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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 • • • • • • • • • • • • 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 • • • • • • low blood pressure fainting severe muscle contractions in the arms, legs, stomach, and back convulsions a bloated stomach heart failure • • • • • • 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. • 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 • Mild overhydration can be corrected by limiting fluid intake. • 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. • • ORS Solution • 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 • 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 • 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: • • • Well balanced supply of essential and non-essential amino acids Rapid improvement of nitrogen balance High flexibility due to different concentrations Characteristics • • • Provides essential and non-essential amino acids 5%; 10%; 12.5% and 15% versions With and without electrolytes. HAEMACCEL • • 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.