What are the main causes of adult dehydration. How can dehydration be diagnosed and treated effectively. Why is proper hydration crucial for overall health and wellbeing. What are the risk factors and complications associated with dehydration in adults.

Understanding Adult Dehydration: A Comprehensive Overview

Dehydration is a common condition that affects individuals across all age groups, but it can be particularly problematic for adults, especially the elderly. It occurs when the body loses more fluids than it takes in, leading to an insufficient amount of water and other fluids to carry out normal bodily functions. While dehydration is often easily treatable and preventable, it can lead to serious complications if left unchecked.

The Prevalence of Dehydration in Adults

Although popular media often claims that 75% of Americans are chronically dehydrated, this statistic is not supported by medical literature. However, dehydration remains a significant concern, particularly among older adults. Studies have shown that approximately 17% to 28% of older adults in the United States experience dehydration. This high prevalence makes it a frequent cause of hospital admissions and a complicating factor in many medical conditions.

The Science Behind Dehydration: Causes and Mechanisms

Dehydration occurs when water losses from the body exceed water replacement. The human body loses water through various channels, including the skin, lungs, kidneys, and gastrointestinal tract. Understanding the different forms of dehydration and their causes is crucial for proper diagnosis and treatment.

Types of Dehydration

• Isotonic Dehydration: Occurs when water and sodium are lost together
• Hypertonic Dehydration: Happens when water losses exceed sodium losses
• Hypotonic Dehydration: Characterized by more sodium loss than water loss

Common Causes of Dehydration

Dehydration can result from various factors, including:

• Failure to replace water loss due to altered mental status, immobility, or impaired thirst mechanism
• Excessive water loss through the skin (e.g., heat, exercise, burns)
• Increased water loss from the kidneys (e.g., diuretics, renal disease)
• Gastrointestinal losses (e.g., vomiting, diarrhea)
• Intra-abdominal losses (e.g., pancreatitis, new ascites)
• Increased insensible losses (e.g., sepsis, hyperthyroidism)

The Physiology of Hydration: How the Body Maintains Water Balance

Water is essential for maintaining multiple physiological functions within the body. The human body is composed of 55% to 65% water, with two-thirds being intracellular and one-third extracellular. Understanding how the body regulates water balance is crucial for appreciating the mechanisms of dehydration and its effects on health.

The Body’s Water Regulation System

The body has a complex system designed to maintain euvolemia, or normal blood volume. This system involves:

1. Osmoreceptors in the brain that detect changes in water concentration
2. The hypothalamus, which controls thirst and water conservation
3. The kidneys, which regulate water excretion

When the body becomes dehydrated, osmoreceptors in the brain stimulate the thirst center in the hypothalamus, leading to water consumption. Additionally, these receptors can trigger water conservation by the kidneys.

Recognizing Dehydration: Signs, Symptoms, and Diagnostic Approaches

Identifying dehydration early is crucial for preventing complications and ensuring prompt treatment. Healthcare providers rely on a combination of physical examination findings and laboratory tests to diagnose dehydration accurately.

Physical Examination Findings

What are the key physical signs of dehydration in adults. Physical examination may reveal:

• Dry mucous membranes
• Decreased skin turgor
• Sunken eyes
• Tachycardia
• Orthostatic hypotension
• Altered mental status in severe cases

Laboratory Testing

Which laboratory tests are most useful for assessing dehydration. Key laboratory tests include:

• Serum electrolytes
• Blood urea nitrogen (BUN) and creatinine
• Urine specific gravity
• Urine osmolality

These tests help identify the type of dehydration (isotonic, hypertonic, or hypotonic) and assess its severity.

Treatment Strategies for Adult Dehydration

The primary treatment for dehydration is fluid replacement. The approach to rehydration depends on the severity of dehydration and the patient’s overall health status.

Oral Rehydration

For mild to moderate dehydration, oral rehydration is often sufficient. This involves drinking water or electrolyte solutions. In some cases, sports drinks or oral rehydration solutions may be recommended to replace both fluids and electrolytes.

Intravenous Fluid Therapy

Severe dehydration often requires intravenous (IV) fluid therapy. The type and amount of IV fluids depend on the patient’s specific needs and the underlying cause of dehydration. Common IV fluids include:

• Normal saline (0.9% sodium chloride)
• Lactated Ringer’s solution
• Dextrose solutions (in cases of hypoglycemia)

Preventing Dehydration: Strategies for Maintaining Proper Hydration

Prevention is key when it comes to dehydration. Implementing strategies to maintain proper hydration can significantly reduce the risk of dehydration-related complications.

Hydration Tips for Adults

• Drink water regularly throughout the day
• Consume water-rich foods (e.g., fruits, vegetables)
• Monitor urine color (pale yellow indicates good hydration)
• Increase fluid intake during hot weather or physical activity
• Limit alcohol and caffeine consumption

Special Considerations for Older Adults

Older adults are at higher risk for dehydration due to factors such as decreased thirst sensation and medication side effects. Additional preventive measures for this population include:

• Setting reminders to drink water
• Keeping water easily accessible
• Encouraging fluid intake during meals
• Monitoring for signs of dehydration in caregiving situations

The Impact of Dehydration on Health and Well-being

Dehydration can have far-reaching effects on an individual’s health and overall well-being. Understanding these impacts can help emphasize the importance of proper hydration.

Short-term Effects of Dehydration

What are the immediate consequences of dehydration. Short-term effects may include:

• Fatigue and weakness
• Headache
• Dizziness
• Decreased cognitive function
• Impaired physical performance

Long-term Consequences of Chronic Dehydration

How does chronic dehydration affect long-term health. Prolonged or recurrent dehydration can lead to:

• Kidney problems, including an increased risk of kidney stones
• Urinary tract infections
• Cardiovascular issues
• Cognitive decline in older adults

The Role of the Interprofessional Team in Managing Dehydration

Effective management of dehydration often requires a collaborative effort from various healthcare professionals. An interprofessional approach can improve patient outcomes and ensure comprehensive care.

Key Team Members and Their Roles

• Physicians: Diagnose dehydration, determine treatment plans, and manage underlying conditions
• Nurses: Monitor patient status, administer fluids, and provide patient education
• Dietitians: Develop hydration strategies and recommend appropriate fluid intake
• Pharmacists: Review medications that may contribute to dehydration and recommend alternatives
• Physical Therapists: Assist with mobility to prevent dehydration in immobile patients

Importance of Communication and Coordination

Effective communication among team members is crucial for:

• Sharing important patient information
• Coordinating treatment plans
• Ensuring consistent patient education
• Monitoring progress and adjusting interventions as needed

By working together, the interprofessional team can provide comprehensive care that addresses all aspects of dehydration management and prevention.

Advancements in Dehydration Research and Future Directions

As our understanding of dehydration continues to evolve, researchers are exploring new avenues for diagnosis, treatment, and prevention. These advancements hold promise for improving patient care and outcomes.

Emerging Diagnostic Tools

What new technologies are being developed to assess hydration status. Researchers are investigating:

• Bioelectrical impedance analysis for rapid assessment of fluid status
• Wearable devices that monitor hydration levels in real-time
• Advanced urine analysis techniques for more accurate hydration assessment

Novel Treatment Approaches

How might future treatments for dehydration differ from current methods. Potential advancements include:

• Personalized hydration solutions based on individual needs and medical conditions
• Improved oral rehydration formulas with enhanced absorption properties
• Development of hydrogels or other innovative delivery systems for sustained hydration

Dehydration in Special Populations: Unique Considerations

While dehydration can affect anyone, certain populations may be at higher risk or require special attention when it comes to hydration management.

Athletes and Active Individuals

How does dehydration impact athletic performance. Athletes and physically active individuals face unique challenges:

• Increased fluid loss through sweat during exercise
• Need for electrolyte replacement in addition to water
• Importance of proper pre-hydration and rehydration strategies

Patients with Chronic Conditions

Which chronic conditions increase the risk of dehydration. Individuals with certain medical conditions may be more susceptible to dehydration:

• Diabetes: Increased urination and risk of diabetic ketoacidosis
• Kidney disease: Altered fluid balance and electrolyte regulation
• Heart failure: Fluid restrictions and use of diuretics
• Gastrointestinal disorders: Increased fluid loss through diarrhea or vomiting

These populations may require tailored hydration strategies and closer monitoring to prevent dehydration-related complications.

The Economic Impact of Dehydration: Healthcare Costs and Societal Burden

Dehydration not only affects individual health but also has significant economic implications for healthcare systems and society as a whole.

Direct Healthcare Costs

How much does dehydration cost the healthcare system. The financial burden of dehydration includes:

• Emergency department visits and hospitalizations
• Treatment of dehydration-related complications
• Increased length of hospital stays for patients with concurrent dehydration

Indirect Societal Costs

What are the broader economic impacts of dehydration. Beyond direct healthcare costs, dehydration can lead to:

• Lost productivity due to illness and absenteeism
• Increased caregiver burden, especially for elderly patients
• Potential long-term health consequences requiring ongoing medical care

By understanding these economic impacts, policymakers and healthcare providers can better appreciate the importance of dehydration prevention and management strategies.

Educating the Public: Raising Awareness About Dehydration

Public education plays a crucial role in preventing dehydration and promoting proper hydration habits. Effective awareness campaigns can help reduce the incidence of dehydration and its associated complications.

Key Messages for Public Education

What essential information should be included in dehydration awareness campaigns. Important points to emphasize include:

• Signs and symptoms of dehydration
• Importance of regular fluid intake
• Situations that increase the risk of dehydration (e.g., hot weather, illness)
• Proper hydration techniques for different activities and populations
• When to seek medical attention for dehydration

Effective Communication Strategies

How can healthcare providers and public health officials effectively convey information about dehydration. Successful approaches may include:

• Utilizing social media platforms to share hydration tips and information
• Developing easy-to-understand infographics and visual aids
• Partnering with community organizations to reach diverse populations
• Incorporating hydration education into school health curricula
• Providing targeted education for high-risk groups and their caregivers

By implementing comprehensive public education initiatives, we can empower individuals to take control of their hydration status and reduce the overall burden of dehydration on public health.

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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• 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]

5.

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]

6.

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]

7.

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 Signs, Symptoms, and Diagnosis 101

By Sheryl Huggins SalomonMedically Reviewed by Justin Laube, MD

Reviewed: December 3, 2018

Medically Reviewed

Fatigue, headache, and dizziness are possible symptoms of dehydration.Eva Bee/Getty Images

Water is necessary for human survival, and yet it is easy for anyone to fall behind on drinking enough. We can be depleted of body fluid by a challenging workout; hot weather; fever, vomiting, and diarrhea from an illness; and excessive urination due to a chronic illness, a medication, or too much alcohol.

The result is dehydration: the condition of losing more fluid and electrolytes than you are taking in, until you don’t have enough left for your body to function normally. (1) Knowing the signs and symptoms can help you to avoid being among the roughly half a million people who are hospitalized in the United States for dehydration each year. (2)

What Are the Early Warning Signs of Dehydration?

Alp Arkun, MD, the chief of service for emergency medicine at the Kaiser Permanente Fontana and Ontario Medical Centers in Southern California, routinely sees people who have lost enough fluid volume to merit a visit to the emergency room. But, he says, “most adults under the age of 50 have a pretty decent thirst drive. You get thirsty, you want a drink, your body corrects [its fluid balance] and life goes on.”

That thirst drive declines after age 50, putting older people at greater risk of becoming dehydrated than younger adults, Dr. Arkun says. Medications, chronic health conditions, dementia, and a decrease in fluid volume as we age can also increase the risk of dehydration in seniors. On the other end of the age spectrum, children are at higher risk for dehydration than adults because they more often have diarrhea, vomiting, and a high fever, and the youngest ones are unable to let you know they’re thirsty. (3)

Even in younger adults, the thirst drive doesn’t always push them to keep up with their fluid needs. Arkun says most will replenish with water or another beverage after experiencing one or more of these top three early warning signs:

• Fatigue
• Dizziness
• Headache

“If one of those three things happens, they usually slow down doing whatever they are doing,” and drink some water, he says.

Other symptoms of dehydration include:

In Adults  (1,3,4)

• Urinating less often than normal
• Dark-colored urine
• Feeling thirsty
• Muscle cramps
• Feeling tired or lethargic
• Fainting
• Confusion
• Dry, shriveled skin
• Constipation

In Children

When children become dehydrated, it can come on suddenly, says Arielle Levitan, MD, an internal medicine doctor at NorthShore Medical Group in Highland Park, Illinois, who owns the personalized vitamin company Vous Vitamin. “They get pretty lethargic and weak suddenly. You have to be watchful.” If you suspect dehydration in a child, one way you can tell is by pinching their skin, she adds. If it doesn’t snap back quickly, that is known as tenting, a telltale sign.

Other signs that an infant or child is dehydrated include: (3)

• Crying without tears
• Dry diaper after more than three hours
• Less urination that normal
• Dry mouth
• Sunken eyes and cheeks
• A sunken soft spot on top of skull
• Irritability

How Should Early Signs of Dehydration Be Handled?

You can usually correct dehydration on your own by noticing the three early signs that Arkun mentions. If overexertion or hot weather has brought on your symptoms, remove yourself immediately from the situation, advises Kevin Coupe, MD, an orthopedic surgeon with Memorial Hermann Ironman Sports Medicine Institute and UT Physicians in the Woodlands, Texas. “If you are at an athletic event and you are burning energy, rest. Sit down, get into the shade, and drink fluid.”

Any fluid is better than none, but Coupe suggests cool water. “You don’t want it [too] cold because it doesn’t get absorbed in your stomach as quickly. Cool water is the best. Commercially available rehydration drinks such as Gatorade or Powerade are okay for the salt intake, but you do have to be careful about how much glucose, or sugar, is in them.”

Salt is a compound containing sodium and chloride, two important electrolytes (minerals that have the ability to conduct electricity in the body). Along with potassium, calcium, and sodium bicarbonate, these electrolytes are necessary for the healthy functioning of cells and tissues, as well as maintaining the right level of fluid. Dehydration can throw off the balance of electrolytes in the body. (4)

Dehydration can elevate your blood glucose level as well. If you have uncontrolled or poorly controlled diabetes, your blood sugar may already be too high. Elevated blood sugar leads to increased excretion of sugar in the urine, which pulls water along with it, thereby dehydrating you even further. Taking in a sugary solution — even if it contains important electrolytes — can worsen the problem. (5)

When Is It Time to Seek Medical Attention for Dehydration?

The truth is, you can lose 3 to 4 percent of your body’s fluid volume without experiencing any symptoms, says Arkun. After that the signs become noticeable, and you enter what medical professionals call the three stages of dehydration.  (4)

Mild (5–6 Percent of Body Fluid Lost)

This is when you experience those three early warning signs Arkun described: fatigue, dizziness, and headache. You might have a dry mouth or you may have muscle cramps, brought on by an electrolyte imbalance. Drink plain water or a sports drink immediately.

More on Dehydration Causes

How Diarrhea May Cause Dehydration

Moderate (7–10 Percent)

At this stage the loss of fluid can lead to low blood pressure and severely decreased urination. You may have a faster-than-normal pulse, or dry skin that tents when you pinch it. A child who is in this stage should receive oral hydration and medical attention. Anyone who is dehydrated and vomiting, particularly for more than four to five hours, should go to the emergency room. (4,6)

Severe (Over 10 Percent)

This stage can be life-threatening, says Arkun. Someone who is severely dehydrated is prone to fainting and injury, and electrolyte abnormalities can induce seizures. It goes without saying that someone who’s severely dehydrated needs to go to the ER. There, doctors will replenish fluids intravenously with water and sodium chloride. Death is likely if fluid loss reaches 15 to 25 percent of the person’s total body weight, he says. But this level of dehydration is rare and usually only happens if someone is isolated for an extended period of time and can’t rehydrate themselves or get help.

Still, don’t let dehydration get even to the moderate stage. Heed symptoms such as a dry mouth or a headache, and drink water, says Brian Schulz, MD, an orthopedic surgeon and sports medicine specialist at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. “Certainly anytime that someone is feeling faint, not sweating in an area in which they should be sweating, not making urine, or [if] they experience any kind of mental status changes, that is a sign they are dehydrated. If the problem doesn’t correct itself after they take in fluids, then they should pursue medical attention.”

How Will Moderate or Severe Dehydration Be Diagnosed and Treated?

In many situations, medical attention comes from a sports team medic or an emergency responder. They may ask you about your symptoms and what led to them, do a physical examination, and check your blood pressure to see if it is low. You may also be checked for a racing heartbeat or your skin may be checked for tenting. Then they may move you to a shaded area and give you water or a sports drink or, perhaps, ice chips to suck on. (2)

If the problem is severe enough to warrant an ER visit, how you’re treated will depend on the way you come in, says Sanjey Gupta, MD, the chair of emergency medicine at Southside Hospital in Bay Shore, New York. If you enter on your own two feet, that may signal that your dehydration isn’t severe. “If this is a younger person that [is] maybe a little dehydrated just because they did not drink enough when they were out running or exercising then we may actually just have them drink a sports drink or another liquid, as long as they can swallow and are not nauseous.”

Regardless of severity, the first steps toward diagnosing dehydration involve taking vital signs and a medical history. Your healthcare team may also run lab tests for electrolyte abnormalities. “If it is advanced dehydration, sometimes you’ll see that someone’s heart rate is elevated,” says Dr. Gupta. “If it’s really bad, sometimes you’ll see that their blood pressure has decreased. That might determine if an IV fluid treatment is needed, rather than giving them something to drink.”

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Typically, intravenous treatment with a sodium chloride and water solution will restore a person’s fluid balance and they can return home within a few hours, Arkun says. A doctor may administer medication to control fluid-depleting symptoms such as nausea and diarrhea if there’s an underlying illness.

It’s easy to prevent dehydration. Dr. Levitan says that while looking for the signs of it are key, it’s even more important to get out ahead of it and drink enough fluid before you have any symptoms. Be aware of environmental conditions that will put you at risk, such as hot weather or dry indoor heating in the wintertime; medications and illnesses that are depleting you of fluid; or overexertion. “Be proactive. It is much better if you can think ahead and hydrate well in advance of exercising or doing something active. You’ll feel much worse if you get to that point of being dehydrated than if you just preemptively stay hydrated in the first place,” Levitan says.

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Editorial Sources and Fact-Checking

1. Dehydration. MedlinePlus. November 13, 2018.
2. Kim S. Preventable Hospitalizations of Dehydration: Implications of Inadequate Primary Health Care in the United States. Annals of Epidemiology. September 2007.
3. Dehydration. Mayo Clinic.
4. Dehydration. Gale Encyclopedia of Children’s Health: Infancy Through Adolescence. Encyclopedia.com. 2006.
5. M Hamaty. How to Manage Your Diabetes in Extreme Summer Heat. Cleveland Clinic. May 29, 2015.
6. Do You Know When to Visit the Hospital for Vomiting? Cleveland Clinic. July 14, 2014.

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Signs and symptoms of dehydration

When the body’s water levels drop to critical levels, dehydration occurs. This pathological condition is fraught with serious consequences. It occurs against the background of insufficient fluid intake, and is aggravated by various chronic and acute diseases. The first alarming symptoms that are important to pay attention to in a timely manner are weakness, lack of concentration, fatigue, malaise, and a feeling of intense thirst.

When the body loses more than 10% of the total amount of water, people show signs of a violation of the normal functioning of internal organs and systems. A loss of 20% is highly likely to end in death. To protect yourself and loved ones, you should read the recommendations in this review, which will help you recognize and prevent dehydration.

The body signals in advance about the need to “replenish stocks” with purified artesian water. You don’t have to wait until you’re thirsty to pour yourself a glass from a pump bottle. The risk of dehydration can also be judged by other characteristic signs:

• • dry mucous membranes;
• • drowsiness;
• • headache;
• • swollen tongue;
• • little saliva;
• • pale skin;
• • difficulty swallowing food.

Also symptoms are irritability, rapid pulse, constipation, confusion.

Causes of dehydration

A pathological condition develops under the influence of internal and external factors. Among them:

1. Uncontrolled use of diuretics, which doctors prescribe to patients with arterial hypertension, leads to serious problems. These drugs are abused by women seeking to reduce body weight. As a result, there is a loss of electrolytes and fluid, and the load on the heart muscle increases.
2. Diarrhea and vomiting are accompanied by dehydration, so it is important to perform oral rehydration using saline solutions prepared in strict accordance with the instructions of the attending physician.
3. Heatstroke after careless sunbathing may be accompanied by convulsions, therefore, in addition to eliminating the cause, supportive therapy should be started urgently.

In addition, dehydration appears with a hangover syndrome, in conditions of constant life stress at home and at work. It can be caused by climate change, poor diet and unbalanced diets, burns. With pyelonephritis, cholecystitis, colitis, fever, bulimia, kidney stones and diabetes, dehydration occurs.

Risk groups

Individuals at risk should be especially attentive to their own health and well-being. These are pregnant and lactating women, people with diagnosed metabolic disorders and hormonal disruptions, small children and pensioners. More liquid is required for professional athletes who are engaged in grueling workouts, as well as for workers working in hot shops, under the scorching rays of the sun, in catering kitchens, etc.

Dehydration: symptoms in adults

01/04/2023

What is dehydration?

Dehydration is a condition in which the body’s water content is too low. As a result, important life processes cannot occur. It is worth remembering that water makes up to 60-70% of the body weight of an adult (in newborns – up to 75%, and in the elderly – only 46-54%). Dehydration is dangerous to health and life. If it is not treated with , it will lead to serious consequences – even death.

There are 3 types of dehydration:

• hypotonic,
• hypertonic,
• isotonic.

Once the type of dehydration is recognized, the appropriate therapy can be applied .

Causes of dehydration

There can be several reasons for dehydration. One of them is insufficient water supply. This condition threatens people who have:

• vomiting or diarrhea ,
• fever,
• excessive sweating,
• hemorrhage,
• hyperventilation (excessive loss of water through the lungs ),
• simple uremia (a disease characterized by the excretion of large amounts of urine ),
• engage in intense physical training or work,
• use diuretics.

Dehydration can result from not drinking enough fluids. Speech is about hypotonic drinks that have a low concentration of electrolytes. It is important to remember that in hot weather and during physical exertion, the need for water increases. In such a situation, even the standard 2 liters of water per day is insufficient and creates a risk of dehydration.

Symptoms of dehydration

Dehydration can be recognized by symptoms. It is worth remembering that at first this happens without any discomfort. They appear only over time, when the loss of water in the body increases. Symptoms of dehydration with a loss of about 2% of water include an intense feeling of thirst and dryness at mouth . If no action is taken at this stage, the disorder progresses and additional complaints appear. These include:

• headache
• dizziness
• weakness
• lack of sweat
• fever,
• painful muscle spasms,
• loss of skin elasticity and dryness of mucous membranes,
• lack of energy and exercise intolerance,
• nausea ,
• heart problems ,
• vision problems ,
• excessive sleepiness,
• syncope,
• impaired consciousness,
• convulsions,
• loss of consciousness.

Symptoms of dehydration in infants and young children are somewhat different. Parents may notice that the child is irritable, has a dry tongue, loose skin, and a sunken fontanel. Alarming signs are the absence of urination for 3 hours and tears when crying. The baby is lethargic, weak and sleepy. With severe dehydration, loss of consciousness occurs.

Treatment of dehydration

Treatment of dehydration involves the administration of sufficient fluids. If the patient’s condition allows, oral rehydration is indicated. It is recommended to use not only water for this purpose, but also electrolytes and preparations containing the necessary elements (including sodium and potassium). They can be purchased at a pharmacy. It is also necessary to recognize and eliminate the cause of dehydration. Patients with severe dehydration need inpatient treatment. They are then given intravenous fluids. Thus, you can balance the water-electrolyte balance.