk up when she drinks more. The other is to talk to the doctor and request blood tests to confirm dehydration.

Now, you don’t necessarily want to request blood tests every time you suspect mild dehydration. But especially if your mother’s dehydration has never been confirmed by a serum osmolality test, it would probably be useful to do this at least once.

3. If frequent urinary tract infections (UTIs) are a concern, learn about asymptomatic bacteriuria and try to determine whether these are real UTIs versus a colonized bladder.

Sometimes I’ve seen families hellbent on increasing hydration or taking other measures, because they are concerned about repeated or persisting urinary tract infections (UTIs).

But UTIs are a bit like dehydration. A UTI is a common problem in older adults and is potentially very serious. But it’s also easily misdiagnosed, even by professionals.

Sometimes, when an older person keeps being diagnosed with a UTI repeatedly, the problem is actually that the older person has asymptomatic bacteriuria. This is a very common condition in which an older person’s bladder becomes colonized with bacteria. It probably happens because people’s immune systems get weaker as they age.

So how is this different from a UTI? Both conditions will cause a positive urine culture, meaning that bacteria is in the urine. The main difference is that in asymptomatic bacteriuria, the older person doesn’t experience pain, inflammation, increased confusion, or other symptoms of infection.

In a young person, bacteria in the urine is very uncommon and almost always corresponds to a clinically significant infection. But in an older person, bacteria in the urine is common.

So you cannot diagnose a UTI in an older person just on the basis of a positive urine culture. Instead, the family and clinician must note other signs of infection, such as pain or delirium.

Families are often surprised to learn that clinical trials have repeatedly found that it is not helpful to treat asymptomatic bacteriuria, but it’s true. In fact, a 2015 study found that treating asymptomatic bacteriuria with antibiotics increased the likelihood of later having a real UTI, and that the real UTI was more likely to be antibiotic-resistant.

For more on this topic, see Q&A: Why Urine Bacteria Doesn’t Mean a UTI Needs Antibiotics.

4. Talk to your mother to get her perspective on drinking more (and to find out if continence issues are a concern for her).

Before you keep pressuring her to drink more: have you spent some time talking to her to learn more about her perspective on drinking more, and on avoiding dehydration?

The more we learn about how an older person sees a situation, the better equipped we are to try to assist them.

In particular, inquiring about how an older adult feels about drinking sometimes reveals that they are concerned about worsening their urinary continence symptoms. (Learn more about managing these here: Urinary Incontinence in Aging: What to know when you can’t wait to go.)

5. Pay attention to figure out which fluids your mother prefers to drink and try scheduling frequent small drinks.

Ultimately, there’s no substitute for paying close attention, keeping track of your observations, and doing some trial and error to figure out what seems to improve things.

No doctor has a magic formula to get an older person to drink more. So identify the drinks your mother prefers, start tracking how much she drinks, and then start experimenting to figure out what works.

Usually, a combination of the following three approaches will improve fluid intake:

• Offer a beverage the person likes,
• Offer small-to-moderate quantities of the beverage on schedule,
• Address any urinary incontinence concerns.

You can also increase fluid intake by offering foods that contain a lot of water, such as watermelon, or perhaps soups.

Do you have any additional questions regarding the prevention of dehydration in older adults?

Post them below and I’ll see how I can help.

This article was reviewed and updated in July 2021.

Memo cholera

CHOLERA

Cholera – acute bacterial infectious disease with diarrheal syndrome, impaired water-salt metabolism, dehydration, toxicosis.

Pathogens: Vibrio cholerae of group 01 of the classical or Eltor biovar and Vibrio cholerae 0139 of the serogroup of the Vibrionaceae family of the Vibrio genus.

Main epidemiological signs

Incubation period: 5 days (from 10 hours to 5 days).

Source of infection: sick person, vibration carrier.

Ways of transmission of the pathogen:

• water;
• food grade;
• contact and household.

Infection conditions:

• staying in the 5 days preceding the disease in a cholera-problematic settlement, region, foreign country;
• diarrhea care;
• Use of non-disinfected water for drinking or use of open water body water for bathing and other needs;
• Eating home-made lightly salted fish, shrimp, crayfish, crabs, seaweed and other products with insufficient heat treatment;
• eating vegetables and fruits brought from cholera-affected areas;
• work related to the operation of open water bodies (divers, fishermen), maintenance of sewage and water supply facilities.

Main clinical signs

Distinguish: mild course cholera, in which loose stools and vomiting can be single. Dehydration is almost not expressed and does not exceed 3% of body weight (dehydration of the 1st degree). The state of health is satisfactory. Complaints of dry mouth and increased thirst. Patients do not seek medical help, their identification is difficult. Without a bacteriological study, it is often impossible to make a differential diagnosis with gastrointestinal diseases of a different etiology.The duration of the disease is 1-2 days.

At moderately severe cholera onset acute with the appearance of abundant stool (sometimes vomiting may precede – gastric variant). The stool becomes more and more frequent – 15-20 times a day, gradually loses its fecal character and takes the form of rice broth (it can be yellowish, brown with a reddish tint, like “meat slops”). Diarrhea is not accompanied by abdominal pain, tenesmus. Sometimes there may be mild pain in the navel area, discomfort, rumbling in the abdomen.Soon profuse vomiting, without nausea, joins the diarrhea. Dehydration of the body increases, fluid loss is 4-6% of body weight (dehydration of the II degree). Convulsions of certain muscle groups appear. The voice is husky. Complaints of patients about dry mouth, thirst, malaise, weakness. There is cyanosis of the lips, sometimes acrocyanosis. Decreases skin turgor. Tongue dry.

The severe course of cholera is characterized by a pronounced degree of dehydration with a loss of fluid of 7 – 9% of body weight and hemodynamic disturbances (dehydration of the III degree).Patients have frequent, profuse watery stools, vomiting, severe muscle cramps. There is a drop in blood pressure. The pulse is weak, fast. Shortness of breath, cyanosis of the skin, oliguria or anuria. The features of the face are sharpened, the eyes and cheeks are sunken, the voice is husky up to aphonia. Skin turgor is sharply reduced, the skin fold does not straighten. The fingers and toes are wrinkled. Tongue dry. Rumbling in the abdomen, slight soreness in the epigastrium and umbilical region. Patients complain of extreme weakness, unquenchable thirst.

Fluid loss of up to 8-10% of the patient’s body weight, as well as salt deficiency, lead to the development of a condition known as algid. With algid, blood pressure drops until it disappears. There is no pulse, severe shortness of breath (up to 50-60 per minute). Pronounced general cyanosis of the skin, muscle cramps in the limbs of the abdomen, face. Oliguria and then anuria. Aphonia. The body temperature is up to 35.5 ⁰ C. The skin is cold, its turgor is sharply reduced, the symptom of a “washerwoman’s hand” is expressed. Stool volume decreases until it stops.With immediate rehydration, frequent stools reappear and vomiting may occur. In the peripheral blood, an increase in the number of erythrocytes, leukocytes, hypokalemia.

Note: The asymptomatic vibriocarriage is of particular diagnostic difficulty. The identification of carriers is based on the positive results of bacteriological research, and the presence of vibrios in the excreta of the carrier is not constant.

Rotavirus infection in preschool children. Transmission mechanism, clinic, diagnostics, treatment

I. Rotavirus statistics

Rotavirus infection is a rotavirus infection that affects the gastrointestinal tract. This disease is characterized by an acute onset and chronic forms of this disease are extremely rare.

Rotavirus infection most commonly affects young children. So, in the first 4 years of life, this pathology is detected in 80.4 percent of patients. In the age group 5-9 years, the disease is determined only in 19.6 percent of cases.

According to Italian scientists, rotavirus is the main cause of all infectious diseases that occur with watery diarrhea, and accounts for 27 to 30 percent.

The main carriers of rotavirus infection are children attending kindergarten or other children’s groups. Among preschool children, the carrier of this virus is from 1.5 to 9 percent of babies.

The main symptoms of rotavirus are diarrhea (observed in all sick children) and vomiting (present in 92.7 percent of cases).In 28.5 percent of diseases, emetic urges are repeated. Often, rotavirus is accompanied by symptoms such as weakness and apathy – 92.3 percent, poor appetite or lack of it – 81.3 percent. Crying and anxiety were noted in 93.7 percent of patients.

II. Transmission mechanism

The causative agent of the disease, a virus similar in shape to a wheel, has a high survival rate. Outside the human body, rotavirus does not die in tap water for 2 months.On vegetables and fruits, the virus retains its viability for a month, and on various objects – from 1 to 7 weeks.

A healthy person becomes infected with rotavirus from a sick person or from a carrier through the alimentary route (fecal-oral). This means that the virus is infected through the digestive system. This route of transmission is typical for most intestinal infections. Most often, infection occurs through contaminated water or food (water or alimentary transmission). When contaminated food or water is consumed, a healthy person carries the virus into their body.The virus enters food through unwashed hands, with improper cooking or storage technology. The waterway is not as common as the food route, but it has an important epidemiological significance. When drinking contaminated water, a large number of people get sick.

Also, the virus can be transmitted by contact and everyday life, through household items or dirty hands from a sick person. Given this route of transmission, great importance should be attached to the rules of personal hygiene when caring for a patient.

The incubation period (the time from the moment the virus enters the body until the first symptoms of the disease appear) with rotavirus infection is 2 days. This time is necessary for the virus to develop and multiply in the body.

III. Clinic

Children of preschool age carry rotavirus infection in different ways, depending on the age and condition of the body as a whole.

The age group of children from one to three years, as well as infants, is the most vulnerable to rotavirus.The disease in this age group is moderate or severe.

The preschool group aged from three to seven years has a milder form of rotavirus infection.

Tab. 1 Main differences in the course of rotavirus infection in children of different age groups

In children of younger preschool age (up to three years), rotavirosis has an acute onset. On the first day of illness, the body temperature rises to 38 – 39 degrees Celsius, less often to 39 – 40 degrees Celsius.High numbers of the mercury column persist from two to four days. Then the temperature drops to subfebrile (37. 1 – 38.0 degrees Celsius).

Rotavirus in children of the older group also has an acute onset, however, the body temperature does not rise above 38.0 – 38.5 degrees Celsius. The elevated temperature can persist for up to two days.

Rotavirus infection mostly affects the mucous membrane of the digestive tract, causing gastroenteritis, so intestinal symptoms are most pronounced.

The group of intestinal symptoms of rotavirus in preschool children includes:

• vomiting;
• diarrhea;
• pain in the abdomen;
• flatulence

Tab. 2 Characteristics of intestinal symptoms of rotavirus in children from one to seven years

Due to the frequent diarrhea and vomiting of rotavirus, the child’s body loses a large amount of water, which leads to dehydration (dehydration). Dryness of the skin, lips and tongue appears. The child becomes apathetic, refuses to eat. Breathing and heart rate increase. The most susceptible to dehydration are children of the younger group (up to two to three years old), as well as children with low body weight.

IV. Diagnostics

One of the main methods for diagnosing rotavirus infection is enzyme-linked immunosorbent assay (ELISA), which helps to detect rotavirus antigens in test materials.It is a fairly simple and highly sensitive method for early diagnosis of rotavirus infection.

Biomaterial sampling: the patient’s fecal samples (feces) are used as biomaterials for the enzyme-linked immunosorbent assay of rotavirus infection. There are several rules for sampling a patient’s feces in order to obtain accurate and reliable ELISA results.

The main points for collecting fecal samples from a patient are:

• Biomaterial sampling should be performed within 72 hours from the onset of the disease.
• pots or boats are used for older children.
• after natural defecation of the patient using a sterile wooden or glass rod, the feces are placed in a sterile container (test tube or jar with a screw cap).
• the amount of biomaterial is one to two grams of feces.
• storage and transportation of stool analysis is carried out at a low temperature (2 – 8 degrees Celsius).
• sampling of biomaterial is performed before the start of taking antibiotics or other therapeutic drugs.

Purpose of the study

The main purpose of the ELISA study is laboratory diagnosis of infection caused by rotavirus. Using the ELISA method, it is possible to determine the infection of the patient’s body with rotavirus during its incubation period or in the acute phase of the disease. Also, the ELISA method can detect asymptomatic carriers of rotavirus.

Variants of ELISA results are:

• positive samples;

90,047 negative samples;

• undefined samples.

Positive samples indicate the presence of a high concentration of rotavirus antigen in the test stool sample.

A negative result indicates the absence of rotavirus antigens in the patient’s fecal samples.

Some samples may be vague or questionable. They contain a small amount of antigen to rotavirus. In this case, the ELISA should be repeated with a new faecal sample.

Interpretation of results:

• Interpretation of ELISA results for rotavirus infection should be carried out only in the aggregate of clinical data.
• a positive result indicates an acute phase of rotavirus infection.
• A negative result usually implies the absence of rotavirus in the patient’s body, and it is concluded that the disease is caused by another pathogen. However, if the clinical signs of the disease and the epidemiological situation suggest rotavirus infection, a negative result forces a repeat ELISA.

V. Treatment

The principles of treatment for rotavirus infection in adults and toddlers are the same as in infants.The main principle of treatment is to replenish lost fluids and prevent dehydration. For this purpose, saline solutions are also accepted. A bag of rehydron is diluted in one liter of boiled but chilled water. Take a solution of 50 ml (one-fifth of a glass) after each bowel movement. With an average degree of dehydration, the recommended solution volume is 10 ml per 1 kg of body weight per hour. So, a person weighing 60 kg should drink 600 ml of rehydron solution per hour. After the first signs of improvement, the dose is reduced to 5 ml per 1 kg of body weight per hour, which will be equal to 300 ml of solution.The solution should be consumed after each liquid bowel movement or vomiting. The volume of the recommended solution is reduced as the condition improves. If you have loose stools 2-3 times a day, the recommended volume of liquid is one liter.

For mild to moderate forms of rotavirus infection, fluid loss can be replenished orally without the use of intravenous infusions. However, in severe cases, when the treatment of rotavirus infection is carried out in a hospital setting, they resort to intravenous administration of colloidal and crystalloid solutions.For this purpose, reopolyglyukin, refortan, perftoran are prescribed. The amount of solution required and the rate of its administration is strictly individual and is determined based on the volume of fluid lost by the patient. This method of treatment is used when the body’s fluid loss is 10 percent or more.

Removal of toxins from the intestines:

For this purpose, activated carbon, smecta, enterosgel are prescribed. Activated carbon (commercial name – carbolene) is prescribed for adults and preschool children three tablets three times a day.

Smecta

Preschool children in the first three days of the disease are prescribed 4 sachets per day, then switch to 2 sachets. The duration of treatment is 5 to 17 days. The contents of the sachet are dissolved in half a glass (125 milliliters) of boiled water and taken during the day.

Enterosgel

For preschool children, the recommended dose of the drug is 1 tablespoon three times a day. The drug is taken one hour before meals with water.If it is impossible to swallow the gel, it is diluted in half a glass of water and taken also one hour before meals.

Patients with rotavirus infection, especially in the acute phase of the disease, are advised to rest in bed and rest. All dairy products are excluded from food, as well as gas-forming products (coffee, rye bread, all types of cabbage). Carbonated drinks are completely excluded, since they can irritate the intestines and increase its peristalsis. Nutrition should be gentle, but at the same time full.It is recommended to use cereals, vegetable soups, jelly. Food should be consumed in small portions.

It is extremely rare for severe forms of rotavirus infection to prescribe antimicrobial agents. The doctor may prescribe a group of these drugs if the patient has a high fever and if there is a risk of bacterial flora attachment. In this case, enterofuril, furazolidone can be prescribed. However, taking these medications can further harm the intestinal flora, therefore, it must be strictly agreed with the doctor.

If fever is present, antipyretics such as paracetamol and ibuprofen are prescribed. If there is a pronounced pain syndrome, then antispasmodics are prescribed, such as no-shpa or papaverine.

Observance of sanitary rules deserves special attention in the treatment of rotavirus infection, as well as in its prevention. An intestinal flu patient needs isolation. The room where it is placed must be well ventilated and clean. It is very important to wash your hands after each use of the bathroom, and to keep your bedding clean.

VI. References

1. Mikhailova, E. V. Modern approaches to the treatment of rotavirus infection in children under 3 years of age / E. V. Mikhailova, D. Yu. Levin // Vestn. St. Petersburg. state honey. academy named after I. I. Mechnikov. 2006. – No. 4. -S.119-124.
2. Mikhailova, E. V. Rotavirus infection in children: modern ideas about the etiology, pathogenesis and prevention of the disease / E. V. Mikhailova, D. Yu. Levin // Infectious diseases.-2004.-T. 4, no. 2.-p. 24.
3. Novikova, N. A. in R.-types of human group A rotavirus and their distribution in Nizhny Novgorod and Dzerzhinsk in 1997-2005 / N. A. Novikova [et al.] // Questions of virology. 2007. – No. 3. – S. 19-23.

Memo to parents: drinking water for intestinal infection

First-class specialists of infectious diseases departments of the Children’s Hospital No. GNSperanskogo specially for moms and dads developed a methodological manual for the timely disposal of intestinal infection before contacting a specialist.If you and your child are at the dacha, on a hike, on vacation abroad or where you cannot immediately get an appointment with a doctor, doctors will tell you how to act so that the baby or teenager recovers as soon as possible.

Prevent dehydration!

With frequent vomiting, fever and loose stools, and you need to immediately begin fractional drinking. It is better to use salt solutions, dry powders for preparation, which are sold in pharmacies. Saline solutions, such as Rehydron, must be alternated with boiled water.If the child is capricious, then you can also offer the child weak tea, mineral water without gas in reasonable quantities (refrain from sulfate or magnesium, so as not to increase loose stools).

How to drink properly? Even a few large sips from a glass can provoke vomiting. The only way to make up for the water deficit is to give the liquid in very small portions. For a baby – one teaspoon each teenager – one tablespoon of water or saline, alternating between them.Interestingly, if you replace the glass with a spoon, vomiting stops in most cases. Infants can be fed using a 2-5 ml syringe, of course without a needle. Small portions of water or solution should be poured into the child every five minutes – at least, otherwise the child will not be able to drink the required volume, but not more often, otherwise the liquid will not have time to be absorbed and the child will vomit.

What not to do?

Drink juices, fruit drinks and dairy products for the child. Focus on his thirst.If a toddler or teenager does not want to drink, he still needs fractional and frequent watering. If he asks for more fluids, do not give – a large volume will cause vomiting.

When to sound the alarm?

If a child becomes lethargic and wants to doze all the time. Do not think that he is tired – this is an alarming sign of increasing dehydration. Never interrupt drinking to give your child some rest. Shake and continue to drink until the child becomes alert again.If lethargy and drowsiness persist, other signs of dehydration have appeared – dry lips and tongue, long absence of urination, incessant vomiting, “sunken” fontanelle in an infant, then in this case drip intravenous administration of fluid in stationary conditions is already necessary.

It is necessary to pay attention to the volume and frequency of urination, the nature of the stool. If a child does not urinate for more than 6-8 hours, a doctor’s examination is necessary, since with some acute intestinal infections, kidney damage is possible.When blood appears in the stool, inpatient treatment is indicated.

Remember that the main prevention of intestinal infections is personal hygiene, proper preparation and storage of food!

90,000 Dehydration with diarrhea in children and adults

Every person in his life now and then faces such an unpleasant problem as diarrhea (diarrhea). Diarrhea can occur in both an adult and a child, and the causes of diarrhea can be varied.In any case, with diarrhea (repeated and loose stools), the human body loses water and electrolytes (salts).

Continuing diarrhea leads to dehydration and disruption of the body’s water-salt balance. These violations often affect the general condition of a person and are especially dangerous in childhood.

Increasing dehydration can lead to serious consequences, posing a threat to health, and sometimes life of a person. It is important not to delay in the fight against dehydration and, if possible, start drinking a person as early as possible.This is especially important for young children whose body is 70-80% water.

It is important to know that not all liquids are suitable in order to restore the water-salt balance.

1) Drinks must contain salt as salts are lost during diarrhea and their lack leads to disruption of the functioning of organs and organ systems.

So the heart, blood vessels and the central nervous system are most sensitive to the loss of salts.

2) Drinks must contain sugars in order for the salts to pass from the intestines into the body

(the process of transport of salts from the intestines into the blood always occurs thanks to the energy that sugars provide).

3) The concentration of sugar and salts in the drinking solution should be such as to restore the loss of water and salts and not oversaturate the human body with excess water or salt and not sharply increase the level of glucose (sugar) in the blood.

The optimal solution in the prevention and control of dehydration in diarrhea in children is oral rehydration therapy (drinking with special glucose-saline solution), which is recommended by the World Health Organization, as well as leading pediatric organizations in the world and in Russia.

The Finnish company Orion is an expert in the development and production of glucose-salt mixtures for drinking.

The drug Regidron was registered in the USSR in 1986 and is suitable for use in adults. The Rehydron Bio product was created in accordance with new world standards and is intended primarily for use in children.

So, when the first signs of diarrhea appear in a child, Orion specialists recommend using Regidron Bio. It is a good, fast-acting and effective remedy that promotes the early recovery of the body during the period of diarrhea.

It is important to remember that you need to drink a person and especially a child throughout the entire period of diarrhea.

I would especially like to note that diarrhea and vomiting can be symptoms of a serious infectious disease that requires professional help, therefore, if they appear, you should consult a doctor.

90,000 How to avoid contracting cholera

Cholera is an acute intestinal infection that occurs when a person is affected by cholera vibrio.Cholera is manifested by severe frequent diarrhea, profuse repeated vomiting. With timely treatment, after suppression of the infection, recovery occurs.

Cholera is an acute intestinal infection that occurs when a person is affected by cholera vibrio. Cholera is manifested by severe frequent diarrhea, profuse repeated vomiting, which leads to significant loss of fluid and dehydration. Signs of dehydration are dry skin and mucous membranes, a decrease in tissue turgor and wrinkling of the skin, sharpening of facial features, oligoanuria.The diagnosis of cholera is confirmed by the results of bacteriological inoculation of feces and vomit, serological methods. Treatment includes isolation of the cholera patient, parenteral rehydration, and tetracycline antibiotic therapy.

General

Cholera is a particularly dangerous infection caused by the enteropathogenic bacterium Vibrio cholerae, which proceeds with the development of severe gastroenteritis and severe dehydration up to the development of dihydration shock.Cholera tends to spread epidemically and has a high mortality rate, therefore WHO is classified as a highly pathogenic quarantine infection. Most often, epidemic outbreaks of cholera are recorded in Africa, Latin America, and Southeast Asia. According to WHO estimates, every year 3-5 million people are infected with cholera, about 100-120 thousand cases of the disease end in death. Thus, today cholera remains a global problem of world health.

Characteristic of the pathogen

To date, more than 150 types of Vibrio cholerae, differing in serological characteristics, have been found.Vibrio cholerae are divided into two groups: A and B. Vibrios of group A cause cholera. Vibrio cholerae is a gram-negative motile bacterium that secretes a thermostable endotoxin during its life, as well as a heat-labile enterotoxin (cholerogen).

The pathogen is resistant to the action of the environment, remains viable in a flowing reservoir for up to several months, up to 30 hours in wastewater. Milk and meat are a good breeding ground. Vibrio cholerae is killed by chemical disinfection, boiling, drying and exposure to sunlight.Sensitivity to tetracyclines and fluoroquinolones is noted.

The reservoir and source of infection is a sick person or a transient carrier of infection. Bacteria are most actively secreted in the first days with vomit and fecal matter. It is difficult to identify infected individuals with mild cholera, but they pose a risk of infection. In the focus of detection of cholera, all contacts are examined, regardless of clinical manifestations. Infection decreases over time, and usually by the 3rd week there is a recovery and release of bacteria.However, in some cases, carriage lasts up to a year or more. Concomitant infections contribute to the lengthening of the carrier period.

Cholera is transmitted by household (dirty hands, objects, dishes), food and water through the fecal-oral mechanism. At present, flies have a special place in the transmission of cholera. The waterway (contaminated water source) is the most common. Cholera is an infection with a high susceptibility, most easily infecting people with hypoacidosis, some anemias, helminths, alcohol abuse.

Cholera symptoms

The incubation period for Vibrio cholerae infection lasts from several hours to 5 days. The onset is acute, usually at night or in the morning. The first symptom is an intense painless urge to defecate, accompanied by an uncomfortable sensation in the abdomen. Initially, the stool has a thin consistency, but retains a fecal character. Quite quickly, the frequency of bowel movements increases, reaching 10 or more times per day, while the stool becomes colorless, watery.In cholera, bowel movements are usually not offensive, unlike other infectious bowel diseases. Increased secretion of water into the intestinal lumen contributes to a noticeable increase in the amount of excreted feces. In 20-40% of cases, feces acquire the consistency of rice water. Stool usually appears as a greenish liquid with white, friable, rice-like flakes.

Rumbling, bubbling in the abdomen, discomfort, transfusion of fluid in the intestine are often noted. The progressive loss of fluid by the body leads to the manifestation of symptoms of dehydration: dry mouth, thirst, then there is a feeling of cold extremities, ringing in the ears, dizziness.These symptoms indicate significant dehydration and require urgent measures to restore the body’s water-salt homeostasis.

Since diarrhea is often associated with frequent vomiting, fluid loss is exacerbated. Vomiting usually occurs several hours later, sometimes the next day after the onset of diarrhea. Vomiting profuse, repeated, begins suddenly and is accompanied by an intense feeling of nausea and pain in the upper abdomen under the sternum. Initially, the remains of undigested food are noted in the vomit, then bile.Over time, the vomit also becomes watery, sometimes taking on the appearance of rice water.

During vomiting, there is a rapid loss of sodium and chlorine ions by the body, which leads to the development of muscle cramps, first in the muscles of the fingers, then in all extremities. With the progression of electrolyte deficiency, muscle cramps can spread to the back, diaphragm, and abdominal wall. Muscle weakness and dizziness increases to the point of inability to get up and walk to the toilet.At the same time, consciousness is completely preserved.

Severe pain in the abdomen, unlike most intestinal infections, with cholera is not noted. 20-30% of patients complain of moderate pain. Fever is also not characteristic, the body temperature remains within normal limits, sometimes reaches subfebrile numbers. Severe dehydration is manifested by a decrease in body temperature.

Severe dehydration is characterized by pallor and dryness of the skin, decreased turgor, cyanosis of the lips and distal phalanges of the fingers.Dryness is also characteristic of the mucous membranes. With the progression of dehydration, hoarseness of the voice is noted (the elasticity of the vocal cords decreases) up to aphonia. Facial features are sharpened, the abdomen is drawn in, dark circles appear under the eyes, the skin on the pads of the fingers and palms wrinkles (a symptom of a “washerwoman’s hands”). On physical examination, tachycardia, arterial hypotension are noted. The amount of urine decreases.

With further loss of fluid (loss of more than 10% of body weight) and ions, dehydration progresses.Anuria, significant hypothermia occurs, the pulse in the radial artery is not palpable, and peripheral arterial pressure is not detected. At the same time, diarrhea and vomiting become less frequent due to paralysis of the intestinal muscles. This condition is called dehydration shock.

Dehydration of the body differs in stages: at the first stage, the loss of fluid does not exceed 3% of the body weight, the second and third stages imply a loss of 3-6 and 6-9% of body weight, respectively, and at the fourth stage (dehydration shock) loss of fluid exceeds 9% of body weight.The increase in the clinical manifestations of cholera can stop at any stage, the course can be erased. Depending on the severity of dehydration and the rate of increase in fluid loss, cholera is distinguished from mild, moderate and severe. Severe cholera occurs in 10-12% of patients. In cases of a fulminant course, the development of dehydration shock is possible within the first 10-12 hours.

Cholera can be complicated by the addition of other infections, the development of pneumonia, thrombophlebitis and purulent inflammation (abscess, phlegmon), mesenteric vascular thrombosis and intestinal ischemia.A significant loss of fluid can contribute to the occurrence of cerebral circulation disorders, myocardial infarction.

Cholera diagnosis

Severe cholera is diagnosed based on clinical findings and physical examination. The final diagnosis is established on the basis of bacteriological culture of feces or vomit, intestinal contents (sectional analysis). The material for inoculation must be delivered to the laboratory no later than 3 hours from the moment of receipt, the result will be ready in 3-4 days.

There are serological methods for detecting infection with Vibrio cholerae (RA, RNGA, vibrocidal test, ELISA, PKA), but they are not sufficient for the final diagnosis, being considered methods of accelerated approximate determination of the pathogen. Luminescence-serological analysis, microscopy in a dark field of vibrios immobilized by O-serum can be considered as accelerated methods for confirming a preliminary diagnosis.

Cholera treatment

Since the main danger in cholera is the progressive loss of fluid, its replenishment in the body is the main task of the treatment of this infection.Cholera treatment is carried out in a specialized infectious diseases department with an isolated ward (box) equipped with a special bed (Phillips bed) with scales and utensils for collecting feces. To accurately determine the degree of dehydration, their volume is recorded, the hematocrit, the level of ions in the serum, and the acid-base indicator are regularly determined.

Primary rehydration measures include replenishing existing fluid and electrolyte deficiencies. In severe cases, intravenous administration of polyionic solutions is performed.After that, compensatory rehydration is performed. The introduction of fluid occurs in accordance with its losses. Vomiting is not a contraindication to continued rehydration. After the restoration of the water-salt balance and the cessation of vomiting, antibiotic therapy is started. With cholera, a course of tetracycline drugs is prescribed, and in the case of re-isolation of bacteria, chloramphenicol.

There is no specific diet for cholera, in the first days they can recommend table N ° 4, and after the expressed symptoms subside and intestinal activity is restored (3-5th laziness of treatment) – nutrition without features.Cholera survivors are advised to increase their dietary intake of potassium-containing foods (dried apricots, tomato and orange juices, bananas).

Prediction and prevention of cholera

With timely and complete treatment, after suppression of the infection, recovery occurs. Currently, modern drugs effectively act on Vibrio cholerae, and rehydration therapy helps prevent complications.

Specific cholera prophylaxis consists in a single vaccination with cholera toxin before visiting regions with a high prevalence of this disease.If necessary, revaccination is performed after 3 months. Non-specific cholera prevention measures imply compliance with sanitary and hygienic standards in populated areas, at catering establishments, in areas of water intake for the needs of the population. Individual prevention consists in maintaining hygiene, boiling the water used, washing food and cooking them correctly. If a case of cholera is detected, the epidemiological focus is subject to disinfection, patients are isolated, all contact persons are monitored for 5 days to identify possible infection.

90,000 Babesiosis / piroplasmosis – symptoms, prevention, treatment

The story is told by the intensive care physician, head of the ICU at the Exvet veterinary clinic Yulia Gurina.

When they say “dog tick”, most often they mean ixodid ticks – parasites that live in the grass during the warm season. It is with these parasites that babesiosis is associated with – a canine disease that, without timely assistance, can quickly lead to death.Earlier in Odessa babesiosis was recorded extremely rarely, mainly in dogs that were taken out of the city. But in the last three years – very often.

Now in order.

What is Babesiosis

Babesiosis (the same as piroplasmosis) is a transmissible (transmitted by insects and ticks, in this case by ticks) disease. In fact, this is an infection with intracellular parasites – babesia, which enter the dog’s bloodstream when a tick bites.

Babesias are dangerous because they infect and destroy red blood cells.Anemia occurs, vital organs are affected, primarily the kidneys.

Ixodid ticks
Babesia in erythrocytes

Symptoms of babesiosis after a tick bite in a dog are as follows

• pale or yellow mucous membranes,
• weakness,
• sometimes vomiting, diarrhea,

• concentrated urine color, up to reddish brown,
• temperature rise to 40 ° and above,
• refusal to eat.

Diagnosis of babesiosis

• smear for babesiosis. Babesium is most easily detected in small peripheral capillary vessels, so we take blood from the vessels of the auricle.

• PCR study for babesiosis.
• clinical signs.

Treatment of a dog after a tick bite in case of babesiosis

Babesiosis is treated depending on the severity of the disease. Most often, treatment takes place in an intensive care unit.

1. We introduce a drug that kills babesia (Pyro-stop or Azidine). The drug is administered twice or more times, depending on the severity of the disease.
2. We provide infusion therapy to correct dehydration, symptomatic therapy.
3. We provide oxygen therapy. This is important because red blood cells are those blood cells that carry oxygen to the organs, and if red blood cells are destroyed and there are critically few of them, there is not enough oxygen for the internal organs to perform their function normally.
4. In severe cases, transfusion of fresh whole blood or red blood cells is necessary. This is done in order to restore the number of red blood cells in the body and improve the blood supply to internal organs. Before transfusion of erythrocytes or fresh whole blood, we need to check the compatibility of the donor and recipient. For this we use special test systems for blood group. Due to the fact that our clinic has a blood bank, we can provide full assistance to the pet.
5. We constantly monitor the general condition, carry out tests – complete blood count, biochemical parameters of the kidneys, blood smears for the presence of the parasite. Analyzes are carried out in order to react in time to changes in the body and adjust the treatment, if required.

On average, babesiosis treatment takes 2 days to 3 weeks. As a rule, the prognosis is from cautious to favorable.

How to avoid babesiosis

Babesia prophylaxis is the prophylaxis of ticks in dogs.Treat your dogs with tick medications regularly! Start processing in advance, before the temperature warms, or better – all year round. Do not disrupt the treatment schedule, do not wait for a break between treatments! Strictly follow the instructions for the drug.

The most effective today are oral forms of drugs (tablets). This method is especially relevant for pets that regularly swim in the summer. This will protect the dog safely and reliably. Tablets – Simparica, Nexgard Spectra, Bravecto – buy only at specialized, reliable points of sale, beware of counterfeits and illegal drugs.Drops on the withers Advantiks, the collar against ticks Foresto are also reliable means of protection when used correctly.

Pay special attention when you and your dog go out into nature or to the country. If there are a lot of ticks, use additional protective equipment – aerosols. Be sure to check your dog regularly for mites, which are usually located at the base of the ears, or on the ears, armpits, groin and genitals.

How to act if a dog has a tick

1. The pliers must be removed correctly – unscrewed.You can twist in any direction – clockwise or counterclockwise. You can use special pincers that are available at pet stores.
2. When the tick has been removed, check to see if it has been removed completely, if the head has come off. Treat the bite site with an antiseptic (such as chlorhexidine) because a local reaction may occur.
3. Be sure to consult a doctor! This is necessary to search for other ticks on the dog, because the owner can not always notice all the parasites.In addition, the doctor will take a smear for babesiosis. Moreover, this must be done both immediately and on the 3rd, 5th, 7th day. Babesia is not immediately detectable in every blood smear. At the beginning of the disease, when they have not had time to multiply, it is not easy to find them. If babesias are found, the dog will receive appropriate treatment.

Be attentive to your pets!

90,000 Intestinal infection – symptoms and treatment of acute intestinal infection

Acute intestinal infection (ACI) affects more than half a billion people in the world every year.This is a group of diseases, united on the basis of a common feature – the localization of the pathogen in the intestine. It is observed with the same frequency in children and adults.

Etiology of OCI

The etiology of intestinal infections is associated with the ingestion of the causative agent of the disease. There are 3 main ways in which they enter the body:

• through food – usually through food that has not undergone sufficient hygienic and heat treatment;
• through water – symptoms and etiology of intestinal diseases when contaminated through water occur when drinking poor-quality water;
• for household contact – through various objects or dirty hands.

Bacterial AEI is often caused by bacteria such as Salmonella, Escherichia coli, and viral bacteria are caused by ingestion of rotaviruses, enteroviruses, etc. Severe clinical symptoms occur with amebiasis and giardiasis, which are relatively rare causes.

Symptoms

Symptoms of intestinal infection in adults and children depend on the type of pathogen. However, there are general signs that indicate the presence of the disease: abdominal pain, weakness, lack of appetite, vomiting, loose stools.

Otherwise, depending on the type of AEI, the clinical sign or several manifestations may differ. For example, in cholera, fever may not be present, while shigellosis is necessarily accompanied by it.

The action of pathogens does not appear immediately. The incubation period is usually 10 to 50 hours.

Acute intestinal infection in adults usually begins with minor malaise followed by abdominal pain and frequent loose stools.Symptoms of acute intestinal infection in children are usually more pronounced.

A common symptom of bowel disease is acute diarrhea. After infection, it may appear after a few hours or days. Together with vomiting, diarrhea sometimes leads to dehydration.

Diagnostics and treatment

The specialists of the clinic, if there is a suspicion of AEI in the patient who has addressed to them, find out the time of the onset of the first symptoms and the risk factors that could cause the disease.

The symptomatology of OCI is inherent in many other ailments, therefore, for an accurate diagnosis, additional studies are needed: analysis of urine, blood, feces, bacterial culture.

Treatment of acute intestinal infection is prescribed by a doctor after examination and study of anamnesis: diet therapy, detoxification therapy, rehydration therapy, treatment with antibacterial drugs, probiotics. Make an appointment with a doctor here.

Prevention is the best treatment for an acute infection.