Download Dehydration / Over-hydration. Learning Objectives: Dehydration

Dehydration / Over-hydration.
Learning Objectives:
By the completion of lecture, the student should be able to:
• Define Dehydration?
• How do we classify dehydration?
• What treatment plan should be taken in mild, moderate and severe
dehydration?
• How do we describe rehydration?
• What is the Composition of ORS.
• What other Intravenous solutions can be used as volume expanders.
Dehydration
Definition:
Dehydration is the loss of water and
salts essential for normal body function.
• Human body needs water to maintain enough blood and other fluids to function
properly.
• Body also needs electrolytes, which are salts
normally found in blood, other fluids, and cells.
Body may lose fluids in a variety of ways:
• when urinating
• when you vomit or have diarrhoea
• when sweating
• from the lungs during normal breathing.
• usual causes of dehydration are a lot of
diarrhoea and vomiting.
Types of dehydration
• Mild dehydration :
loss of no more than 5% of the body's fluid.
• Loss of 5-10% is considered moderate
dehydration.
• Severe dehydration (loss of 10-15% of body fluids)
is a life-threatening condition.
Symptoms of early or mild dehydration
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Flushed face
Extreme thirst, more than normal or unable to drink
Dry, warm skin
Cannot pass urine or reduced amounts, dark, yellow
Dizziness made worse when you are standing
Weakness
Cramping in the arms and legs
Crying with few or no tears
Sleepy or irritable
Unwell
Headaches
Dry mouth, dry tongue; with thick
saliva.
Symptoms of moderate to severe dehydration
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low blood pressure
fainting
severe muscle contractions in the arms, legs, stomach, and back
convulsions
a bloated stomach
heart failure
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sunken fontanelle - soft spot on a infants head
sunken dry eyes, with few or no tears
skin loses its firmness and looks wrinkled
lack of elasticity of the skin (when a bit of skin lifted up stays folded and
takes a long time to go back to its normal position)
rapid and deep breathing - faster than normal
fast, weak pulse
In severe dehydration:
• These effects become more pronounced.
• Patient may develop evidence of hypovolaemic
shock, including:
– diminished consciousness,
– lack of urine output,
– cool moist extremities,
– a rapid and feeble pulse
(the radial pulse may be undetectable),
– low or undetectable blood pressure,
– and peripheral cyanosis.
– Death follows soon if rehydration is not started quickly.
Home drinks to prevent dehydration
• Mothers can use household liquids.
• preferably rice water or carrot soup.
• Ideally these drinks should contain starches and/or sugars as a source of glucose
and energy, some sodium and preferably some potassium.
• A simple salt/sugar solution is also suitable for early oral rehydration therapy.
• 1 level teaspoon (5 ml) of salt should be mixed with 8 level teaspoons of sugar in a
litre of drinking water.
• Do not use too much salt.
• too much salt can, in extreme cases, cause convulsions.
Rehydration:
• Replenishment of water and electrolytes
lost through dehydration.
• Can be performed by mouth (oral
rehydration) or by adding fluid and
electrolytes directly into the blood stream
(intravenous rehydration).
Over Hydration
Definition:
• A condition in which the body contains too
much water.
• Also called water excess or water intoxication,
• Overhydration occurs when the body takes in more
water than it excretes and its normal sodium level is
diluted.
• Results in digestive problems, behavioral changes,
brain damage, seizures, or coma.
• Most common in patients whose kidney function is
impaired and may occur when doctors, nurses, or other
healthcare professionals administer greater amounts of
water-producing fluids and medications than the
patient's body can excrete.
• Overhydration is the most common electrolyte
imbalance in hospitals, occurring in about 2% of all
patients.
Causes and symptoms
• The patient may become confused, drowsy, or inattentive.
• Shouting and delirium are common.
• blurred vision, muscle cramps and twitching, paralysis on one side of the body, poor
coordination, nausea and vomiting, rapid breathing, sudden weight gain, and
weakness.
• The patient's complexion is normal or flushed.
• Blood pressure is sometimes higher than normal, but elevations may not be noticed
even when the degree of water intoxication is serious.
• Overhydration can cause acidosis, anemia, cyanosis (a condition that occurs when
oxygen levels in the blood drop sharply), hemorrhage, and shock.
Diagnosis
• Overhydration is characterized by excess water both within and around the body's
cells,
• While excess blood volume occurs when the body has too much sodium and can not
move water to reservoirs within the cells.
• In cases of overhydration, symptoms of fluid accumulation do not usually occur.
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In cases of excess blood volume, fluid tends to accumulate around cells in the lower
legs, abdomen, and chest.
• Overhydration can occur alone or in conjunction with excess blood volume, and
differentiating between these two conditions may be difficult.
Treatment
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Mild overhydration can be corrected by limiting fluid intake.
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In more serious cases, diuretics may be prescribed to increase urination, although these drugs
tend to be most effective in the treatment of excess blood volume.
Identifying and treating any underlying condition (such as impaired heart or kidney function) is
a priority, and fluid restrictions are a critical component of every treatment plan.
In patients with severe neurologic symptoms:
– A powerful diuretic and fluids to restore normal sodium concentrations are administered
rapidly at first.
– When the patient has absorbed 50% of the therapeutic substances, blood levels are
measured.
– Therapy is continued at a more moderate pace in order to prevent brain damage as a result
of sudden changes in blood chemistry.
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ORS Solution
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A special drink for diarrhoea
• ORS (oral rehydration salts) is a special
combination of dry salts that is mixed with safe
water. It can help replace the fluids lost due to
diarrhoea.
When should ORS be used?
• When a child has three or more loose stools in a
day, begin to give ORS.
How is the ORS drink prepared?
• Put the contents of the ORS packet in a clean container. Check the
packet for directions and add the correct amount of clean water. Too little
water could make the diarrhoea worse.
• Add water only. Do not add ORS to milk, soup, fruit juice or soft drinks.
Do not add sugar.
• Stir well, and feed it to the child from a clean cup. Do not use a bottle.
How much ORS drink to give?
• Encourage the child to drink as much as possible.
• A child under the age of 2 years needs at least 1/4 to 1/2 of a large (250millilitre) cup of the ORS drink after each watery stool.
• A child aged 2 years or older needs at least 1/2 to 1 whole large (250millilitre) cup of the ORS drink after each watery stool.
What if ORS is not available?
• Give the child a drink made with 6 level teaspoons of sugar and 1/2 level
teaspoon of salt dissolved in 1 litre of clean water.
• Be very careful to mix the correct amounts. Too much sugar can make
the diarrhoea worse. Too much salt can be extremely harmful to the
child.
• Making the mixture a little too diluted (with more than 1 litre of clean
water) is not harmful.
New formulation of Oral Rehydration Salts
(ORS) with reduced osmolarity
Reduced
grams/litre
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osmolarity ORS
Reduced
mmol/litre
osmolarity ORS
Sodium chloride
2.6
Sodium
75
Glucose,
anhydrous
13.5
Chloride
65
Potassium
chloride
1.5
Glucose,
anhydrous
75
Trisodium
2.9
citrate, dihydrate
Potassium
20
Citrate
10
Total Osmolarity 245
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Other Available solutions for Intra venous infusions(Dextrose
water5%, 10 %, 25%, Ringer lactate, Normal saline, amino acids
solutions, Hemaxcel.
• Intravenous therapy may be used to correct electrolyte
imbalances, to deliver medications, for blood transfusion or as
fluid replacement to correct, for example, dehydration.
• Compared with other routes of administration, the intravenous
route is the fastest way to deliver fluids and medications
throughout the body.
Ringer's lactate solution
• A standardized sterile physiologic–ie, isotonic–
0.9% solution containing calcium chloride, KCl,
NaCl, sodium lactate; it is used as a topical
irrigant and as a crystalloid solution for
restoring fluid volumes.
Normal Saline Solution
Other Names
• 0.9% Sodium Chloride Solution.
Action
• Normal Saline is a sterile, nonpyrogenic solution for fluid and electrolyte
replenishment.
• contains no antimicrobial agents.
• It contains 9 g/L Sodium Chloride with an osmolarity of 308 mOsmol/L.
Indications
•source of water and electrolytes.
Amino acid solution for parenteral nutrition:
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Well balanced supply of essential and non-essential amino acids
Rapid improvement of nitrogen balance
High flexibility due to different concentrations
Characteristics
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Provides essential and non-essential amino acids
5%; 10%; 12.5% and 15% versions
With and without electrolytes.
HAEMACCEL
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sterile, pyrogen-free and does not contain any preservatives.
when given intravenously, adapts itself to the blood volume situation.
INDICATIONS:
Volume-deficiency shock
Loss of blood
Loss of plasma
Exsiccosis
Volume losses during and after surgery.
Also in conjunction with a heart-lung machine, and during
haemodialysis.