Adult Dehydration – StatPearls – NCBI Bookshelf

Continuing Education Activity

Dehydration is a common condition that affects patients of all ages. Dehydration may complicate other medical problems and may cause significant illness. Physical examination is used to diagnose dehydration. Laboratory testing identifies the complications of dehydration. Fluid replacement is used to treat dehydration. This activity outlines the evaluation and treatment of adult dehydration and highlights the importance of the interprofessional team.

Objectives:

• Identify the etiology of adult dehydration medical conditions and emergencies.

• Review the evaluation of adult dehydration.

• Outline the management options available for adult dehydration.

• Describe the interprofessional team strategies for improving care coordination and communication to advance adult dehydration and improve outcomes.

Access free multiple choice questions on this topic.

Introduction

According to the lay press, 75% of Americans are chronically dehydrated. While this is not supported by medical literature, dehydration is common in elderly patients. It has been reported to occur in 17% to 28% of older adults in the United States.[1] Dehydration is a frequent cause of hospital admission. It can cause morbidity and mortality on its own and complicates many medical conditions. Dehydration may also be over-diagnosed. This can lead to misdiagnosis of the real cause of the patient’s illness and lead to over-treatment with fluids. Dehydration is easily treatable and preventable. A thorough understanding of the causes and diagnosis of dehydration can improve patient care.

Etiology

Body water is lost through the skin, lungs, kidneys, and GI tract. The loss of body water without sodium causes dehydration. Water is lost from the skin, lungs, gastrointestinal tract, and kidneys. Dehydration results when water losses from the body exceed water replacement. It may be caused by failure to replace obligate water losses. There are several forms of dehydration.[1] Isotonic water loss occurs when water and sodium are lost together. Causes of isotonic water loss are vomiting, diarrhea, sweating, burns, intrinsic kidney disease, hyperglycemia, and hypoaldosteronism. Hypertonic dehydration occurs when water losses exceed sodium losses. Serum sodium and osmolality will always be elevated in hypertonic dehydration. Excess pure water loss occurs through the skin, lungs, and kidneys. Etiologies are fever, increased respiration, and diabetes insipidus. Hypotonic dehydration is mostly caused by diuretics, which cause more sodium loss than water loss. Hypotonic dehydration is characterized by low sodium and osmolality.

The source of water loss may also understand the etiologies of dehydration:

• Failure to replace water loss: altered mentation, immobility, impaired thirst mechanism, drug overdose leading to coma

• Excess water loss from the skin: heat, exercise, burns, severe skin diseases

• Excess water loss from the kidney: medications such as diuretics, acute and chronic renal disease, post-obstructive diuresis, salt-wasting tubular disease, Addison disease, hypoaldosteronism, hyperglycemia

• Excess water loss from the GI tract: vomiting, diarrhea, laxatives, gastric suctioning, fistulas

• Intraabdominal losses: pancreatitis, new ascites, peritonitis

• Excess insensible loss: sepsis, medications, hyperthyroidism, asthma, chronic obstructive pulmonary disease (COPD), drugs

Epidemiology

There is no recent data on rates of dehydration in the general population, but we do know much of the epidemiology of dehydration in adults. Healthy adults with access to water rarely become dehydrated. Any adult may develop dehydration as a complication of an illness such as hyperglycemia. Dehydration may cause illness or be caused by an illness, so searches of databases may not capture all cases of dehydration. The data that we do have shows that older adults are more likely to develop dehydration. The elderly population is also 20% to 30% more prone to developing dehydration due to immobility, impaired thirst mechanism, diabetes, renal disease, and falls.[2][3]

Pathophysiology

Water plays a key role in maintaining multiple physiological functions within the body. The human body is 55% to 65% of water. Two-thirds of that water is intracellular, and one-third is extracellular. One-fifth of extracellular water is intravascular. The body has a complex system designed to maintain euvolemia. Water is absorbed through the gastrointestinal tract. The primary control of water homeostasis is through osmoreceptors in the brain. As perceived by these osmoreceptors, dehydration stimulates the thirst center in the hypothalamus, which leads to water consumption. These osmoreceptors can also cause the conservation of water by the kidney. When the hypothalamus detects lower water concentration, it causes the posterior pituitary to release antidiuretic hormone (ADH), which stimulates the kidneys to reabsorb more water. Decreased blood pressure, which often accompanies dehydration, triggers renin secretion from the kidney. Renin converts angiotensin I to angiotensin II, which increases aldosterone release from the adrenals. Aldosterone increases the absorption of sodium and water from the kidney. Using these mechanisms, the body regulates body volume and sodium and water concentration.

History and Physical

Hypovolemic patients can present with a wide assortment of symptoms and physical exam findings. Some of the most common presenting symptoms of dehydration include but are not limited to fatigue, thirst, dry skin and lips, dark urine or decreased urine output, headaches, muscle cramps, lightheadedness, dizziness, syncope, orthostatic hypotension, and palpitations. The patient’s history may elicit factors that could cause dehydration, such as exercise, heat exposure, medications, illness, impaired access to water, fever, or fluid loss.

Vital signs may show hypotension, tachycardia, fever, and tachypnea. Hypotension will not appear until significant dehydration is present. Tachycardia may be absent due to medications such as beta-blockers. A patient may appear lethargic or obtunded upon observation in severe cases of dehydration. The physical examination could show dry mucosa, skin tenting, delayed capillary refill, or cracked lips. A 2015 Cochrane review evaluated predictors of dehydration in the elderly.[4] Historical and physical findings tested were dry axilla, mucous membranes, tongue, increased capillary refill time, poor skin turgor, sunken eyes, orthostatic blood pressure drop, dizziness, thirst, urine color, weakness, blue lips, altered mentation, tiredness, and appetite. Of all these factors, only fatigue and missed drinks between meals predicted the diagnosis of dehydration.

Evaluation

There is no gold standard test for dehydration. Serum and plasma osmolality tests are often used to diagnose but may be affected by fluid loss or fluid loss acuity. A reasonable definition of dehydration due to water loss is serum osmolality greater than or equal to 295 mOsm/kg. The 2015 Cochrane review used serum osmolality of greater than 294 mOsm/kg to define dehydration. Weight loss equal to or greater than 3% over 7 days may also indicate dehydration if this data is available. The 2015 Cochrane review of diagnostic tests for dehydration in elderly patients, bioelectrical impedance analysis, urine specific gravity, the osmolality of urine, saliva, or tears, tear volume, number of urine voids, and urine volume were not useful as stand-alone tests for dehydration in the elderly. 

Blood urea nitrogen to creatinine ratio should be higher than 10:1 in dehydration, but this may be mimicked by high urea production, low creatinine due to low muscle lass, and urea reabsorption due to upper gastrointestinal bleed. Urine tests may suggest volume depletion. Urine sodium concentration should be low, fractional excretion of sodium should be under 1%, and urine osmolality should be greater than 450 mOsm/kg. These tests of renal perception of low blood flow may also be abnormal in heart failure, cirrhosis, nephrotic syndrome, and other causes of kidney disease.

Ultrasound can be used to assess a patient’s fluid volume by measuring the collapsibility of the inferior vena cava (IVC) with respiration. A variation in the diameter of the IVC greater than 50% with respiration indicates a collapsible IVC. IVC collapse with inspiration may correlate with right atrial pressure and intravascular volume.[5] Ultrasound evaluation of the IVC may be influenced by cirrhosis, chronic heart conditions, and ventilation (spontaneous or mechanical). IVC ultrasound has limited ability to predict fluid responsiveness.[6] It may be used as part of the entire clinical picture.

Treatment / Management

Treatment of dehydration is aimed at rapid fluid replacement as well as identification of the cause of fluid loss. Patients with fluid deficits should be given isotonic fluid boluses tailored to the individual circumstance. Patients with more severe dehydration get larger boluses of isotonic fluid. A more careful approach is needed in elderly patients and patients with heart failure and kidney failure. In these patients, small boluses should be given, followed by frequent reassessment and additional bolus as needed.[7]

Blood pressure, heart rate, serum lactate, hematocrit (if bleeding, there is no blood loss), and urine output may be used to assess the volume deficit and to assess response to fluids.

Isotonic crystalloid fluid should be used in most cases of dehydration. Colloids such as albumin may be used in specific situations but do not improve outcomes.[8]

The choice of crystalloid should be customized to the patient. Normal saline lactated Ringer’s solution and a balanced crystalloid solution may all be used. Normal saline may cause hyperchloremic metabolic acidosis in large volumes. Buffered crystalloids may cause hyponatremia. Lactated Ringer’s solution also contains potassium, so it should not be used in renal failure or hyperkalemia. No fluid has proved superior in all patients.

In patients with dehydration and severe hyponatremia, rapid volume repletion may cause a rapid rise in sodium. This can cause central pontine myelinolysis (CPM). The clinician must weigh the risks of continued dehydration against the risks of CPM. The patient’s volume status and serum sodium must be followed closely.

As the patient is being resuscitated, clinical and laboratory examination must focus on the discovery and correction of the cause of dehydration.

Differential Diagnosis

The principle differential of dehydration in adults is the loss of body water versus the loss of blood. This is important because blood loss should be replaced with blood, while water loss should be replaced with fluid. The next point to consider is the differential diagnosis of the cause of dehydration, as discussed under etiology.

Prognosis

When the underlying cause of dehydration is treated, and the patient’s volume has been restored, the majority of patients recover fully. Failure to treat dehydration in older adults may lead to significant mortality.[9]

Complications

Complications of dehydration occur due to inadequate fluid replacement and over-aggressive fluid replacement. Complications of under-resuscitation are due to hypoperfusion of vital organs and complications due to renal efforts to retain fluid. Altered mental status, renal failure, shock liver, lactic acidosis, hypotension, and death are related to organ-hypoperfusion. Fluid and electrolyte abnormalities such as uremia, hyponatremia, hypernatremia, hypokalemia, hyperkalemia, metabolic acidosis, and metabolic alkalosis may occur. Excess fluid administration to correct dehydration may cause peripheral edema and pulmonary edema. In patients with severe hyponatremia, volume correction may cause a rapid rise in sodium, which can cause central pontine myelinolysis.  

Consultations

Renal consultation will be needed at times, especially with severe hyponatremia, but in most cases, the treating clinician can evaluate and correct dehydration.

Deterrence and Patient Education

Although the CDC does not have defined water intake recommendations, adults are encouraged to maintain between 2-3 L per day. [10] Patients should be encouraged to replace their losses to keep up with activity. For example, marathon runners water should drink more than a nonmobile person. In elderly patients, excessive free water drinking can cause hyponatremia, so balanced hydration solutions are recommended.

Pearls and Other Issues

• Because adequate volume is essential to the peak function of the human body, there are multiple mechanisms to achieve and maintain euvolemia.

• The diagnosis of volume depletion depends on the careful assessment of physical exam, history, and laboratory tests. There is no one test to diagnose dehydration.

• The first goal of treatment of dehydration is to restore circulating volume. The second goal is to find the cause of the dehydration so that it will not recur.

• In patients with normal heart and renal function, liberal fluid may be given to restore volume quickly. In patients with heart failure and renal disease, volume still needs to be replaced, but a more a=careful approach is indicated. This is best accomplished with small volumes given quickly, followed by immediate reassessment and redosing as needed.

• In severe hyponatremia, rapid correction of volume deficits may cause a sharp rise in the serum sodium that can cause central pontine myelinolysis (CPM). The clinician must assess the risks and benefits of rapid volume repletion versus the risk of CPM. In all cases, the volume status and sodium levels must be monitored closely.

Enhancing Healthcare Team Outcomes

Often because water intake is not the most pressing topic for the average clinical visit, it is often overlooked regarding patient care. If we can encourage more healthy lifestyle choices and daily hydration, it can lead to decreased morbidity, mortality, and complications associated with dehydration. Healthcare providers should look toward implementing more incentives and initiatives toward increasing hydration amongst staff and patient populations.

Review Questions

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References

1.

Weinberg AD, Minaker KL. Dehydration. Evaluation and management in older adults. Council on Scientific Affairs, American Medical Association. JAMA. 1995 Nov 15;274(19):1552-6. [PubMed: 7474224]

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Miller HJ. Dehydration in the Older Adult. J Gerontol Nurs. 2015 Sep 01;41(9):8-13. [PubMed: 26375144]

3.

Kayser-Jones J, Schell ES, Porter C, Barbaccia JC, Shaw H. Factors contributing to dehydration in nursing homes: inadequate staffing and lack of professional supervision. J Am Geriatr Soc. 1999 Oct;47(10):1187-94. [PubMed: 10522951]

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Hooper L, Abdelhamid A, Attreed NJ, Campbell WW, Channell AM, Chassagne P, Culp KR, Fletcher SJ, Fortes MB, Fuller N, Gaspar PM, Gilbert DJ, Heathcote AC, Kafri MW, Kajii F, Lindner G, Mack GW, Mentes JC, Merlani P, Needham RA, Olde Rikkert MG, Perren A, Powers J, Ranson SC, Ritz P, Rowat AM, Sjöstrand F, Smith AC, Stookey JJ, Stotts NA, Thomas DR, Vivanti A, Wakefield BJ, Waldréus N, Walsh NP, Ward S, Potter JF, Hunter P. Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database Syst Rev. 2015 Apr 30;2015(4):CD009647. [PMC free article: PMC7097739] [PubMed: 25924806]

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Lamarche J, Rivera AP, Courville C, Taha M, Antar-Shultz M, Reyes A. Role of Point-of-Care Ultrasonography in the Evaluation and Management of Kidney Disease. Fed Pract. 2018 Dec;35(12):27-33. [PMC free article: PMC6366586] [PubMed: 30766335]

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Long E, Oakley E, Duke T, Babl FE., Paediatric Research in Emergency Departments International Collaborative (PREDICT). Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness: A Systematic Review and Meta-Analysis. Shock. 2017 May;47(5):550-559. [PubMed: 28410544]

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Castera MR, Borhade MB. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 5, 2022. Fluid Management. [PubMed: 30335338]

8.

Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R., SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004 May 27;350(22):2247-56. [PubMed: 15163774]

9.

Mahowald JM, Himmelstein DU. Hypernatremia in the elderly: relation to infection and mortality. J Am Geriatr Soc. 1981 Apr;29(4):177-80. [PubMed: 7204813]

10.

Gandy J. Water intake: validity of population assessment and recommendations. Eur J Nutr. 2015 Jun;54 Suppl 2(Suppl 2):11-6. [PMC free article: PMC4473081] [PubMed: 26048039]

Disclosure: Kory Taylor declares no relevant financial relationships with ineligible companies.

Disclosure: Elizabeth Jones declares no relevant financial relationships with ineligible companies.

Dehydration – Symptoms & causes

Overview

Dehydration occurs when you use or lose more fluid than you take in, and your body doesn’t have enough water and other fluids to carry out its normal functions. If you don’t replace lost fluids, you will get dehydrated.

Anyone may become dehydrated, but the condition is especially dangerous for young children and older adults.

The most common cause of dehydration in young children is severe diarrhea and vomiting. Older adults naturally have a lower volume of water in their bodies, and may have conditions or take medications that increase the risk of dehydration.

This means that even minor illnesses, such as infections affecting the lungs or bladder, can result in dehydration in older adults.

Dehydration also can occur in any age group if you don’t drink enough water during hot weather — especially if you are exercising vigorously.

You can usually reverse mild to moderate dehydration by drinking more fluids, but severe dehydration needs immediate medical treatment.

Products & Services

Symptoms

Thirst isn’t always a reliable early indicator of the body’s need for water. Many people, particularly older adults, don’t feel thirsty until they’re already dehydrated. That’s why it’s important to increase water intake during hot weather or when you’re ill.

The signs and symptoms of dehydration also may differ by age.

Infant or young child

• Dry mouth and tongue
• No tears when crying
• No wet diapers for three hours
• Sunken eyes, cheeks
• Sunken soft spot on top of skull
• Listlessness or irritability

Adult

• Extreme thirst
• Less frequent urination
• Dark-colored urine
• Fatigue
• Dizziness
• Confusion

When to see a doctor

Call your family doctor if you or a loved one:

• Has had diarrhea for 24 hours or more
• Is irritable or disoriented and much sleepier or less active than usual
• Can’t keep down fluids
• Has bloody or black stool

Causes

Sometimes dehydration occurs for simple reasons: You don’t drink enough because you’re sick or busy, or because you lack access to safe drinking water when you’re traveling, hiking or camping.

Other dehydration causes include:

• Diarrhea, vomiting. Severe, acute diarrhea — that is, diarrhea that comes on suddenly and violently — can cause a tremendous loss of water and electrolytes in a short amount of time. If you have vomiting along with diarrhea, you lose even more fluids and minerals.
• Fever. In general, the higher your fever, the more dehydrated you may become. The problem worsens if you have a fever in addition to diarrhea and vomiting.
• Excessive sweating. You lose water when you sweat. If you do vigorous activity and don’t replace fluids as you go along, you can become dehydrated. Hot, humid weather increases the amount you sweat and the amount of fluid you lose.
• Increased urination. This may be due to undiagnosed or uncontrolled diabetes. Certain medications, such as diuretics and some blood pressure medications, also can lead to dehydration, generally because they cause you to urinate more.

Risk factors

Anyone can become dehydrated, but certain people are at greater risk:

• Infants and children. The most likely group to experience severe diarrhea and vomiting, infants and children are especially vulnerable to dehydration. Having a higher surface area to volume area, they also lose a higher proportion of their fluids from a high fever or burns. Young children often can’t tell you that they’re thirsty, nor can they get a drink for themselves.
• Older adults. As you age, your body’s fluid reserve becomes smaller, your ability to conserve water is reduced and your thirst sense becomes less acute. These problems are compounded by chronic illnesses such as diabetes and dementia, and by the use of certain medications. Older adults also may have mobility problems that limit their ability to obtain water for themselves.
• People with chronic illnesses. Having uncontrolled or untreated diabetes puts you at high risk of dehydration. Kidney disease also increases your risk, as do medications that increase urination. Even having a cold or sore throat makes you more susceptible to dehydration because you’re less likely to feel like eating or drinking when you’re sick.
• 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, and this can lead to an increased body temperature and the need for more fluids.

Complications

Dehydration can lead to serious complications, including:

• Heat injury. If you don’t drink enough fluids when you’re exercising vigorously and perspiring heavily, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion or potentially life-threatening heatstroke.
• Urinary and kidney problems. Prolonged or repeated bouts of dehydration can cause urinary tract infections, kidney stones and even kidney failure.
• Seizures. Electrolytes — such as potassium and sodium — help carry electrical signals from cell to cell. If your electrolytes are out of balance, the normal electrical messages can become mixed up, which can lead to involuntary muscle contractions and sometimes to a loss of consciousness.
• Low blood volume shock (hypovolemic shock). This is one of the most serious, and sometimes life-threatening, complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body.

Prevention

To prevent dehydration, drink plenty of fluids and eat foods high in water such as fruits and vegetables. Letting thirst be your guide is an adequate daily guideline for most healthy people.

People may need to take in more fluids if they are experiencing conditions such as:

• Vomiting or diarrhea. If your child is vomiting or has diarrhea, start giving extra water or an oral rehydration solution at the first signs of illness. Don’t wait until dehydration occurs.
• Strenuous exercise. In general, it’s best to start hydrating the day before strenuous exercise. Producing lots of clear, dilute urine is a good indication that you’re well-hydrated. During the activity, replenish fluids at regular intervals and continue drinking water or other fluids after you’re finished.
• Hot or cold weather. You need to drink additional water in hot or humid weather to help lower your body temperature and to replace what you lose through sweating. You may also need extra water in cold weather to combat moisture loss from dry air, particularly at higher altitudes
• Illness. Older adults most commonly become dehydrated during minor illnesses — such as influenza, bronchitis or bladder infections. Make sure to drink extra fluids when you’re not feeling well.

Modern approaches to rehydration therapy of infectious diarrhea in children uMEDp

The article deals with the problem of dehydration syndrome that develops in acute infectious diarrhea in children. Approaches to the correction of dehydration with the help of oral rehydration are given. The effectiveness of hypoosmolar solutions has been demonstrated.

Table 1. Severity of dehydration as a percentage of the child’s body weight before illness

Table 2. WHO assessment of fluid deficiency in a child

Table 3. CDS

Dehydration Scale

Table 4. Clinical assessment of dehydration

Table 5. Calculation of the required amount of oral rehydration fluid for exsicosis in children

Table 6 Oral Rehydration Plan B

Table 7 Oral Rehydration Plan C

Table 8. Comparative composition of Regidron Bio and oral rehydration solution according to ESPGHAN 9 criteria0003

Acute intestinal infections (AII) still rank second in the structure of infectious morbidity in children. In Europe, from 0.5 to 1.9 episodes of infectious diarrhea are recorded annually in children under three years of age [1, 2].

With infectious diarrhea, the severity of the patient’s condition is determined by the presence and severity of a number of pathological symptoms. In particular, we are talking about a general infectious syndrome (fever, intoxication, lethargy), dehydration syndrome (toxicosis with exicosis), metabolic acidosis syndrome, a syndrome of local changes (diarrhea, vomiting, flatulence, intestinal paresis).

The cause of frequent dehydration (exicosis) in children is considered to be anatomical and physiological features that cause a rapid disruption of adaptive mechanisms and the development of decompensation of the functions of organs and systems in conditions of infectious pathology, accompanied by loss of water and electrolytes.

Dehydration syndrome in children, patients with moderate and severe forms of acute viral gastroenteritis is associated with significant uncompensated fluid loss with vomiting and pathological stools. As a result, the deterioration of central and peripheral hemodynamics, the development of pathological changes in all types of metabolism, the accumulation of toxic metabolites in cells and intercellular space and their secondary effect on organs and tissues. It has been proven that the main cause of dehydration syndrome is rotavirus gastroenteritis [3–5].

The algorithm for the treatment of acute intestinal infections in children involves primarily affecting the macroorganism, aimed at correcting water and electrolyte disorders and eliminating the pathogen. Pathogenetic therapy is considered fundamental: rehydration, diet therapy, enterosorption and the use of probiotics [6]. With watery diarrhea, experts from the World Health Organization (WHO) (2006) recognize the absolutely proven effectiveness of only two therapeutic measures – rehydration and adequate nutrition [1, 6]. There is an opinion that for any specialist, and not just a pediatrician, the treatment of AEI is not difficult.

As our experience (teaching and expert) has shown, unfortunately, it is during rehydration therapy that the largest number of mistakes are made. Even with parenteral administration of a fluid to stop dehydration, in most case histories, the calculation of the required fluid is either absent or performed incorrectly. With oral rehydration, the calculation is not carried out at all. However, the most impressive fact is that even with a solid experience of practical work, doctors of various specialties do not understand why the rehydrating salt should be dissolved in a strictly defined volume of liquid, why it is impossible to mix glucose-salt and salt-free solutions. It is no secret that cases of unjustified infusion therapy are not uncommon, since the legal representatives of the child or medical personnel do not want to make it difficult for themselves to perform oral rehydration or do not have effective means for this.

Before proceeding with the correction of fluid deficiency in AII, it is necessary to determine the degree of fluid deficiency and the amount of pathological losses. We tried to analyze various approaches to assessing the degree of dehydration syndrome: the traditional approach of Russian pediatric infectious disease specialists and resuscitation anesthesiologists and the WHO criteria and ESPGHAN / ESPID (European Society for Pediatric Gastroenterology, Hepatology, and Nutrition) criteria, which are widely used in everyday practice, hepatologists and nutritionists / European Society for Pediatric Infectious Diseases – European Association of Pediatric Infectious Diseases) (2008, 2014). The severity of the dehydration syndrome is assessed primarily by the percentage of body weight loss (Table 1). Using the WHO criteria, assessing the degree of dehydration, one can immediately determine the fluid deficiency (Table 2).

There are no universal laboratory tests that can assess the severity of dehydration. The purpose of determining the severity of dehydration is the amount of deficiency (in ml) for subsequent replenishment. Assessment of the severity of dehydration according to clinical data is, of course, subjective. For these purposes, ESPGHAN recommends using the clinical dehydration scale CDS (Clinical Dehydration Scale): 0 points – no dehydration, from 1 to 4 points – mild dehydration, 5-8 points correspond to moderate and severe dehydration (Table 3) [7].

Before starting treatment of a child with infectious diarrhea, it is necessary to carefully collect and analyze the history of the disease, assess the severity of the condition. Particular attention is paid to the frequency, consistency, approximate volume of feces, the presence and frequency of vomiting, the possibility of fluid intake (volume and composition), the frequency and rate of diuresis, the presence or absence of fever. Be sure to determine the body weight before starting treatment. During therapy, a strict record of the volume of received and excreted fluid is kept (weighing diapers and diapers, measuring the volume of vomit, installing a urological catheter, etc.).

An integrated approach to the diagnosis of dehydration syndrome V.V. Kurek and A.E. Kulagina (2012) (Table 4) is easy to perform, allows you to avoid errors in assessing the degree of dehydration, as well as to conduct rehydration therapy without the threat of complications [8].

The dehydration syndrome occurs when there is a loss of water and electrolytes, and the quantitative loss can be different. Depending on this, dehydration is divided into hypertonic, hypotonic and isotonic. An increase in the levels of blood protein, hemoglobin, hematocrit and erythrocytes is characteristic of all species, but with isotonic dehydration, these indicators can sometimes be normal.

Hypertonic (water-deficient, intracellular) dehydration occurs against the background of the loss of mainly water, which, due to an increase in the concentration of sodium in the plasma, moves into the bloodstream. Losses occur mainly with diarrhea. As a result, intracellular dehydration occurs, which is clinically manifested by unquenchable thirst, aphonia, “crying without tears.” The skin is dry, warm, a large fontanel does not sink due to an increase in the volume of cerebrospinal fluid. Laboratory data: high plasma sodium ≥ 150 mmol/l, reduced volume of erythrocytes and high hemoglobin content. The osmolarity of plasma and urine is increased. Sodium loss – 3-7 mmol / kg.

Hypotonic (salt-deficient, extracellular) dehydration occurs with a significant loss of electrolytes (sodium, potassium), observed in the case of the predominance of vomiting over diarrhea. The loss of salts leads to a decrease in plasma osmolarity and the movement of fluid from the vascular bed into the cells (intracellular edema). Thirst is moderate. External signs of dehydration are weakly expressed: the skin is cold, pale, moist, the mucous membranes are not so dry, a large fontanel sinks. Decreased plasma sodium levels are characteristic

Isotonic (normotonic) dehydration is considered the most common and is accompanied by a simultaneous loss of fluid and salts. As a rule, the content of plasma sodium is normal, although the level of its losses varies from 11 to 13 mmol / kg. The average volume of erythrocytes and hemoglobin concentration, plasma and urine osmolarity are within the normal range.

Usually, with AII, there is no isolated extra- or intracellular dehydration. There is total dehydration, mostly from the extracellular sector.

As clinical experience shows, in most cases of exsicosis syndrome there is a proportional loss of water and electrolytes. As a result, isotonic dehydration develops in 80% of cases, hyperosmolar in 15%, and hypoosmolar in 5%.

The basic principle of oral rehydration is the fractional and gradual introduction of fluid. In our opinion, the most convenient calculation of the replacement fluid for oral rehydration, adopted by the Russian medical community [9-eleven]. Oral rehydration is carried out in two stages:

stage I – in the first six hours after the patient’s admission, the water-salt deficiency that arose before the start of treatment is eliminated. With dehydration syndrome of the first degree, the amount of fluid for primary rehydration at this stage is 40-50 ml / kg of body weight for the first six hours, with dehydration syndrome of the second degree – 80-90 ml / kg of body weight for the first six hours;

stage II – the entire subsequent period is carried out maintenance therapy, taking into account the daily need of the child for fluids and salts, as well as their losses. Maintenance therapy depends on continued fluid and salt loss through vomiting and feces. For each subsequent six-hour period, the child should drink as much solution as he lost fluids with feces and vomit during the previous six hours. This rehydration step continues until the diarrhea stops. The approximate volume of the solution for maintenance rehydration is from 80 to 100 ml / kg of body weight per day (when weighing no more than 25 kg).

The calculation of the required amount of liquid for oral rehydration in exicosis in children is given in Table. 5.

You can use the WHO recommended fluid replacement calculation for emerging economies. In the absence of significant dehydration, plan A is implemented: children under 24 months – 50-100 ml after each episode of diarrhea, children over 24 months – 100-200 ml. For moderate dehydration, plan B is implemented, for severe dehydration, plan C. The latter is not used in countries with a good level of medical care, since in case of severe dehydration (second or third degree), infusion therapy should be carried out (Tables 6 and 7).

Please note: the effectiveness of oral rehydration is evaluated by reducing the volume of fluid loss, stopping clinical signs of dehydration, normalizing diuresis, and improving the general condition of the child. Contraindications for oral rehydration are infectious-toxic shock (septic), hypovolemic shock, dehydration of the second or third degree, occurring with unstable hemodynamics, indomitable vomiting, fluid loss with vomiting and diarrhea exceeding 1. 5 l / h (in adults), oligoanuria as a manifestation of acute renal failure, diabetes mellitus, glucose malabsorption.

WHO recommends oral rehydration using glucose-salt solutions for AII accompanied by watery diarrhea (cholera, enterotoxigenic escherichiosis), as well as for diarrhea of ​​​​a different etiology, characterized by the development of enteritis, gastroenteritis and gastroenterocolitis. When using glucose-salt solutions, the lost salts are replaced. Glucose not only makes it possible to replenish the energy losses of the macroorganism, but also promotes the transport of sodium and potassium through the mucous membrane of the small intestine, which leads to a faster restoration of water-salt homeostasis.

Rehydration therapy, whose history began in the 1960s, has been widely introduced into everyday practice. Until the early 1990s solutions with normal osmolarity (290–315 mOsm/l) have been used since the late 1990s. – with reduced (220–260 mOsm/l) [12].

According to the results of numerous studies, the osmolarity of improved rehydration solutions should not exceed 245 mOsm / l (recommended by WHO in 2004). The following requirements are imposed on the solutions: the ratio “sodium / glucose” – 60/90 mmol / l, osmolarity – 200-240 mOsm / l, energy value – up to 100 kcal. Only when using solutions with low osmolarity does the absorption of water and electrolytes in the intestine improve, the volume and duration of diarrhea are reduced, and there is less need for infusion therapy. Moreover, these observations also apply to cholera [13].

In our country, solutions with reduced osmolarity (ORS-200, Humana Electrolyte) have been used for more than ten years [14]. In the works of L.N. Mazankova showed that against the background of the use of a solution with reduced osmolarity, the duration and severity of diarrhea, vomiting and fever are reduced [14, 15].

The unique rehydrating solution Regidron Bio (Orion Pharma LLC) is presented on the domestic pharmaceutical market, which, in addition to salts, includes maltodextrin, silicon dioxide and Lactobacillus rhamnosus GG – 1 × 10 ⁹ CFU. Silicon dioxide has a sorbing, regenerating effect in the intestinal lumen, that is, it provides an additional detoxifying effect. Maltodextrin provides a lower osmolarity of the solution and has a bifidogenic effect. Add to rehydration solution Lactobacillus rhamnosus GG guarantees the production of a highly effective and safe probiotic strain recommended (with a high level of evidence) by ESPGHAN for the treatment of infectious diarrhea in children [7]. As is known, strain Lactobacillus rhamnosus GG is resistant to the acidic environment of the stomach, has a high adhesive ability to epithelial cells, pronounced antagonistic activity against pathogenic and opportunistic microorganisms, affects the production of anti-inflammatory cytokines and is characterized by a high safety profile [16, 17] .

The results of studies conducted by V.F. Uchaikin, confirmed the high efficiency of Regidron Bio in infectious diarrhea, both watery and osmotic. The use of Regidron bio leads to faster relief of symptoms of dehydration, intoxication, abdominal pain, flatulence and normalization of stool character [18]. In addition, Lactobacillus rhamnosus GG contributes to the normalization of the number of lactobacilli and enterococci in the intestine, but does not affect the level of anaerobes and E. coli (Table 8).

Our own experience of using Regidron bio in 40 children with viral gastroenteritis showed faster relief of diarrhea, and most importantly, high adherence to therapy. 90% of patients who received Regidron bio used the entire solution prescribed for the day. Among patients (30 people) who received a solution with normal osmolarity, only 40% could drink the entire calculated volume of glucose-salt solution. The advantages of Regidron bio include good organoleptic properties.

Thus, oral rehydration is the main treatment for infectious diarrhea in children. It is important to correctly assess the degree of dehydration and use rehydrating solutions with reduced osmolarity.

In the treatment of gastroenteritis in children, enteral rehydration is effective in most cases. The effectiveness of such therapy surpasses parenteral rehydration therapy in some respects [19, 20].

an effective way to combat dehydration

Content

• 1 Oral rehydration salts
  • 1.1 Dehydration problem
  • 1.2 Related videos:
  • 1.3 Symptoms of dehydration
  • 1.4 Causes of dehydration
  • 1.5 Importance of rehydration
  • 1.6 What are oral rehydration salts
  • 1.7 Benefits oral rehydration salts
  • 1.8 Rapid rehydration
  • 1.9 Improved digestion
  • 1.10 Directions for use
  • 1.11 Side effects
  • 1.12 Q&A:
    • • 1.12.0.1 What problem does this product solve?
      • 1.12.0.2 What are oral rehydration salts?
      • 1.12.0.3 What are the main components of these salts?
      • 1.12.0.4 How to use oral rehydration salts?
      • 1.12.0.5 Does this product have any side effects?

Oral rehydration salts are an important tool for the rapid restoration of fluid and electrolyte balance in diarrhea and vomiting. Learn how to properly use rehydration salts and what advantages they have over other methods of restoring hydration.

Dehydration is a serious problem that can lead to various diseases and a weakened immune system. However, there is an effective solution to this problem – oral rehydration salts.

This product consists of specially selected minerals and salts that quickly and effectively restore the water balance in the body. Oral rehydration salts are widely used in medical practice and are recommended by doctors for the prevention and treatment of dehydration.

The advantages of using oral rehydration salts are obvious:

1. Effectiveness: specially selected composition of salts quickly restores the water-salt balance in the body, which contributes to the rapid restoration of strength and energy.

2. Ease of Use: Oral Rehydration Salts are water-soluble and can be taken at home or on the go, making them ideal for combating dehydration in any setting.

3. Safety: product has passed all the necessary clinical tests and is completely safe for health. Oral rehydration salts do not contain harmful additives or artificial colors.

Avoid dehydration! Choose an effective and proven remedy – oral rehydration salts.

The problem of dehydration

Dehydration is a serious problem faced by many people. It can be caused by various factors, such as intense physical activity, excessive sweating, insufficient intake of water and other fluids, and uncontrolled use of certain medications.

Dehydration disrupts homeostasis, the balance of water and electrolytes, which can lead to serious health consequences. Symptoms of dehydration range from mild dizziness and dry mouth to severe kidney and heart problems. Therefore, it is important to take steps to prevent and treat dehydration.

Oral rehydration salts are an effective treatment for dehydration. These salts contain a specific ratio of electrolytes such as sodium, potassium, and chlorides that help restore electrolyte balance, replenish fluid loss, and prevent further complications.

The advantage of oral rehydration salts is their convenient powder form that dissolves easily in water. Such a drug can be taken at home, at work, on the road, or even during physical activity. A distinctive feature of oral rehydration salts is their rapid action – they help restore hydration in the body within a few hours after ingestion.

It must be remembered that the signs of dehydration may vary from person to person, so it is recommended to consult a doctor before starting oral rehydration salts for a more accurate assessment of the state of the body and the dosage of the drug.

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Symptoms of dehydration

Dehydration can lead to a number of unpleasant symptoms that must be taken seriously and dealt with. One of the first signs of dehydration is extreme thirst. The body tries to compensate for the loss of water and signals the need to increase its intake.

Dry mouth and dizziness can be another characteristic symptom of dehydration. Lack of water in the body can lead to a decrease in the concentration of plums, which causes dryness and discomfort in the mouth. Dizziness is associated with reduced blood supply to the brain due to lack of water.

In addition, dehydration can manifest itself as reduced skin elasticity and symptoms of dehydration. The skin becomes dry, dull and loses its elasticity. Muscle cramps and abdominal pain often occur.

If you notice these symptoms, you must immediately take measures to rehydrate the body. Oral rehydration salts are an effective and safe way to quickly restore the water-salt balance. They will help to quickly replenish the missing moisture and minerals, restore energy levels and relieve the uncomfortable symptoms of dehydration.

Causes of dehydration

Dehydration is a condition where the body loses more fluid than it receives. Dehydration can be caused by a variety of factors:

1. Excess fluid loss: When you sweat heavily, especially during intense physical activity or during hot weather, the body can quickly lose moisture through the skin.
2. Diseases: some diseases can lead to increased urination or vomiting and diarrhea, which also leads to significant fluid loss.
3. Insufficient fluid intake: improper drinking behavior, in which the body does not get enough water, can lead to dehydration.

To prevent dehydration, you need to properly assess your fluid needs and drink regularly throughout the day. However, in case of severe dehydration, seek medical attention and, if necessary, use oral rehydration salts, which will help restore the balance of electrolytes in the body and return it to normal.

The importance of rehydration

Dehydration can have serious consequences for our health. Most of our functions are based on water – it is the main component of our body and is necessary to maintain the vital activity of all organs and systems.

Fluid loss can occur for a variety of reasons, including physical activity, increased body demand during illness, or drinking diuretic drinks. However, regardless of the cause, it is important to pay attention to the rehydration process in order to restore normal levels of moisture in the body.

Oral rehydration salts are an effective way to combat dehydration. They contain a balanced ratio of electrolytes such as sodium, potassium and chloride to help replenish those lost due to dehydration.

The administration of oral rehydration salts has a number of advantages over other methods of restoring moisture in the body. First, these salts are easy and convenient to take in the form of a solution that you can drink. Secondly, they provide a quick rebalancing of electrolytes in the body, which promotes active recuperation and overall well-being.

Do not forget that timely rehydration is the key to a successful fight against dehydration. Signs of dehydration can vary, including dry skin, headache, fatigue, and weakness. It is important to notice these signals and take timely action to restore the normal level of moisture in the body with the help of oral rehydration salts.

What are Oral Rehydration Salts

Oral Rehydration Salts are a specially formulated product that helps restore the body’s natural fluid and mineral balance. It is especially useful for dehydration caused by a variety of causes, including strenuous exercise, vomiting, diarrhea, or excess fluid loss through sweat.

The main constituent of oral rehydration salts are electrolytes such as sodium, potassium and chloride. These electrolytes play an important role in keeping the body hydrated and the cells functioning properly.

The benefits of using oral rehydration salts include rapid restoration of fluid levels in the body, improvement in the general condition of the patient, and a reduction in the risk of serious complications associated with dehydration.

Oral Rehydration Salts are available in a variety of formats, including powder, tablets and solutions, making them easy to use in any situation, whether at home, traveling or at work.

Regular consumption of oral rehydration salts can improve overall health and help the body overcome dehydration. However, before using this product, it is recommended that you consult your doctor to determine the correct dosage and regimen for taking into account the individual characteristics of the organism.

Benefits of oral rehydration salts

1. Fast and effective rehydration. Oral Rehydration Salts are an effective way to restore fluid levels in the body. They contain the optimal combination of salts and minerals necessary for the rapid restoration of water and electrolyte balance. Taking oral rehydration salts allows the body to replenish electrolytes and water lost during dehydration, which helps speed up the rehydration and recovery process.

2. Simplicity and ease of use. Oral rehydration salts are available as a powder or tablet that dissolves easily in water. This makes salt preparations convenient to use in any environment – at work, at home or on a hike. You do not need to look for special tools or professional help to take rehydration salts – just dissolve them in water and drink the resulting solution.

3. Neutral taste and no side effects. Oral rehydration salts have a neutral taste, which makes them pleasant to use. They do not cause discomfort during the reception and do not leave an aftertaste. In addition, salt preparations have no side effects and are well tolerated by the body. This is especially important for people with sensitive digestion or allergies.

4. Suitable for the whole family. Oral rehydration salts can be taken by both adults and children. They are safe and effective in restoring fluid and electrolyte balance in all family members. If necessary, the dosage of rehydration salts can be adjusted depending on the age and weight of the patient. This makes salt preparations universal and convenient for use in family practice.

5. Availability and economy. Oral rehydration salts are widely available in pharmacies and stores. Their cost is affordable for most buyers, and the effectiveness of the drugs makes them economical to use. One package of oral rehydration salts can be enough for multiple doses, saving you the expense of buying expensive shakes or other specialized rehydration products.

Rapid rehydration

Does your body experience intermittent dehydration without the required amount of fluid? Our solution – oral rehydration salts – will help you quickly and effectively restore the water balance in the body.

Oral Rehydration Salts are specially formulated to quickly replace lost fluids and electrolytes. They contain the optimal combination of salts and minerals necessary for the normal functioning of the body.

Benefits of using oral rehydration salts:

• Accelerate the process of restoring water balance after physical activity or exposure to high temperatures;
• Increase the effectiveness of athletic training and help prevent dehydration;
• Support the normal functioning of the body in conditions of stress and nervous tension;
• Contribute to the rapid recovery of the body after a cold or gastrointestinal diseases.

Buying oral rehydration salts is easy and simple. They are available in various formats: portion sachets or tablets for solution. Choose a convenient option and stay always ready for an active life!

Improved digestion

Digestive problems can cause discomfort and dissatisfaction after eating. Improving digestion is key to maintaining a healthy lifestyle.

One of the key ingredients that can improve digestion are oral rehydration salts. These salts help restore electrolyte balance in the body and increase the rate of absorption of nutrients from food.

Oral Rehydration Salts, also known as ORS, provide essential nutrients to help strengthen the digestive system. They contain important components such as sodium, potassium, and glucose, which help support healthy stomach and intestinal function.

In addition, oral rehydration salts also contain vitamins and minerals that aid in food processing and nutrient absorption. As a result, the general condition of the body improves, gastric and intestinal discomfort decreases, energy levels increase and the immune system is strengthened.

If you are experiencing digestive problems or want to improve your overall well-being, oral rehydration salts can be an effective and easy way to achieve these goals. Start today and take care of your health.

Suggested Use

Oral Rehydration Salts are effective in combating dehydration and restoring fluid and electrolyte balance in the body. To achieve the best result, it is recommended to follow the following recommendations:

1. Correct dosage: Before you start taking salts, you must read the instructions and strictly follow the recommended dosage. An overdose can lead to side effects, and an insufficient amount of salts may not bring the desired result.
2. Timing of administration: It is recommended that rehydration salts be taken regularly and at fixed intervals. This will help maintain a constant level of electrolytes in the body and effectively fight dehydration.
3. Water combination: Salts must be taken with sufficient water. This will help to absorb salts faster and restore the water and electrolyte balance of the body.
4. Compliance with the composition: Before buying rehydration salts, it is important to familiarize yourself with their composition and choose the appropriate option, taking into account the characteristics of the organism and the needs for electrolytes.
5. Dry storage: To maintain the quality of the salt for a long time, it is recommended to store it in a dry and cool place out of the reach of children.

By following these guidelines, you will be able to effectively use oral rehydration salts and restore fluid and electrolyte balance in the body.

Side Effects

1. Gastrointestinal Disorders: Various digestive problems may occur when consuming oral rehydration salts. Some people may experience stomach discomfort, constipation or diarrhea. In such cases, it is recommended to reduce the dosage or consult a doctor.

2. Allergic reactions: Some people may experience allergic reactions to components of oral rehydration salts. They may appear as skin rashes, itching, or swelling. If these symptoms occur, stop using the product immediately and consult a doctor.

3. Interactions with other drugs: oral rehydration salts may interfere with the effectiveness of other drugs taken at the same time. This is especially important for people taking drugs for the cardiovascular or renal system. Talk to your doctor or pharmacist before taking rehydration salts.

4. Electrolyte disorders: oral rehydration salts contain sodium, potassium and other electrolytes that are essential for normal body functioning. However, if these salts are used improperly, electrolyte imbalances can occur, which can lead to serious health consequences. Therefore, before using oral rehydration salts, you should consult your doctor and strictly follow the recommendations for dosage.

Q&A:

What problem does this product solve?

This product helps with dehydration.

What are oral rehydration salts?

Oral Rehydration Salts are a mixture of mineral salts used to restore the body’s water-salt balance when dehydrated.

What are the main components of these salts?

The main components in oral rehydration salts are sodium chloride, potassium chloride, sodium citrate, glucose. They help restore essential minerals and bring energy to the body.

How to use oral rehydration salts?

Oral rehydration salts are usually sold in powder form. They are diluted in water according to the instructions and drunk. To determine the dosage and plan of administration, it is better to consult a doctor.

Does this product have any side effects?

When oral rehydration salts are used correctly, there are usually no side effects. However, as with any drug, individual reactions to the components of the product are possible.