Dehydration

1 - DEFINITION
Dehydration is loss of water and important blood salts like potassium (K+) and sodium (Na+).
Dehydration means that the body does not have enough fluids to function at an optimal level.
Dehydration can be caused by :
1. fluid loss (through vomiting, diarrhea, excessive urination or excessive sweating),
2. inadequate intake,
3. or a combination of both.

Dehydration is classified as mild, moderate, or severe based on the percentage of body

weight lost during the acute illness: Depending on age,
• Mild dehydration -- a loss of 3-5% of body weight
• Moderate dehydration -- a loss of 6-9% of body weight
• Severe dehydration -- a loss of more than 10-15% of body weight. This is a life-
threatening emergency!

Vital organs like the kidneys, brain, and heart can’t function without a certain minimum of
water and salt.

In underdeveloped countries, dehydration from diseases like cholera and dysentery kills
millions every year (usually infants and children).

2 - SYMPTOMS
• excessive loss of fluid through vomiting, urinating, stools or sweating
• poor intake of fluids, "can't keep anything down"
• decreased or absent urine output (oliguria or anuria)
• with severe dehydration -- lethargic or comatose

Below are some additional warning signs :

Signs of Dehydration
Mild Moderate Severe
Thirst Very dry mouth membranes All signs of moderate dehydration
Dry lips Sunken eyes Rapid, weak pulse (more than 100 at
Slightly dry mouth membranes Skin doesn’t bounce back rest).
quickly when lightly pinched and Cold hands and feet
released. Rapid breathing
Blue lips
Confusion, lethargy, difficult to arouse

2.1 - PHYSICAL EXAMINATION

A physical examination may also show signs of:
• low blood pressure(hypotension)
• rapid heart rate(tachycardia)
• blood chemistries (to check electrolytes, especially sodium, potassium, and
bicarbonate levels)
• urine specific gravity (a high specific gravity indicates significant dehydration)
• BUN (blood urea nitrogen -- may be elevated with dehydration)
 • creatinine (creatinine -- may be elevated with dehydration)
• Complete Blood Count (CBC) to look for signs of concentrated blood
(hemoconcentration)
• Other tests may be done to determine the specific cause of the dehydration (for
example, a blood sugar to check for diabetes).

3 - TREATMENT
When dehydration is recognized and treated promptly, the outcome is generally good.

3.1 - Mild dehydration :

Drinking fluids is often sufficient for mild dehydration
Mild dehydration is safe to self-treat at all ages, as long as it doesn’t worsen.
To treat dehydration, you must first address the cause: fever, Vomiting, Diarrhea, and Heat
Exhaustion are the most common reasons for dehydration. While you’re treating the
underlying problem, begin small amounts of oral re-hydrating solution (ORS).
Commercial ORS replaces important blood salts and water in balanced amounts designed
especially for dehydration in sick people They are formulated to allow your intestines to
absorb maximum amounts of water along with small amounts of salts. Don’t confuse ORS
with sports drinks designed for concentrated energy and salt replacement in healthy, high-
performance athletes. These drinks can actually aggravate vomiting and diarrhea and are
so concentrated they can limit intestinal water absorption.
Once signs of dehydration have disappeared, ORS is no longer necessary, but a clear
liquid diet might still be useful if vomiting or diarrhea persists.
3.2 - Moderate dehydration
In teenagers and adults with, careful home treatment can be safe, but phone contact with a
physician is advisable.
3.3 - Severe dehydration :
If you’re severely dehydrated, you must get to a hospital right away.
Intravenous fluids and hospitalization may be necessary for moderate to severe
dehydration. The health care provider must also determine and, if possible, treat the cause
of the dehydration.

4 - Complications
Untreated severe dehydration may result in seizures, permanent brain damage, or death.
Severe dehydration decreases blood volume and causes the blood to clot more readily. A
renal vein thrombosis may occur.
When the blood clot in the renal vein is moving into in the heart or the lungs, it can cause
serious complications as a pulmonary embolism. Death can be a consequence if it is not
cured in time.
Most cases of renal vein thrombosis resolve without any permanent damage.

5 - PREVENTION

The real key to preventing dehydration is to stay ahead of the game. Drink a minimum of two
liters of water or juice each day. By very hot weather, this quantity can reach 5 liters. The drinks
should be spaced out over the course of the day rather than consumed in a short period of time.
Again, avoid caffeinated beverages.

6 – OTHER EXAMPLES OF DEHYDRATION

6.1 - Dehydration and Divers
When a person is dehydrated, there is a reduced volume of blood in the body. Less volume
means less blood flow to the tissues. This in turn affects the body's ability to wash out
waste, such as nitrogen. The result is that a diver surfaces without having off-gassed as
efficiently as he would have if he had been well hydrated. The increased nitrogen
remaining in the body translates into a higher risk of DCS.

Blood flow to certain tissues is further compromised during dehydration by the body's own
means of compensating for a low blood volume. To guarantee an adequate supply of blood
to vital organs like the brain and kidneys, the body signals blood vessels supplying other
parts, like skin and muscles, to clamp down, restricting flow even more.

In addition to the increased risk of DCS, dehydration can adversely affect divers in other
ways. Since there is a reduced volume of blood circulating through the body, the heart has
to work harder and pump faster in order to meet the body's demand. This leads to
decreased endurance and increased fatigue, which diminishes diving performance. Clearly,
it's important to be aware of those factors that can lead to dehydration.
When we are above water, the greatest force upon our bodies is gravity. When we are
sitting or standing, the force of gravity causes blood to collect or pool in the legs. When we
enter the water, the most significant force acting upon the body is the atmospheric
pressure of the water, which serves to force the pooled blood out of the legs and into the
body's general circulation. Another response of the body upon entering the water is to
clamp down the blood vessels to the skin in order to minimize heat loss. This also serves to
push more blood to the center of the body.
Your body perceives this increased blood flow as a volume overload, and signals the
kidneys to make more urine to correct it. The result is that all too familiar urge.

It is important to mention that the increase in circulating blood does not offset the effects of
dehydration. There is still less blood flowing through your body than there would be if you
were well hydrated.

6.1 - Dehydration and Travellers

(by Russell Eaton)
www.airtravelsurvival.com
Avoiding Blood Clots When You Travel
Many travel experts say that DVT (Deep Vein Thrombosis) is not specifically linked to flying
and can occur anywhere people are immobile for lengthy periods. This is indeed an
argument often used by the airline industry, and is a myth that is even held by many
doctors. As explained in my book 'Air Travel Survival' (www.airtravelsurvival.com) there is a
wide-held misconception that a long journey on a bus, car or train is no different to a long
journey on a plane if the seating is equally cramped. This is not so. In the context of blood
clots, air travel is fundamentally different to any other kind of travel because of dehydration.
Air travel dehydration (i.e. insufficient water in the body) is caused by not drinking sufficient
water during the journey, by drinking alcohol, tea and coffee instead of water, and by
super-dry cabin air.
So unlike a bus, car or train journey, when you travel by air you are much more likely to
suffer dehydration, and this in turn increases the danger of blood clots. This is so for four
reasons:
 1) - BLOOD THICKENING. Dehydration makes the blood thicker and heavier from lack of
water, and therefore more likely to settle in the legs instead of circulating freely around the
body. The thicker blood allows a blood clot to form and grow more quickly.
2) - VEIN CONSTRICTION. Dehydration dries the skin and constricts the surface veins.
This slows down the blood circulation, also making your blood thicker, thus increasing the
likelihood of a blood clot.

RESOURCES:
"Vascular Diseases of Acute Onset: Renal Vein Thrombosis." In The Merck Manual of Diagnosis
and Therapy. 16th ed. Ed. Robert Berkow. Rahway, NJ: Merck Research Laboratories, 1992.

CAUTION :
The information provided herein should not be used during any medical emergency or for the
diagnosis or treatment of any medical condition. A licensed physician should be consulted for
diagnosis and treatment of any and all medical conditions.