POAC CLINICAL GUIDELINE

Acute Adult Dehydration

AIMS
EXCLUDE:
Children(refer
Paediatricpathway)
Diabetes
RenalFailure
Septicaemia
Signsofshock
HeartFailure
Undiagnosed
abdominalpain
Intracranialcauses

Improvementinclinicalsigns
Achieveadequateurineoutput
(Recordfluidbalance)
Reductioninfluidlosses
Abletomanageoralrehydrationsolutionsafelyathome

CAUTION:
OlderAdults
Preexistingheart
failure
Prolongeddurationof
symptoms
SignificantCo
morbidity
Featuresofevolving
illness
Recentoverseastravel

PersistentVomitingand/orDiarrhoea
Hyperemesisintractablevomitingin
pregnancy<20weeks

Assessdehydrationstatus

MILD(<5%)

MODERATE(69%)

SEVERE(>10%)

Mayhavenosymptoms
Mildthirst
ConcentratedUrine

Significantthirst
Oliguria
Sunkeneyes
Drymucousmembranes
Weakness
Lightheaded
Posturalhypotension
(>20mmHg)

Significantthirst
Tachycardia
Lowpulsevolume
Coolextremities
Reducedskinturgor
Markedhypotension
Confusion

Ketones0+

Ketones+++
TrialofOralFluids
+/antiemetic
34litresfluidover24Hrs

Observationnotrequiredin
clinic.

POACFUNDINGDOESNOT
APPLY

INVESTIGATIONS
Consider:
Glucose
MSU
Weight
Electrolytes
FaecalSpecimen
P
T t

Admission
Recommended

TrialofOralFluids+antiemetic
Observeinclinicforupto60minutes
underPOAC
Aim34litresoralfluidover24hours

Ifinsufficientresponsetooralintake:
IntravenousFluidsANDAntiemetic
NormalSaline
1000mlstat(1820gangiocath)
Reviewhydrationstatus
LIMIT=2000mlperconsultation

Migraine
GiveIVstemetil12.5mg

IVfluidsnotindicated
unlesspatientis
dehydratedandisnot
abletotakeoralfluids

Reviewdailyandrepeatcycleprn
Iffluidsrequired>2LIVperday/cycleAdmit
Monitorintake/losses
Encourageoralfluids
Providepatientwithcontact/emergencynumbersand
instructions

WATCHFOR
Signsoffluidoverload
Inadequateresponse
Persistingfluidlosses
Ketosis
Deteriorationof
symptoms
Signsofevolving
illness

POACClinicalGuideline:AcuteAdultDehydration
July2015

POAC CLINICAL GUIDELINE

Acute Adult Dehydration

Aim
Toenablethepatienttocontinuetomanageadequateoralfluidrehydrationsafelyathome.

Dehydration
Thisguidelineisspecifictobodyfluidlossessecondarytohyperemesis,vomitingand/ordiarrhoea.Itaimsto
serve as a general guideline and support aid in the assessment and management of mild to moderate
dehydration.Severedehydrationistheresultoflargefluidlossesandmaybecomplicatedbyelectrolyteand
acidbasedisturbanceswhichrequiretreatmentandobservationoveraprolongedperiod.Severedehydration
isnotsuitableforcareunderPrimaryOptionsandadmissiontohospitalisrecommended.

Exclusions
Vomiting and/or diarrhoea are symptoms which may result from a wide range of diagnoses. A working
diagnosis is important in the management of subsequent dehydration. Patients with the following are
excludedandadmissionshouldbeconsidered:

Children<15years(refertopaediatricpathway

Diabetes

Renalfailure

Septicaemia

Shockresultingfrombloodloss

Heartfailure

Casesofabdominalpainwherethereisnotacleardiagnosis

Intracranialcauses

Cautionisalsorecommendedforcasesinvolvingolderadults,preexistingheartfailure,wheresymptomshave
beenprolongedorinvolvedoverseastravel,wherethereisadditionalsignificantcomorbidityorwherethe
socialsettingmayimpairmanagementathome.

Dehydration status
Assessment should include consideration of duration of symptoms combined with prospective total daily
losses.

Average70kgpersonnormaldailylossesrange25003000ml.

Averagevomitequalorgreaterthan200ml

Averagediarrhoeaequalorgreaterthan300ml

ForPOACfundingclinicalnotesmustgivedetailsupportingthediagnosisanddegreeofdehydration.

POACClinicalGuideline:AcuteAdultDehydration
July2015

POAC CLINICAL GUIDELINE

Acute Adult Dehydration
Investigations
Investigationsmaynotbenecessary.Clinicaljudgementisrecommendedfollowingtheassessmentofeachcase.
Ifrequired,simpletestswhichareeasytoperforminclude;

FaecalCulture

MSUinfection/ketones

Glucosefingerprick

Electrolytes Electrolyte disturbances and renal impairment may result from excessive fluid losses
andmaybeespeciallyimportantinolderpatients.

Pregnancytest

Fluid replacement
Forbothmildandmoderatedehydrationconsideratrialoforalrehydrationcombinedwithanantiemetic.
(Metoclopramide in pregnancy, and metoclopramide or prochlorperazine or ondansetron in Nonpregnant
cases) Specific oral fluid solution is at the Physicians discretion. Normal saline is the intravenous fluid of
choice,howeverPlasmalyteisanacceptablealternative.

Itisrecommendedthattheintravenousresuscitationfluidvolumeisrestrictedtoanupperlimitof2000ml
per consultation. Fluid volumes beyond this level are likely to require more investigation and clinical
monitoring.Shouldtheclinicianfeelfurtherfluidvolumesbeyondthislevelareneededthendiscussionwith
theappropriatespecialistorhospitaladmissionisrecommended.

In all cases of intravenous fluid replacement, details of fluid balance should be recorded. Observation and
reassessmentofhydrationstatusatregularintervalswillallowcalculationoffluidvolumerequirementsand
reducerisksoffluidoverload.

DISCLAIMER:
This management guideline has been prepared to provide general guidance with respect to a specific clinical
condition.Itshouldbeusedonlyasanaidforclinicaldecisionmakingandinconjunctionwithotherinformation
available.Thematerialhasbeenassembledbyagroupofprimarycarepractitionersandspecialistsinthefield.
Whereevidencebasedinformationisavailable,ithasbeenutilisedbythegroup.Intheabsenceofevidencebased
information,theguidelineconsistsofaconsensusviewofcurrent,generallyacceptedclinicalpractice.

Thisguidelineshouldnotreplaceprofessionalclinicaljudgmentinmanagingeachindividualpatient.

ENDORSEMENT:
ThisguidelinehasbeenendorsedbythePOACClinicalReferenceGroup,July2015

POACClinicalGuideline:AcuteAdultDehydration
July2015