Dehydration occurs when the body loses more fluid than it takes in, disrupting mineral balances and body functions. Common causes are diarrhea, vomiting, fever, excessive sweating, and increased urination. Symptoms range from mild thirst to severe life-threatening complications due to electrolyte and fluid imbalance. Treatment focuses on oral or intravenous fluid replacement depending on severity. Proper hydration is important to prevent dehydration.
Dehydration occurs when the body loses more fluid than it takes in, disrupting mineral balances and body functions. Common causes are diarrhea, vomiting, fever, excessive sweating, and increased urination. Symptoms range from mild thirst to severe life-threatening complications due to electrolyte and fluid imbalance. Treatment focuses on oral or intravenous fluid replacement depending on severity. Proper hydration is important to prevent dehydration.
Dehydration occurs when the body loses more fluid than it takes in, disrupting mineral balances and body functions. Common causes are diarrhea, vomiting, fever, excessive sweating, and increased urination. Symptoms range from mild thirst to severe life-threatening complications due to electrolyte and fluid imbalance. Treatment focuses on oral or intravenous fluid replacement depending on severity. Proper hydration is important to prevent dehydration.
Dehydration occurs when the body loses more fluid than it takes in, disrupting mineral balances and body functions. Common causes are diarrhea, vomiting, fever, excessive sweating, and increased urination. Symptoms range from mild thirst to severe life-threatening complications due to electrolyte and fluid imbalance. Treatment focuses on oral or intravenous fluid replacement depending on severity. Proper hydration is important to prevent dehydration.
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Dehydration
Under supervision of
Dr: Mohamed Amer
Prepared by:
ايمان محمود السيد بالل •
إيناس قدري علي محمد •
ايه احمد قبيصي عباس •
ايه السيد ابراهيم عبد النعيم •
ايه السيد محمد السيد •
ايه السيد محمد جاد الكريم •
ايه ثروت محمد حسانين •
ايه جابر محمود عليوة •
ايه جاد محمد خليفة •
ايه رزق عبد الاله السيد •
Outlines:
• Introduction of Dehydration
• Definition of Dehydration
• Pathophysiology of Dehydration
• Types of Dehydration
• Causes of Dehydration
• Risk factors
• Diagnosis of Dehydration
• Signs & Symptoms of Dehydration
• Complications of Dehydration
• Treatment of Dehydration
• Nursing consideration
• Nursing care plan of Dehydration
• Prevention of Dehydration Dehydration
Introduction
Dehydration occurs when your body loses more fluid than you take in. When the normal water content of your body is reduced, it upsets the balance of minerals (salts and sugar) in your body, which affects the way it functions. Water makes up over two-thirds of the healthy human body. It lubricates the joints and eyes, aids digestion, flushes out waste and toxins, and keeps the skin healthy. Some of the early warning signs of dehydration include feeling thirsty and lightheaded, dry mouth, tiredness, having dark colored strong smelling urine, passing urine less often than usual. babies and infants‐ they have a low body weight and are sensitive to even small amounts of fluid loss.
Definition
The World Health Organization defines dehydration as a condition that results
from excessive loss of body water. The most common causes of dehydration in children are vomiting and diarrhea.
Pathophysiology
Dehydration causes a decrease in total body water in both the intracellular and extracellular fluid volumes. Volume depletion closely correlates with the signs and symptoms of dehydration. The total body water (TBW) in humans is distributed in two major compartments. 2/3rd the of TBW is in the intracellular compartment and the other 1/3rd is distributed between interstitial space (75%) and plasma (25%). The total body water is higher in infants and children as compared to the adults. In infants, it is 70% of the total weight, whereas it is 65% and 60% respectively in children and adults. As indicated earlier dehydration is total water depletion with respect to the sodium and volume depletion is the decrease in the circulation volume. Volume depletion is seen in acute blood loss and burns, whereas distributive volume depletion is seen in sepsis and anaphylaxis. In much of the literature, the distinction between dehydration and volume depletion is a blur.
Metabolic acidosis is seen in infants and children with dehydration, the
pathophysiology of which is multifactorial.
1. Excess bicarbonate loss in the diarrhea stool or in the Urine is certain types of renal tubular acidosis
2. Ketosis secondary to the glycogen depletion seen in starvation which sets in
infants and children much earlier when compared to adults.
3. Lactic acid production secondary to poor tissue perfusion
4. Hydrogen ion retention by the kidney from decreased renal perfusion and decreased glomerular filtration rate.
In children with pyloric stenosis have a very unique electrolyte abnormalities
from the excessive emesis of gastric contents. This is seen mostly in the older children. They lose chloride, sodium, potassium in addition to volume resulting in hypo-chloremic, hypokalemic metabolic alkalosis. Kidney excretes base in the form of Hco3 ion to maintain acid-base balance of loss of Hydrogen ion in the emesis in the form of hydrogen chloride. It is interesting to note that kidney also excretes hydrogen ion to save sodium and water, which could be the reason for aciduria.
Recently published article has shown that many children with pyloric stenosis may not have metabolic alkalosis. Types of Dehydration
> 145 mEq/L) indicates excessive free water loss. For example, a child who is on gavage feeding with a fixed daily fluid intake and develops excessive fluid loss from tachypnea or fever will gradually develop hypernatremia. Hypernatremia is also seen in a small proportion of children with gastroenteritis and dehydration, presumably from excessive loss of water in relation to solute.
3. Iso-natremic: Equal loss of water and electrolytes sodium 135_154 ml.
Types of dehydration based on severity
4. Mild When the total fluid loss reaches 5% or less .
5. Moderate When the total fluid loss reaches 5_10% .
6. Severe When the total fluid loss reaches more than 10%, considered an emergency case.
Causes of Dehydration:
1. Diarrhea, vomiting: Severe, acute diarrhea that is, diarrhea that comes on suddenly and violently can cause a tremendous loss of water and electrolytes in a short amount of time. If you have vomiting along with diarrhea, you lose even more fluids and minerals.
2. Fever: In general, the higher your fever, the more dehydrated you may become. The problem worsens if you have a fever in addition to diarrhea and vomiting.
3. Excessive sweating:You lose water when you sweat. If you do vigorous
activity and don't replace fluids as you go along, you can become dehydrated. Hot, humid weather increases the amount you sweat and the amount of fluid you lose.
4. Increased urination: This may be due to undiagnosed or uncontrolled
diabetes. Certain medications, such as diuretics and some blood pressure medications, also can lead to dehydration, generally because they cause you to urinate more. Risk Factors
Anyone can become dehydrated, but certain people are at greater risk:
1. Infants and children: The most likely group to experience severe diarrhea and vomiting, infants and children are especially vulnerable to dehydration. Having a higher surface area to volume area, they also lose a higher proportion of their fluids from a high fever or burns. Young children often can't tell you that they're thirsty, nor can they get a drink for themselves.
2. Older adults: As you age, your body's fluid reserve becomes smaller, your ability to conserve water is reduced and your thirst sense becomes less acute. These problems are compounded by chronic illnesses such as diabetes and dementia, and by the use of certain medications. Older adults also may have mobility problems that limit their ability to obtain water for themselves.
3. People with chronic illnesses Having uncontrolled or untreated diabetes
puts you at high risk of dehydration. Kidney disease also increases your risk, as do medications that increase urination. Even having a cold or sore throat makes you more susceptible to dehydration because you're less likely to feel like eating or drinking when you're sick.
4. People who work or exercise outside: When it's hot and humid, your risk of dehydration and heat illness increases. That's because when the air is humid, sweat can't evaporate and cool you as quickly as it normally does, and this can lead to an increased body temperature and the need for more fluids. Diagnosis of Dehydration
1. Blood tests: Blood samples may be used to check for a number of factors, such as the levels of your electrolytes especially sodium and potassium and how well your kidneys are working (BUN & creatinine).
2. Urinalysis: Tests done on your urine can help show whether you're dehydrated and to what degree. They also can check for signs of a bladder infection.
Signs and Symptoms
1. Mild dehydration S&S
No dehydration
Thirsty
Conscious
Less than 5% of body Weight is lost.
2. Moderate dehydration S&S
Dry skin and mucous membranes
Thirst
Decreased urine output
Crying baby with tears
Muscle weakness
Drowsiness
Light headache Sunken fontanels
Decreased BP
Increased Pulse rate (tachycardia)
5 to10 % of body Weight is lost
Capillary refill
Shallow rapid RR
3. Severe dehydration S&S
Extreme thirst
Very dry mouth, skin and mucous membranes
Sunken eyes
Sunken fontanels
No tears
Anuria
Dry skin that lacks elasticity and slowly “bounces back” when pinched into a fold
Rapid heartbeat
Rapid and shallow breath
Unconsciousness
More than 10 % of body Weight is loss
Delay Capillary refill for more than 2 seconds
Complications
1. Heat injury: If you don't drink enough fluids when you're exercising vigorously and perspiring heavily, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion or potentially life-threatening heatstroke.
2. Urinary and kidney problems: Prolonged or repeated bouts of dehydration
can cause urinary tract infections, kidney stones and even kidney failure.
3. Seizures: Electrolytes — such as potassium and sodium — help carry
electrical signals from cell to cell. If your electrolytes are out of balance, the normal electrical messages can become mixed up, which can lead to involuntary muscle contractions and sometimes to a loss of consciousness.
4. Low blood volume shock (hypovolemic shock): This is one of the most serious, and sometimes life-threatening, complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body.
5. Swelling of the brain (cerebral edema): Sometimes, when you're getting
fluids again after being dehydrated, the body tries to pull too much water back into your cells. This can cause some cells to swell and rupture. The consequences are especially grave when brain cells are affected.
6. Coma and death: When not treated promptly and appropriately, severe dehydration can be fatal. Treatment
Treatment Plan A Plan B Plan C
For No signs of For some signs For severe dehydration
dehydration of dehydration dehydration
Where given? Treated at home Outpatient, In hospital
rehydration center
1.Fluid therapy More fluids than usual - Give ORS Give I.V. Fluids (rice water, soup, cereal What type? water, fresh fruit juice, pansol herbal tea), ORS, breast polyelectrolyte milk, plain clean water Ringer‘s lactate
Normal saline
How much? Give after each loose 75 ml /kg given -100ml/kg, in 3-6hr stool: in 1st 30ml/kg: in ½-1 hr child<2y: 50-100 4-6 hr Next70ml/kg:in2.5-5hr ml *longer time for inf <1y child<2y:100- 200ml
How given? Slowly (1spoon/1- slow(1sp/1-2m Intravenous in
2min) cup,sp,dropper/ syring, or NGT peripheral vein By: Cup, spoon, dropper ,syringe (without needle) 2. Feeding Breast feeding: never be stopped even during initial rehydration. Milk or formula: give the usual formula (after rehydration) Soft& semisolid food usually in infant>4mon (after rehydration) e.g. yoghurt, mashed potatoes, cereals, vegetable soup& beans. Avoid hyperosmolar (too sweet food) or with high fiber content 3.Further Advise mother to back if: Re-assess patient‘s assessment & - Baby develops fever condition: IF recommendations -Unable to drink or breastfeed -No signs of dehyd-→shift -Be sicker/no improvement to plan A -Some -Repeated vomiting -↑ thirst dehydration →shift to plan B -Severe dehydration →Repeat plan C Daily Maintenance Fluid Requirements
• Calculate child’s weight in kg.
• Allow 100 ml/kg for first 10 kg body weight.
• Allow 50 ml/kg for second 10 kg body weight.
• Allow 20 ml/kg for remaining body weight.
Nursing consideration
1. Assess vital signs, noting peripheral pulses.
2. Monitor blood pressure.
3. Monitor intake and output.
4. Observe the physical properties of the urine.
5. Correctly infuse the right amount of IVF in case of severe dehydration .
6. Encourage small, frequent feedings.
7. Provide skin care.
8. Administer medications as prescribed.
Nursing care plan
Nursing diagnosis: Deficient fluid volume may be related to active fluid loss due to (hemorrhage, vomiting, diarrhea, burns, wounds) .
Nursing intervention:
1. Assist with identification and treatment of underlying cause.
2. Encourage fluid intake.
3. Monitor intake and output.
4. Give IV fluid as ordered if needed.
5. Provide skin care .
6. Turn frequently, gently massage skin, and protect bony prominences.
7. Encourage fluid intake.
8. Advice to use skin moisturizers .
Prevention
1. Respond to Thirst When the Feeling Strikes
2. Assess the Inside of Your Mouth for Dehydration Symptoms
3. Ignore the Popular Rule to Drink 8 Glasses of Water a Day (It’s Not Enough)
4. Increase Your Water Intake When Exercising
5. Bring in Extra Electrolytes When Needed
6. Drink More Water When You are Sick or in Hot Weather
7. Think Beyond Plain Water to Help Stave Off Dehydration
