What is dehydration and how does it affect the body. How can dehydration be diagnosed and treated effectively. What are the potential complications of severe dehydration. How can you prevent dehydration in your daily life.

Understanding Dehydration: A Critical Health Concern

Dehydration occurs when the body lacks sufficient water to function properly. This condition can range from mild to severe, with potentially life-threatening consequences if left untreated. The human body relies heavily on water for various physiological processes, including regulating blood pressure, heart rate, and body temperature.

How much water does the human body contain? Approximately 60% of an adult’s body weight is water, highlighting its crucial role in maintaining overall health. When this delicate balance is disrupted, it can lead to a cascade of health issues.

The Impact of Dehydration on Body Functions

Even mild dehydration can have noticeable effects on the body. These may include:

• Fluctuations in blood pressure
• Irregular heart rate
• Difficulty regulating body temperature
• Decreased cognitive function
• Impaired physical performance

In severe cases, dehydration can progress to more serious symptoms such as weakness, confusion, and even brain damage. Understanding the importance of proper hydration is crucial for maintaining optimal health and preventing these potentially dangerous outcomes.

Common Causes of Dehydration: Beyond Thirst

Dehydration can result from various factors, often extending beyond simply not drinking enough water. Identifying these causes is essential for prevention and proper treatment.

Environmental and Physical Factors

What environmental conditions contribute to dehydration? Hot weather and high humidity are significant contributors, as they increase the body’s need for water to regulate temperature through sweating. Similarly, engaging in intense physical activity or spending time in a sauna can lead to rapid fluid loss through perspiration.

Illness-Related Causes

Certain health conditions can dramatically increase the risk of dehydration:

• Diarrhea: Can lead to rapid loss of both water and electrolytes
• Vomiting: Prevents the body from retaining fluids and nutrients
• Fever: Increases body temperature and fluid loss through sweating

Medication-Induced Dehydration

Can medications contribute to dehydration? Yes, certain medications, particularly diuretics (often referred to as “water pills”), can increase urine production and lead to increased fluid loss. It’s crucial for individuals taking such medications to be aware of this side effect and adjust their fluid intake accordingly.

Recognizing the Signs and Symptoms of Dehydration

Identifying dehydration early is key to preventing its progression to more severe stages. The symptoms can vary in intensity and may manifest differently in each individual.

Common Indicators of Dehydration

What are the tell-tale signs of dehydration? Look out for:

1. Increased thirst
2. Fatigue or tiredness
3. Dizziness or lightheadedness
4. Muscle cramps
5. Dry mouth or tongue
6. Reduced urine output
7. Dark yellow or brown-tinged urine
8. Headache
9. Dry skin
10. Rapid heart rate and breathing

In more severe cases, individuals may experience fainting spells or confusion. It’s important to note that by the time you feel thirsty, you may already be mildly dehydrated.

Dehydration in Different Age Groups

How does dehydration manifest in various age groups? While the core symptoms remain similar, certain groups may be more susceptible or display unique signs:

• Infants and young children: May have a sunken soft spot on the head, few or no tears when crying, and irritability
• Older adults: May experience confusion, dizziness, or difficulty with balance
• Athletes: Might notice decreased performance, increased perceived effort, and heat intolerance

Understanding these age-specific indicators can help in early detection and prompt treatment of dehydration across different populations.

Diagnosing Dehydration: Medical Approaches and Tests

Proper diagnosis of dehydration is crucial for determining the appropriate treatment approach. Healthcare providers employ various methods to assess a patient’s hydration status accurately.

Clinical Evaluation

What does a typical dehydration assessment involve? A healthcare provider will usually start with:

• A thorough medical history, including recent illnesses or activities that may have contributed to fluid loss
• Physical examination to check for signs of dehydration
• Vital sign measurements, including blood pressure, heart rate, and temperature

Diagnostic Tests

In cases where the severity of dehydration is unclear or additional information is needed, healthcare providers may order specific tests:

1. Blood tests: To check electrolyte levels, kidney function, and blood concentration
2. Urinalysis: To assess urine concentration and check for signs of infection
3. Skin turgor test: Evaluating how quickly pinched skin returns to its normal position

These diagnostic tools help healthcare providers determine the extent of dehydration and guide treatment decisions.

Effective Treatment Strategies for Dehydration

The treatment approach for dehydration varies depending on its severity and underlying cause. Prompt and appropriate intervention is essential to prevent complications and restore proper hydration.

Mild to Moderate Dehydration

How can mild to moderate dehydration be treated effectively? For less severe cases, oral rehydration is typically the first line of treatment:

• Drinking water and other fluids
• Consuming electrolyte-rich beverages like sports drinks or oral rehydration solutions
• Eating foods with high water content, such as fruits and vegetables

It’s important to avoid beverages containing caffeine or alcohol, as these can further contribute to dehydration.

Severe Dehydration

In cases of severe dehydration, more aggressive treatment is necessary. This often involves:

1. Intravenous (IV) fluid administration in a hospital setting
2. Close monitoring of vital signs and electrolyte levels
3. Treatment of underlying causes, such as severe diarrhea or vomiting

Severe dehydration is considered a medical emergency and requires immediate professional intervention to prevent life-threatening complications.

Addressing Underlying Causes

What role does treating underlying conditions play in managing dehydration? Addressing the root cause is crucial for effective treatment and prevention of recurrence. This may involve:

• Prescribing anti-diarrheal medications for persistent diarrhea
• Administering anti-emetics to control vomiting
• Managing fever with appropriate medications and cooling measures

By tackling these underlying issues, healthcare providers can help break the cycle of fluid loss and promote more effective rehydration.

Preventing Dehydration: Strategies for Optimal Hydration

Prevention is key when it comes to dehydration. By adopting proper hydration habits and being aware of risk factors, individuals can significantly reduce their chances of experiencing dehydration.

Daily Fluid Intake Recommendations

How much fluid should an average adult consume daily? While individual needs may vary, a general guideline is to aim for:

• Approximately 2 to 3 quarts (1.9 to 2.8 liters) of fluid per day
• This translates to about 12 8-ounce glasses of fluid daily

It’s important to note that these recommendations may need to be adjusted based on factors such as climate, physical activity level, and overall health status.

Choosing the Right Fluids

What types of fluids are best for maintaining proper hydration? While water is the most obvious choice, other options can contribute to your daily fluid intake:

1. Water (plain or infused with fruits for added flavor)
2. Fruit juices (in moderation due to sugar content)
3. Sports drinks (particularly useful during intense physical activity)
4. Herbal teas
5. Low-fat milk
6. Clear broths or soups

It’s advisable to limit or avoid beverages high in caffeine or alcohol, as these can have a diuretic effect and potentially contribute to dehydration.

Situational Hydration Strategies

How should hydration practices be adjusted in different situations? Consider the following scenarios:

• Hot weather: Increase fluid intake and seek shade when possible
• During exercise: Drink water before, during, and after physical activity
• Illness: Consume extra fluids to compensate for losses from fever, diarrhea, or vomiting
• Air travel: Combat the dehydrating effects of low humidity in airplanes by drinking extra water

Being proactive about hydration in these situations can help prevent the onset of dehydration and its associated symptoms.

Potential Complications of Severe Dehydration

While mild dehydration can often be easily remedied, severe cases can lead to serious health complications if left untreated. Understanding these potential risks underscores the importance of prompt recognition and treatment of dehydration.

Acute Complications

What immediate dangers does severe dehydration pose? Some of the most pressing concerns include:

• Heat injury: Ranging from mild heat cramps to life-threatening heat stroke
• Seizures: Due to electrolyte imbalances, particularly low sodium or potassium
• Hypovolemic shock: A dangerous drop in blood volume and pressure
• Cerebral edema: Swelling of the brain, particularly if rehydration is done too quickly

Long-term Health Impacts

Can severe dehydration have lasting effects on health? Yes, prolonged or recurrent severe dehydration may lead to:

1. Kidney problems: Including kidney stones and urinary tract infections
2. Cognitive impairment: Especially in older adults
3. Muscle damage: Due to breakdown of muscle tissue
4. Gastrointestinal issues: Such as constipation or acid reflux

These potential complications highlight the critical nature of maintaining proper hydration and seeking prompt medical attention when signs of severe dehydration are present.

Special Considerations for Vulnerable Populations

Which groups are at higher risk for complications from dehydration? Certain populations require extra vigilance:

• Infants and young children: At risk for rapid dehydration due to their smaller body size
• Older adults: May have reduced thirst sensation and be taking medications that increase fluid loss
• Individuals with chronic illnesses: Such as diabetes or kidney disease, which can affect fluid balance
• Athletes and outdoor workers: Exposed to conditions that increase fluid loss through sweating

For these groups, preventive measures and early intervention are crucial in avoiding the potentially severe complications of dehydration.

Innovative Approaches to Hydration Management

As our understanding of hydration and its impact on health evolves, new strategies and technologies are emerging to help individuals maintain optimal fluid balance.

Hydration Monitoring Devices

How can technology assist in preventing dehydration? Several innovative tools are now available:

• Smart water bottles: Track water intake and remind users to drink
• Wearable hydration sensors: Monitor sweat rate and electrolyte loss
• Urine color charts: Simple tools to assess hydration status based on urine color
• Bioelectrical impedance devices: Measure body water percentage

These technologies can provide valuable insights into personal hydration needs and help individuals maintain proper fluid balance throughout the day.

Personalized Hydration Strategies

Can hydration recommendations be tailored to individual needs? Absolutely. Factors to consider include:

1. Body weight and composition
2. Activity level and type of exercise
3. Climate and altitude
4. Diet and salt intake
5. Medical conditions and medications

By taking these factors into account, healthcare providers and nutritionists can develop personalized hydration plans that optimize fluid intake for each individual’s unique circumstances.

Novel Hydration Products

What new products are available to enhance hydration? The market has seen an influx of innovative options:

• Electrolyte tablets and powders: For quick and convenient electrolyte replenishment
• Hydrogen-rich water: Claimed to have additional health benefits beyond hydration
• Plant-based hydration drinks: Offering natural alternatives to traditional sports drinks
• Oral rehydration solutions: Specially formulated to treat dehydration from illness

While these products can be useful tools in maintaining hydration, it’s important to consult with a healthcare provider before incorporating them into your routine, especially if you have underlying health conditions.

By staying informed about these emerging approaches and technologies, individuals can take a more proactive and personalized approach to hydration management, potentially reducing their risk of dehydration and its associated complications.

Dehydration | Cedars-Sinai

ABOUT

CAUSES
DIAGNOSIS

TREATMENT

NEXT STEPS

What is dehydration?

Dehydration is when you don’t have enough water in your body. The
human body normally contains a lot of water. It helps keep your body healthy and
working well. Mild dehydration can cause problems with blood pressure, heart rate,
and body temperature. Severe dehydration can also cause weakness or confusion. In
extreme cases, it can lead to brain damage and even death.

Everyone loses body water daily through sweat, tears, breathing,
urine, and stool. This water is replaced by drinking fluids and eating foods that
contain water. Dehydration can have many causes. You may have lost water from
diarrhea or vomiting. Or you may be sweating from exercise or hot weather. Loss of
water often leads to an imbalance of electrolytes in the body. Electrolytes are
minerals and salts that the body needs to function. They include sodium, potassium,
magnesium, and calcium.

What causes dehydration?

Dehydration can be caused by:

• Sweating from hot weather, exercise, sauna use
• Diarrhea
• Vomiting
• Fever
• Some medicines that cause extra urination, such as diuretics
  (water-pills)

Who is at risk for dehydration? 

You are more at risk if you:

• Have diarrhea
• Have vomiting
• Are in hot weather
• Are sweating a lot from exercise
• Are an older adult age 60 or older

What are the symptoms of dehydration?

Symptoms can occur a bit differently in each person. They can
include:

• Thirst
• Tiredness
• Dizziness
• Lightheadedness
• Muscle cramps
• Dry mouth
• Less urine
• Urine that’s dark yellow or even light brown in color
• Headache
• Dry skin or tongue
• Fainting
• Confusion
• Fast heart rate and breathing

The symptoms of dehydration can look like other health conditions.
See your healthcare provider for a diagnosis.

How is dehydration diagnosed?

Your healthcare provider will ask about your symptoms and health
history. The provider may also ask about recent illness or activity. You will also
have a physical exam. Your blood pressure, temperature, and heart rate will be
checked. You may have blood or urine tests.

How is dehydration treated?

Treatment will depend on your symptoms, your age, and your general
health. It will also depend on how severe the condition is. You also may be treated
for diarrhea, vomiting, or a high fever if illness caused your dehydration.

For moderate to severe dehydration, you may need IV (intravenous)
fluids. Severe dehydration is a medical emergency. It needs to be treated right away
with IV fluids in a hospital.

For mild dehydration, you can drink fluids. You may need to
restore not just water, but also electrolytes such as sodium and potassium. Sports
drinks can replace water and electrolytes. You can also drink water, fruit juices,
tea, and soda.

Don’t have drinks with caffeine. These include some energy drinks,
teas, sodas, and coffee drinks. Don’t drink alcohol. Caffeine and alcohol may cause
your body to lose more water.

Talk with your healthcare providers about the risks, benefits, and
possible side effects of all treatments.

What are possible complications of dehydration? 

Severe dehydration that is not treated can cause kidney damage,
brain damage, and death.

What can I do to prevent dehydration?

Advice varies. On average, an adult should drink about 2 to 3
quarts of fluid per day. Drinking 12 8-ounce glasses of fluid every day would help
reach this goal. Drink more if you are in hot weather or exercising. Drinks may
include:

• Water
• Fruit juices
• Sports drinks. Be careful of the sugar in these drinks,
  especially if you have diabetes.
• Other drinks that have electrolytes
• Soda with no caffeine
• Tea with no caffeine
• Coffee with no caffeine

If you have been diagnosed with a kidney or heart disease, ask
your healthcare provider how much and what types of fluids you should drink to
prevent dehydration. When you have kidney or heart disease, fluid can build up in
the body. This can be dangerous to your health.

When should I call my healthcare provider?

Call the healthcare provider if you have:

• Diarrhea more than 5 times a day
• Continued vomiting
• Small amount of blood (red or black color) or mucus in
  diarrhea
• Small amount of blood in vomit
• Belly pain
• Swollen belly
• Fever of 100.4°F (38°C) or higher, or as directed by your
  healthcare provider

Call

911
or go to the emergency room (ER)
right away if you have:

• Weakness
• Dizziness or fainting
• Drowsiness or confusion
• Large amount of blood (red or black color) or mucus in
  diarrhea
• Large amount of blood in vomit

Key points about dehydration

• Dehydration is when you don’t have enough water in your
  body.
• Symptoms can include thirst, dry mouth, and less urine.
• Mild dehydration can cause problems with blood pressure,
  heart rate, and body temperature.
• Severe dehydration can also cause weakness or confusion. In
  extreme cases, it can lead to kidney damage, brain damage and even death.
• For mild dehydration, you can drink fluids (but not alcohol
  or caffeine). These include sports drinks, water, fruit juices, and
  non-caffeinated tea and soda.
• For moderate to severe dehydration, you may need IV
  (intravenous) fluids. Severe dehydration is a medical emergency. It needs to be
  treated right away with IV fluids in a hospital.

Next steps

Tips to help you get the most from a visit to your healthcare
provider:

• Know the reason for your visit and what you want to
  happen.
• Before your visit, write down questions you want
  answered.
• Bring someone with you to help you ask questions and
  remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and
  any new medicines, treatments, or tests. Also write down any new instructions
  your provider gives you.
• Know why a new medicine or treatment is prescribed, and how
  it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the
  results could mean.
• Know what to expect if you do not take the medicine or have
  the test or procedure.
• If you have a follow-up appointment, write down the date,
  time, and purpose for that visit.
• Know how you can contact your provider if you have
  questions.

Medical Reviewer: Eric Perez MD

Medical Reviewer: Ronald Karlin MD

Medical Reviewer: Maryann Foley RN BSN

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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

• Access free multiple choice questions on this topic.

• Comment on this article.

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]

2.

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]

4.

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]

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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]

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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]

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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.

Kidney failure – symptoms in men and women, treatment at the Research Institute. ON THE. Lopatkin.

Table of contents

Kidney failure is a disease of an acute or chronic nature, in which the excretory and filtration functions of the kidneys are impaired. The result is a malfunction of the whole organism against the background of poisoning by decay products that enter the bloodstream. More recently, it was believed that kidney failure develops due to glomerulonephritis, but recently the opinion of doctors has changed. Now the main causes are diabetes and hypertension – these diseases contribute to the destruction of small blood vessels in the kidneys.

Acute renal failure develops for the following reasons:

• genetic predisposition;
• living in regions with bad ecology;
• unbalanced diet;
• forced long-term use of certain drugs;
• infectious diseases;
• the presence of parasites in the body;
• chronic pathologies of the cardiovascular, endocrine and urinary systems;
• metabolic disorder.

More often renal failure develops in men and over the age of 60 years. Also, acute renal failure can rapidly develop against the background of an organ injury and a large loss of blood, poisoning with poisons, obstruction of the ureters, acute / complicated pyelonephritis.

Women may develop kidney failure during pregnancy.

Symptoms and signs of kidney failure

Acute kidney failure is in almost every case a complication of another internal disease. Therefore, the first symptoms and signs of it may be unexpressed, but if they are identified on time, and doctors begin treatment, then the process of destruction of kidney tissues can be stopped and their functionality can be fully restored. The first sign is a decrease in the amount of urine excreted: no more than 600 ml per day. If you ignore this symptom, then dehydration quickly develops, an infection joins. With proper treatment, it will be possible to restore the functionality of the kidneys within 6-12 months. If renal failure occurs without treatment, then it is transformed into a chronic form of the course.

Chronic renal failure is manifested by the following symptoms and signs :

• apathy, weakness, fatigue;
• intense and constant thirst;
• an unpleasant taste in the mouth is a pronounced sign of poisoning of the body with toxins;
• memory problems;
• sleep disorders;
• constant feeling of nausea.

These symptoms appear as chronic renal failure progresses, and the first signs are always frequent urination at night and a decrease in total urine output.

If there is no treatment, then the person’s condition is complicated by neurological disorders – kidney failure provokes the appearance of involuntary muscle twitches, profuse vomiting, regardless of food intake, and a decrease in the reaction rate.

Symptoms in a man and signs in a woman are almost the same, but there may be differences:

• in women, pain and burning appear during urination;
• libido decreases in men;
• chronic renal failure in women leads to gynecological inflammatory diseases;
• chronic renal failure in men can cause prostatitis.

Diagnosis of renal failure

The diagnosis of “renal failure” is made on the basis of the results of laboratory, instrumental studies:

• urinalysis – the cause of the disease is established;
• clinical blood test – the level of leukocytes is assessed;
• biochemical blood test – the most informative study, the level of urea and creatinine is determined;
• ultrasound examination of the kidneys – there is a decrease in size if the kidney failure is chronic;
• computed or magnetic resonance imaging of the abdominal cavity and small pelvis.

If diagnosis is difficult, then a kidney biopsy is prescribed – a fragment of the organ is sent for histological examination under a microscope. Kidney failure in this case will be diagnosed on a specific basis: the replacement of healthy tissues with scar tissue.

Additional diagnostics are for men – ultrasound and manual examination of the prostate gland, for women – ultrasound of the organs of the reproductive system and manual examination on the gynecological chair.

Treatment of renal failure

If the diagnosis has confirmed that the patient has acute renal failure, then he is immediately admitted to the inpatient department of a medical institution. It will be necessary to treat immediately both the underlying disease and renal failure. It is mandatory to prescribe drug therapy to stabilize the patient’s condition and normalize kidney function:

• saline solutions – administered by drip, necessary to restore the overall water-salt balance;
• diuretics – renal insufficiency is characterized by urinary retention, which must be eliminated;
• means for improving blood circulation in the pelvic organs;
• erythropoietin preparations;
• vitamin D.

If renal failure occurs in a chronic form and there is a long-term impairment of the filtration function of the kidneys, then the patient is prescribed a hemodialysis procedure – hardware blood purification. Manipulation is performed regularly, eliminates toxins from the body. If chronic renal failure is severe, hemodialysis does not give positive results, then the patient is shown kidney transplantation. After the operation, therapy is carried out that increases immunity and prevents rejection of the transplanted organ by the body.

Regardless of whether acute or chronic renal failure is diagnosed, general measures are indicated for patients:

• fluid restriction – will help stabilize the water-salt balance and normalize urination;
• refusal to use certain medications – the action is agreed with narrow specialists if the patient is prescribed medication for life;
• menu correction – diet implies strict control over the intake of salt, nuts, dairy products, liver, meat.

Treatment is prescribed at the Research Institute of Urology and Interventional Radiology named after. ON THE. Lopatkin on an individual basis, after receiving the results of analyzes and instrumental examinations. In men, the treatment of the inflammatory process in the prostate gland can be carried out in parallel. If kidney failure is diagnosed in a woman during pregnancy, then the treatment will be aimed at stabilizing the water-salt balance and cleansing the body of toxins.

Possible complications

If kidney failure goes untreated, its symptoms and signs are ignored, then serious complications may develop:

• arrhythmia and pericarditis;
• anemia and heart failure;
• encephalopathy and peptic ulcer of the stomach, duodenum;
• vascular atherosclerosis with subsequent development of heart attack, stroke.

In a man, renal insufficiency is complicated by lack of sexual desire, prostatitis and impotence. In a woman during pregnancy, kidney failure can lead to congenital malformations of the fetus and miscarriage.

Without treatment, chronic renal failure is fatal for the patient because uremic coma and cardiovascular complications develop.

Kidney failure is a serious impairment of kidney function that, if left untreated, leads to complications and death. Symptoms and signs are not expressed only at the initial stage of development. Diagnosis consists in a laboratory study of blood and urine tests, ultrasound of the pelvic organs and the abdominal cavity. If acute renal failure is being treated, then the chances of recovery and full restoration of kidney function are high. Chronic renal failure is introduced into the stage of long-term remission, and if the patient follows the doctor’s recommendations / prescriptions, his life will remain active.

Branches and departments that treat kidney failure

• 3rd urology department S.A. Maslov

• Day hospital – outpatient hemodialysis, Head – T. A. Korobova

Intestinal obstruction — diagnosis and treatment at SM-Clinic

The surgeon deals with the treatment of this disease

• What is intestinal obstruction?
• Classification
• Symptoms of bowel obstruction
• Causes of bowel obstruction
• Diagnosis of intestinal obstruction
• Treatment of intestinal obstruction
• Prophylaxis
• Doctors

Classification

There are the following types of intestinal obstruction:

• Dynamic (paralytic and spastic). Appears as a result of increased muscle tone of the intestinal musculature. The main causes are irritation due to worms, acute pancreatitis, trauma by foreign bodies, as well as paralysis of the intestinal muscles caused by food infections, surgical interventions, drugs containing morphine or heavy metal salts.
• Mechanical (strangulation and obturation). It happens in various forms, appears due to the occurrence of an obstacle in the way of the movement of the food mass, for example, stones, foreign bodies, tumors and cysts of other organs that compress the intestinal lumen. A serious condition is a volvulus or a knot of intestinal loops.

Symptoms of intestinal obstruction

Signs of intestinal obstruction in all manifest themselves in different ways and depend on the type of disease and the severity of the process. In general, bowel obstruction can manifest itself:

• severe pain that may disturb the patient constantly or be cramping. Painful sensations occur regardless of food intake, are not concentrated in a specific place;
• stool and gas retention. With high obstruction, the bowel may empty below the level of the obstruction;
• Constant vomiting begins, which does not stop for a long time. If the obstruction is in the upper part, then vomiting is more severe;
• The abdomen swells, rumbling is observed.

In a difficult case, such as volvulus, there is constant and intense pain, which sometimes becomes unbearable.

If you find such symptoms of intestinal obstruction, you should immediately seek medical help, otherwise the patient will begin to rise in temperature, breathing will become rapid, dehydration and impaired urination will appear.

Causes of intestinal obstruction

The following factors contribute to the development of the disease:

• the presence of oncological diseases of the intestine or an organ located nearby;
• compression of the intestine by adhesions formed after operations;
• strangulated hernia;
• blockage due to the formation of fecal stones, balls of worms or foreign bodies;
• poisoning;
• peritonitis.

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:

+7 (495) 292-39-72

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Why SM-Clinic?

1

Treatment is carried out in accordance with clinical recommendations

2

Comprehensive assessment of the nature of the disease and treatment prognosis

3

Modern diagnostic equipment and own laboratory

4

High level of service and balanced pricing policy

Diagnosis of intestinal obstruction

To diagnose the disease, it is required to conduct research and pass the necessary tests. The doctor may prescribe:

• blood test – depending on complaints, a general or biochemical blood test may be prescribed;
• Ultrasound – performed throughout the abdominal cavity to determine the size of intestinal loops, the presence of fluid in the cavity, peristalsis;
• x-ray examination – the doctor examines intestinal loops, fluid and gas filling;
• colonoscopy – mainly prescribed for obstruction of the large intestine.

Treatment of intestinal obstruction

If intestinal obstruction is confirmed, urgent surgical intervention is necessary. Depending on the cause, the following is carried out:

• removal of parts of the intestine;
• removal of feces to the outside;
• cutting formed adhesions;
• untwisting of bowel loops;
• hernia repair.

If the disease is at an early stage, the doctor may resort to the following treatment methods: probing, the use of siphon enemas, injections of saline solutions, the appointment of special drugs for spasms and to stimulate motor skills, therapeutic colonoscopy.

Prophylaxis

To prevent the occurrence of obstruction, it is recommended to lead a healthy lifestyle, adhere to a proper diet and maintain the body’s water balance. Doctors recommend several times a week to attend sports classes and move more. And:

• regular check-ups to diagnose the possible development of the disease at an early stage and start treatment immediately;
• prevent the appearance of foreign bodies in the intestines;
• after surgical interventions to carry out the prevention of adhesive processes;
• carry out treatment for worms.

If signs of obstruction are found, you should immediately contact a medical institution.

Aliev, S.A. Primary radical surgical interventions for acute obstruction of the colon of tumor origin in patients of elderly and senile age. Aliyev // Surgery, 2001. – No. 8.

Diagnosis and tactics of treatment of patients with acute intestinal obstruction / T. I. Tamm et al.// Kharkov, 2003.

Zemlyanoy A.G. How to reduce mortality in acute intestinal obstruction / A.G. Zemlyanoy, N.I. Glushkov // Mater. All-Russian. conf. surgeons: Topical issues of abdominal surgery.-Pyatigorsk. -1997.

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Diseases referred by the Surgeon

Soft tissue abscess
liver abscess
Appendicitis
Ascites
Atheroma
femoral hernia
Crohn’s disease
Gangrene
soft tissue hematoma
Giant cell tumor of bone
Hygroma
festering wounds
Hernia
Hernia of the white line of the abdomen
hiatal hernia
Diastasis rectus abdominis
Intestinal diverticulosis
Cholelithiasis
Keratoma
liver cyst
pancreatic cyst
salivary gland cyst
Neck cyst
stab wound
stab wound
Lipoma
Mechanical jaundice
burns
Oleogranuloma
kidney tumor
Acute pancreatitis
Felon
Pancreatic necrosis
Inguinal hernia
Peritonitis
Barrett’s esophagus
Postoperative hernia
Umbilical hernia
Cancer of the extrahepatic bile ducts
Stomach cancer
gallbladder cancer
bowel cancer
adrenal cancer
Parathyroid Cancer
Liver cancer
Esophageal carcinoma
colon cancer
thyroid cancer
Fistula of the gallbladder
Seroma
Thyroiditis
Intestinal injury
vein thrombosis
Thrombophlebitis
Furuncle (boil)
Furunculosis
cholestasis
Cholecystitis
Chronic cholecystitis
Esophageal ulcer
Peptic ulcer of the stomach and duodenum

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