Approach to Dehydrated Patient

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It refers to the loss of body water, with or without salt at a rate greater than the body can replace it.  The  cause  of  dehydration  is  a  combination  of  physiological  and  disease  processes.  Persons  at greatest risk for dehydration include persons with diarrhoea, vomiting, fever, diabetes or infections, impaired level status.  

Table 1.3: Types of Dehydration 

  Mild Moderate Severe
Consciousness is normal May be irritable but is conscious Unconscious
Skin pinched up Becomes normal immediately Takes two seconds for folds to disappear Remain in folds for over 2s
Eyes Moist and tears are present Sunken, tears and/or absent Sunken and tearless
Mouth Not dry Is dry Is dry
Urine Output Decreased Oliguria Oliguria/anuria
Fontanel Normal Depressed Sunken
Blood Pressure Normal Normal but orthostasis Decreased
Capillary Refill 2s 2-4s More than 4s

Investigations 

  • Blood chemistry (to check electrolytes, especially sodium, potassium, and bicarbonate levels) 
  • Blood urea nitrogen (BUN) and creatinine
  • Bedside USS-IVC
  • Complete blood count
  • Urine specific gravity
  • Blodd Gas analysis
  • Lactate

Other tests may be done to determine the cause of the dehydration (for example, blood sugar level  to check for diabetes). 

Non-pharmacological Treatment 

  • Perform both primary and secondary assessment and provide the necessary interventions.
  • Give oxygen if hypoxic or increased work of breathing
  • Put TWO large bore IV cannulas for fluid resuscitations

The  treatment  for  minor  dehydration  often  considered  the  most  effective,  is  drinking  water  and  stopping fluid loss. 

Pharmacological Treatment 

In  more  severe  cases,  correction  of  a  dehydrated  state  is  accomplished  by  the  replenishment  of  necessary water and electrolytes. 

A: oral rehydration salt (ORS) 

OR 

A: 0.9% sodium chloride (IV): Adult 1-2litres; Paediatrics 20mls/kg) 

OR 

A:compound sodium lactate (IV): Adult 1-2litres; Paediatrics 20ml/kg 

Remember to do reassessment after fluids resuscitations. If there is no electrolyte loss; give 

A: dextrose (IV) 5% 

If the underlying disease condition is diagnosed; treat as per specific condition in guidelines.  Referral: Refer to high center with expertise if no improvement. 

Note: Dehydration in Children refer to Plan A,B and C in IMCI guideline