Table Of Contents:
Causes, Incidence, & Risk Factors
Signs & Tests
Calling Your Health Care Provider
Dehydration is loss of or lack of adequate body fluids, such as water and important blood salts like potassium (K+) and sodium (Na+) for the body to carry on normal functions at an optimal level (by loss, inadequate intake, or a combination of both). Losses of only a few percent in an adult and up to 5% in infants are considered mild dehydration. Vital organs like the kidneys, brain, and heart cannot 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). Still, with severe vomiting or diarrhea and occasionally with excessive sweating, anyone can become dangerously dehydrated.
SUMMER-TIME & HOT WEATHER WARNING!
HEAT-RELATED DEHYDRATION & HEAT STROKE
The summer months are just around the corner, we hope. Every year one of the most frequent causes of employee injury or illness is Dehydration and Heat Stroke. Here is some information from the University of Maryland School of Medicine.
The danger of dehydration and heat stroke: Dehydration and heat stroke are two very common heat-related diseases that can be life-threatening if left untreated.
What is dehydration? Dehydration can be a serious heat-related disease, as well as being a dangerous side-effect of diarrhea, vomiting and fever. Children and persons over the age of 60 are particularly susceptible to dehydration.
What causes dehydration? Under normal conditions, we all lose body water daily through sweat, tears, urine and stool. In a healthy person, this water is replaced by drinking fluids and eating foods that contain water. When a person becomes so sick with fever, diarrhea, or vomiting or if an individual is overexposed to the sun, dehydration occurs. This is caused when the body loses water content and essential body salts such as sodium, potassium, calcium bicarbonate and phosphate. Occasionally, dehydration can be caused by drugs, such as diuretics, which deplete body fluids and electrolytes. Whatever the cause, dehydration should be treated as soon as possible.
What are the symptoms of dehydration? The following are the most common symptoms of dehydration, although each individual may experience symptoms differently. Symptoms may include:
- Less-frequent urination.
- Dry skin.
- Dry mouth and mucous membranes.
- Increased heart rate and breathing.
In children, additional symptoms may include:
- Dry mouth and tongue.
- No tears when crying.
- No wet diapers for more than 3 hours.
- Sunken abdomen, eyes or cheeks.
- High fever.
- Skin that does not flatten when pinched and released.
Treatment for dehydration: If caught early, dehydration can often be treated at home under a health care provider's guidance. In children, directions for giving food and fluids will differ according to the cause of the dehydration, so it is important to consult your pediatrician. In cases of mild dehydration, simple rehydration is recommended by drinking fluids. Many sports drinks on the market effectively restore body fluids, electrolytes, and salt balance. For moderate dehydration, intravenous fluids may be required, although if caught early enough, simple rehydration may be effective. Cases of serious dehydration should be treated as a medical emergency, and hospitalization, along with intravenous fluids, is necessary. Immediate action should be taken.
How can dehydration be prevented? Take precautionary measures to avoid the harmful effects of dehydration, including:
- Drink plenty of fluids, especially when working or playing in the sun.
- Make sure you are taking in more fluid than you are losing.
- Try to schedule physical outdoor activities for the cooler parts of the day.
- Drink appropriate sports drinks to help maintain electrolyte balance.
- For infants and young children, solutions like Pedialyte will help maintain electrolyte balance during illness or heat exposure. Do not try to make fluid and salt solutions at home for children.
What is heat stroke? Heat stroke is the most severe form of heat illness and is a life-threatening emergency. It is the result of long, extreme exposure to the sun, in which a person does not sweat enough to lower body temperature. The elderly, infants, persons who work outdoors and those on certain types of medications are most susceptible to heat stroke. It is a condition that develops rapidly and requires immediate medical treatment.
What causes heat stroke? Our bodies produce a tremendous amount of internal heat and we normally cool ourselves by sweating and radiating heat through the skin. However, in certain circumstances, such as extreme heat, high humidity or vigorous activity in the hot sun, this cooling system may begin to fail, allowing heat to build up to dangerous levels. If a person becomes dehydrated and can not sweat enough to cool their body, their internal temperature may rise to dangerously high levels, causing heat stroke.
What are the symptoms of heat stroke? The following are the most common symptoms of heat stroke, although each individual may experience symptoms differently. Symptoms may include:
- Disorientation, agitation or confusion.
- Sluggishness or fatigue.
- Hot, dry skin that is flushed but not sweaty.
- A high body temperature.
- Loss of consciousness.
- Rapid heart beat.
How is heat stroke treated? It is important for the person to be treated immediately as heat stroke can cause permanent damage or death. There are some immediate first aid measures you can take while waiting for help to arrive.
- Get the person indoors.
- Remove clothing and gently apply cool water to the skin followed by fanning to stimulate sweating.
- Apply ice packs to the groin and armpits.
- Have the person lie down in a cool area with their feet slightly elevated.
- Intravenous fluids are often necessary to compensate for fluid or electrolyte loss.
- Bed rest is generally advised and body temperature may fluctuate abnormally for weeks after heat stroke.
How can heat stroke be prevented? There are precautions that can help protect you against the adverse effects of heat stroke. These include:
- Drink plenty of fluids during outdoor activities, especially on hot days. Water and sports drinks are the drinks of choice; avoid tea, coffee, soda and alcohol as these can lead to dehydration.
- Wear lightweight, tightly woven, loose-fitting clothing in light colors.
- Schedule vigorous activity and sports for cooler times of the day.
- Protect yourself from the sun by wearing a hat, sunglasses and using an umbrella.
- Increase time spent outdoors gradually to get your body used to the heat.
- During outdoor activities, take frequent drink breaks and mist yourself with a spray bottle to avoid becoming overheated.
- Try to spend as much time indoors as possible on very hot and humid days.
If you live in a hot climate and have a chronic condition, talk to your health care provider about extra precautions you can take to protect yourself against heat stroke.
HAVE A GREAT SUMMER - BE SAFE, STAY COOL!
CAUSES, INCIDENCE, & RISK FACTORS
Dehydration can be caused by excessive loss of water from the body as in:
Dehydration can also occur from inadequate intake as in:
- Diarrhea (especially well recognized in cholera).
- Excessive urine output (polyuria).
- Sweating, excessive.
Dehydration in children is most often a combination of both as in:
- Stomatitis or pharyngitis.
- Acute illness with loss of appetite.
Fluid losses up to 5 percent are considered mild; up to 10 percent are considered moderate; and up to 15 percent are considered severe. Severe dehydration can result in cardiovascular collapse and death if not treated quickly.
- Stomach flu with vomiting and diarrhea.
- Acute illness where the child refuses fluids and loses excessive fluid through sweating with fever.
Parents should consider the possibility of dehydration developing any time their child is ill. If you believe that dehydration is developing, they should consult the health care provider before the child becomes moderately or severely dehydrated. A few simple measures may prevent the development of severe dehydration.
Always provide adequate fluids during an illness, and pay attention to both the intake and output of fluid. For infants and young children, specific solutions (such as Pedialyte) are available that provide the right amount of electrolytes to prevent derangements of serum chemistries.
- Excessive loss of fluid through vomiting or excessive, urine, stools or sweating.
- Poor intake of fluids.
- Sunken eyes.
- Markedly sunken fontanelles in an infant.
- Dry or sticky mucus membranes in the mouth.
- The skin may lack its normal elasticity and sag back into position slowly when pinched up into a fold (poor skin turgor).
- Decreased or absent urine output (oliguria or anuria).
- Decreased tears.
SIGNS & TESTS
Physical examination may also show signs of:
- Low blood pressure (hypotension).
- Rapid heart rate (tachycardia).
- Blood chemistry tests (to check electrolytes, especially carbon dioxide).
- Urine specific gravity.
Other tests may be done to determine the specific cause of the dehydration (for example, a blood sugar to check for diabetes).
WARNING SIGNS FOR LEVELS OF DEHYDRATION
Slightly dry mouth membranes.
Very dry mouth membranes.
Skin does not bounce back quickly when lightly pinched and released.
All signs of moderate dehydration.
Rapid, weak pulse (more than 100 at rest).
Cold hands and feet.
Rapid, deep breathing (more than 20 breaths per minute).
Confusion, lethargy, difficult to arouse.
Fever (mild - less than 37°C or 100°F).
If a baby is not breastfeeding enough, if it has diarrhea or is vomiting, if it has a fever, or if the weather is very hot, a baby can become dehydrated very quickly. Dehydration is very dangerous to a baby or a young child and it may die if untreated. In addition to the warning signs above, other signs to watch out for with an infant include:
- Not urinating enough (wets less than 4 times a day).
- Dark urine.
- Eyes without tears.
- Sudden weight loss.
- Sunken fontanelle (soft spot) on an infant's head.
To check for loss of elasticity, pinch the skin on your own arm and release it. Notice how quickly it returns to normal. Then pinch the skin on the baby's belly and release it. If it returns to normal slowly, the baby may be dehydrated.
Have the mother breastfeed often and give the baby a lot of rehydration drink in between breastfeedings. It is best to boil the water for rehydration drink first. Give the drink with a spoon or an eye dropper. Give a few drops every minute for several hours until the baby is better.
If you do not have rehydration drink and cannot get the salt or sugar you need to make it, give plain water.
Get medical help if the infant does not get better in 4 hours.
Warning!: If you, a child, or an infant becomes severely dehydrated, you must get to a hospital right away. Intravenous fluids (IVs) will quickly reverse dehydration, and are often life-saving in young children and infants.
If the baby seems ill or stops breastfeeding well, look for signs of infection.
DEHYDRATION IN LABOR
A woman in labor is working hard and can use up the liquids in her body quickly as if she had been working out strenuously in a gymnasium. If she does not drink enough, she can easily become dehydrated from too little liquid in her body. This will make her labor much longer and harder. She may show any or all signs (listed above).
To keep her from becoming dehydrated, she should drink at least one cup of liquid each hour. Her midwife should write down when and how much the mother drinks, and how often she urinates. An estimate of urine output can be noted along with the intensity of color (darker the urine, the greater the need for more fluids to be consumed). The mother should be urinating at least every 2 hours. This is important, not only to check her fluid intake and output, but also to make sure her bladder does not overfill. The overfull bladder can hinder the process of labor causing pain, longer and more difficult labor and problems with pushing out the placenta and bleeding afterwards.
If the mother is vomiting and cannot drink one cup of liquid at once, have her take small sips after every contraction. This way she will get liquid without upsetting her stomach. These liquids may help her feel better: Coconut water, fruit juice mixed with water, water with sugar or honey in it, or peppermint or chamomile tea with honey or sugar. If the labor lasts 12 hours or more, or if the mother has trouble drinking liquids, try to give her Rehydration Drink. This drink helps keep the chemicals in the mother's body balanced. If the mother feels hungry during labor, it is fine to give her foods that are easy to digest - like bread, rice or yogurt.
Oral rehydration may be sufficient for mild dehydration. Intravenous fluids and hospitalization may be necessary for moderate to severe dehydration. The health care provider or midwife must also determine and treat the cause of the dehydration.
In teenagers and adults with moderate dehydration, careful home treatment can be safe, but phone contact with a health care provider is advisable. Children under 10 with moderate dehydration should see a health care provider first, though hospitalization usually is not necessary.
Mild dehydration is safe to self-treat at all ages, as long as it does not worsen.
To treat dehydration, you must first address the cause: The most common reasons for dehydration may be due to fever, vomiting, diarrhea, or heat exhaustion for dehydration. While you are treating the underlying problem, begin small amounts of oral re-hydrating solution (ORS).
ORAL HYDRATION SOLUTIONS (ORS)
Commercial ORS replaces important blood salts and water in balanced amounts designed especially for dehydration in sick people They are formulated to allow the 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. If using a commercial brand of ORS, be sure follow instructions carefully and to taste it before giving it to a sick or dehydrated person. The solution should be no saltier to taste than tears.
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.
TYPES OF ORAL REHYDRATION SOLUTIONS
KAOLECTROLYTE: (carbohydrate and electrolyte powder packets).
This is the product that most closely approximates World Health Organization and American Academy of Pediatrics guidelines on oral rehydrating solutions. Because they come in small, easily transportable packets and dissolve in 8 oz. of water in seconds, they are more convenient than pre-mixed brands. They also come in several flavors.
HOME-MADE REHYDRATION DRINK:
Type 1: With Sugar & Salt
(Raw sugar or molasses can be used instead of sugar. Blackstrap molasses has many valuable nutrients that are very beneficial to someone who is ill, besides having a nice flavor.)
In 1 liter of clean water put 1/2 level teaspoon of salt and 8 level teaspoons of sugar. Caution: Before adding the sugar, taste the drink and be sure it is less salty than tears.
Type 2: With powdered cereal and salt
(Powdered rice is best. Or use finely ground maize, wheat flour, sorghum, or cooked and mashed potatoes.)
In 1 liter of clean water put 1/2 level teaspoon of salt and 8 heaping teaspoons (or 2 handfuls) of powdered cereal. Boil for 5 to 7 minutes to form a liquid gruel or watery porridge. Cool the drink quickly and start giving it to the dehydrated person. Caution: Taste the drink each time before you give it to be sure it is not spoiled. Cereal drinks can spoil in a few hours in hot weather.
To either of these drinks, add a half cup of fruit juice, coconut water, or mashed ripe banana, if available. This provides potassium which may help the person to accept more liquid.
Try to adapt the drink to your region. If liter containers or teaspoons are not in most homes, adjust quantities to local forms of measurement. If you do not have a measuring cup or spoons, use a pinch of salt and a small handful of sugar. where people traditionally give cereal gruels to young children, add enough water to make it liquid and use that. Look for an easy and simple way.
Rapid recognition and treatment of dehydration results in a good outcome.
Untreated severe dehydration may result in seizures, permanent brain damage, or death.
CALLING YOUR HEALTH CARE PROVIDER
Call your health care provider or midwife if you suspect dehydration. Note that an infant or child can become severely dehydrated at a rapid rate.
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