Dehydration

From Wikipedia, the free encyclopedia

Dehydration, also known as

hypohydration, is not enough
body water,[1] with an
accompanying disruption of
metabolic processes. The term
dehydration may be used
loosely to refer to any condition
where fluid volume is reduced;
most commonly, it refers to
hypernatremia (loss of free water
and the attendant excess
concentration of salt), but is also
used to refer to hypovolemia
(loss of blood volume,
particularly plasma).

Dehydration

Nurses encourage a patient to drink an oral rehydration solution to reduce

dehydration he acquired from cholera.
Classification and external resources
Specialty

Critical care medicine

ICD-10

E86

Dehydration occurs when water

(http://apps.who.int/classifications/icd10/browse/2015/en#/E86)
loss exceeds water intake,
ICD-9-CM 276.51 (http://www.icd9data.com/getICD9Code.ashx?
usually due to exercise or
icd9=276.51)
disease. Most people can
tolerate a three to four percent
MedlinePlus 000982
decrease in body water without
(http://www.nlm.nih.gov/medlineplus/ency/article/000982.htm)
difficulty. A five to eight percent
eMedicine article/801012 (http://emedicine.medscape.com/article/801012decrease can cause fatigue and
overview)
dizziness. Over ten percent can
cause physical and mental
deterioration, accompanied by severe thirst. A decrease more than fifteen to twenty-five percent of the body
water is invariably fatal.[2] Mild dehydration is characterised by thirst and general discomfort and usually
resolved with oral rehydration.

Contents
1 Definition
2 Signs and symptoms
3 Cause
4 Prevention
5 Treatment
6 See also
7 Notes
8 References
9 External links

Definition

Dehydration occurs when water intake is insufficient to replace free water lost due to normal physiologic
processes (e.g. breathing or urination) and other causes (e.g. diarrhea or vomiting). Hypovolemia is specifically
a decrease in volume of blood plasmaisotonic intravascular volume depletionwhereas the loss of
intracellular pure water in dehydration results in an increase in salt concentration, hypernatremia.[3][4] Some
authors have reported three types of dehydration based on serum sodium levels: hypotonic or hyponatremic
(referring to this as primarily a loss of electrolytes, sodium in particular), hypertonic or hypernatremic (referring
to this as primarily a loss of water), and isotonic or isonatremic (referring to this as equal loss of water and
electrolytes).[5] The terms hyponatremic and eunatremic dehydration refer to hypovolemia. In humans, it is
thought that the most commonly seen type of dehydration by far is isotonic (isonatraemic) dehydration, but this
effectively refers to hypovolemia. Dehydration is thus a term that has loosely been used to mean loss of water,
regardless of whether it is as water and solutes (mainly sodium) or as free water. Hypotonic dehydration refers
to solute loss, and thus loss of intravascular volume, but in the presence of exaggerated intravascular volume
depletion for a given amount of total body water gain. Neurological complications can occur in hypotonic and
hypertonic states. The former can lead to seizures, while the latter can lead to osmotic cerebral edema upon
rapid rehydration.[6]

Signs and symptoms

Symptoms of dehydration include thirst, headache, general discomfort, loss of appetite, dry skin, decreased
urine volume, confusion, unexplained tiredness, and irritability.[7][8][9] More prolonged or severe dehydration
leads to abnormally dark urine, rapid breathing, constipation, decreased blood pressure (hypotension), dizziness
or fainting when standing up due to orthostatic hypotension, listlessness, insomnia, and loss of skin elasticity.[7]
Athletes may suffer a loss of performance[10] and experience flushing, low endurance, rapid heart rates, elevated
body temperatures, and rapid onset of fatigue. Untreated dehydration generally results in delirium, extreme
lethargy, seizures, sunken fontanelle ("soft spot" of the skull) in infants, fainting, sunken eyes, unconsciousness,
swelling of the tongue and, in extreme cases, death.[7][11] Blood tests may show hyperalbuminemia, an
overabundance of protein in the blood plasma, poor kidney function, or excess concentration hemoglobin;
urinalysis may show concentrated urine.[7][11] Dehydration symptoms generally become noticeable after 2% of
normal euhydration water volume has been lost.[12]
The symptoms of dehydration become increasingly severe with greater water loss. Heart and respiration rates
begin to increase to compensate for decreased plasma volume and blood pressure, while body temperature may
rise because of decreased sweating. At around 5% to 6% water loss, grogginess or sleepiness, severe
headaches or nausea, and a tingling in the limbs (paresthesia) may all be experienced. With 10% to 15% fluid
loss, muscles may become spastic, skin may shrivel and wrinkle (decreased skin turgor), vision may dim,
urination will be greatly reduced and may become painful, and delirium may begin. Losses greater than 15% are
usually fatal as organs fail, starting with the kidneys.[2]
In people over age 50, the bodys thirst sensation diminishes and continues diminishing with age. Many senior
citizens suffer symptoms of dehydration. Dehydration along with hyperthermia results in the elderly dying
suddenly during extreme hot weather.
In studies of terminally ill patients who have chosen to die, deaths by terminal dehydration are generally peaceful
and are not associated with suffering when supplemented with adequate pain medication.[13][14]

Cause

Water leaves the body in many ways, categorized into either sensible water loss or insensible" water loss
depending on whether the loss can be perceived by the senses. Sensible water loss includes such processes as
sweating and vomiting. Insensible" water loss occurs mainly through the skin and respiratory tract.[15] In
humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the
body. These include the following:
External or stress-related causes
Prolonged physical activity with sweating without consuming adequate water, especially in a hot or
dry environment
Prolonged exposure to dry air, e.g. in high-flying airplanes (5%12% relative humidity)
Blood loss or hypotension due to physical trauma
Loss of fluid through weeping burns or other injury
Crying
Diarrhea
Fever
Hyperthermia
Shock (hypovolemic)
Vomiting or nausea
Infectious diseases
Cholera
Gastroenteritis
Shigellosis
Yellow fever
Malnutrition
Electrolyte disturbance
Hypernatremia (also caused by dehydration)
Hyponatremia
Fasting
Recent rapid weight loss
Patient refusal of nutrition and hydration
Inability to swallow (obstruction of the esophagus)
Other causes of obligate water loss
Severe hyperglycemia, especially in diabetes mellitus
Glycosuria
Uremia
Diabetes insipidus
Acute emergency dehydration event
Foodborne illness
Crohn's disease
Likelihood of dehydration increases with consumption of diuretics, including caffeinated or alcoholic
beverages.[12]

Prevention

For routine activities, thirst is normally an adequate guide to maintain proper hydration. With exercise, exposure
to hot environments, or a decreased thirst response, additional water may be required. An accurate
determination of fluid volume lost during a workout can be made by performing weight measurements before
and after a typical exercise session.[16][17][18][19]
Normal water loss occurs through the lungs as water vapor (about 350ml), through the skin by perspiration
(100ml) and by diffusion through the skin (350ml), or through the kidneys as urine (10002000ml, about 900ml
of which is obligatory water excretion that gets rid of solutes). Some water (about 150200ml, in the absence of
diarrhea) is also lost through the feces.[20] In warm or humid weather or during heavy exertion, however, the
water loss can increase by a factor of 10 or more through perspiration; all of which must be promptly replaced.
In extreme cases, the losses may be great enough to exceed the body's ability to absorb water from the
gastrointestinal tract; in these cases, it is not possible to drink enough water to stay hydrated, and the only way
to avoid dehydration is to either pre-hydrate[17] or find ways to reduce perspiration (through rest, a move to a
cooler environment, etc.)
When large amounts of water are being lost through perspiration and concurrently replaced by drinking,
maintaining proper electrolyte balance becomes an issue. Drinking fluids that are hypertonic or hypotonic with
respect to perspiration may have grave consequences (hyponatremia or hypernatremia, principally) as the total
volume of water turnover increases.

Treatment
The treatment for minor dehydration, often considered the most effective, is drinking water and stopping fluid
loss. Plain water restores only the volume of the blood plasma, inhibiting the thirst mechanism before solute
levels can be replenished.[21] Solid foods can contribute to fluid loss from vomiting and diarrhea.[22] Urine
concentration and frequency will customarily return to normal as dehydration resolves.[11]
In more severe cases, correction of a dehydrated state is accomplished by the replenishment of necessary water
and electrolytes (through oral rehydration therapy or fluid replacement by intravenous therapy). As oral
rehydration is less painful, less invasive, less expensive, and easier to provide, it is the treatment of choice for
mild dehydration. Solutions used for intravenous rehydration must be isotonic or hypotonic. Pure water injected
into the veins will cause the breakdown (lysis) of red blood cells (erythrocytes).
When fresh water is unavailable (e.g. at sea or in a desert), seawater and ethanol will worsen the condition.
Urine contains a similar solute concentration to seawater, and numerous guides advise against its consumption in
survival situations.[23][24][25][26]
For severe cases of dehydration where fainting, unconsciousness, or other severely inhibiting symptom is present
(the patient is incapable of standing or thinking clearly), emergency attention is required. Fluids containing a
proper balance of replacement electrolytes are given orally or intravenously with continuing assessment of
electrolyte status; complete resolution is the norm in all but the most extreme cases.
Some research indicates that artificial hydration to alleviate symptoms of dry mouth and thirst in the dying patient
may be futile.[27]

See also
Hydrational fluids
Terminal dehydration

Dryness (medical)

Notes
1. "Definition of dehydration" (http://www.medterms.com/script/main/art.asp?articlekey=2933) at medicine net
2. Ashcroft F, Life Without Water in Life at the Extremes. Berkeley and Los Angeles, 2000, 134-138.
3. MedicineNet > Definition of Hypovolemia (http://www.medterms.com/script/main/art.asp?articlekey=3871)
Retrieved on July 2, 2009
4. TheFreeDictionary.com --> hypovolemia (http://medical-dictionary.thefreedictionary.com/hypovolemia) Citing
Saunders Comprehensive Veterinary Dictionary, 3 ed. Retrieved on July 2, 2009
5. Fleisher, Gary Robert; Ludwig, Stephen (2010). Textbook of Pediatric Emergency Medicine
(http://books.google.com/books?id=a7CqcE1ZrFkC&pg=PA811). Lippincott Williams & Wilkins. p. 811.
ISBN 978-1-60547-159-4.
6. Dehydration (http://emedicine.medscape.com/article/906999-overview) at eMedicine
7. Kaneshiro, Neil K. "Dehydration" (http://www.nlm.nih.gov/medlineplus/ency/article/000982.htm). National
Library of Medicine. Retrieved 10 June 2014.
8. Shirreffs SM, Merson SJ, Fraser SM, Archer DT; Merson; Fraser; Archer (June 2004). "The effects of fluid
restriction on hydration status and subjective feelings in man"
(http://journals.cambridge.org/abstract_S0007114504001163). Br. J. Nutr. 91 (6): 9518.
doi:10.1079/BJN20041149 (https://dx.doi.org/10.1079%2FBJN20041149). PMID 15182398
(https://www.ncbi.nlm.nih.gov/pubmed/15182398).
9. "Dehydration Affects Mood, Not Just Motor Skills / November 23, 2009 / News from the USDA Agricultural
Research Service" (http://www.ars.usda.gov/is/pr/2009/091123.htm#_top). Ars.usda.gov. Retrieved
2012-11-09.
10. Bean, Anita (2006). The Complete Guide to Sports Nutrition. A & C Black Publishers Ltd. pp. 8183. ISBN 07136-7558-6.
11. Wedro, Benjamin. "Dehydration" (http://www.medicinenet.com/dehydration/article.htm). MedicineNet.
Retrieved 10 June 2014.
12. Kleiner, SM (February 1999). "Water: an essential but overlooked nutrient". Journal of the American Dietetic
Association 99 (2): 2006. doi:10.1016/S0002-8223(99)00048-6 (https://dx.doi.org/10.1016%2FS00028223%2899%2900048-6). PMID 9972188 (https://www.ncbi.nlm.nih.gov/pubmed/9972188).
13. Printz LA (April 1992). "Terminal dehydration, a compassionate treatment" (http://archinte.amaassn.org/cgi/pmidlookup?view=long&pmid=1373053). Archives of Internal Medicine 152 (4): 697700.
doi:10.1001/archinte.152.4.697 (https://dx.doi.org/10.1001%2Farchinte.152.4.697). PMID 1373053
(https://www.ncbi.nlm.nih.gov/pubmed/1373053).
14. Sullivan RJ (April 1993). "Accepting death without artificial nutrition or hydration". Journal of General Internal
Medicine 8 (4): 220224. doi:10.1007/BF02599271 (https://dx.doi.org/10.1007%2FBF02599271).
PMID 8515334 (https://www.ncbi.nlm.nih.gov/pubmed/8515334).
15. Alok K. Maintenance Fluid Therapy in Children [Online]. University of Texas Medical Branch.
http://www.utmb.edu/pedi_ed/CORE/Fluids&Electyrolytes/page_02.htm[16 March,2014]
16. "Water, Water, Everywhere" (http://www.webmd.com/balance/features/water-water-everywhere). WebMD.
17. Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS; Sawka; Burke; Eichner;
Maughan; Montain; Stachenfeld (February 2007). "American College of Sports Medicine position stand.
Exercise and fluid replacement" (http://meta.wkhealth.com/pt/pt-core/templatejournal/lwwgateway/media/landingpage.htm?issn=0195-9131&volume=39&issue=2&spage=377). Med Sci
Sports Exerc 39 (2): 37790. doi:10.1249/mss.0b013e31802ca597
(https://dx.doi.org/10.1249%2Fmss.0b013e31802ca597). PMID 17277604
(https://www.ncbi.nlm.nih.gov/pubmed/17277604).
18. Nancy Cordes (April 2, 2008). "Busting The 8-Glasses-A-Day Myth"
(http://www.cbsnews.com/stories/2008/04/02/eveningnews/main3991145.shtml). CBS.
19. ""Drink at Least 8 Glasses of Water a Day" Really?"
(http://dms.dartmouth.edu/news/2002_h2/08aug2002_water.shtml). Dartmouth Medical School.
20. "Major Minerals" (http://www.sparknotes.com/health/minerals/major/section1.html). SparkNotes.
21. Murray, Robert; Stofan, John (2001). "Ch. 8: Formulating carbohydrate-electrolyte drinks for optimal efficacy"
(http://books.google.com/books?id=bS12dnUsGJcC&pg=PA197). In Maughan, Ron J.; Murray, Robert. Sports
Drinks: Basic Science and Practical Aspects. CRC Press. pp. 197224. ISBN 978-0-8493-7008-3.
22. "Healthwise Handbook," Healthwise, Inc. 1999

22. "Healthwise Handbook," Healthwise, Inc. 1999

23. water (http://www.simplesurvival.net/water.htm)
24. Tracker Trail - Mother Earth News - Issue #72
(http://trackertrail.com/publications/motherearthnews/72/index.html)
25. EQUIPPED TO SURVIVE (tm) - A Survival Primer (http://www.equipped.com/primer.htm)
26. Five Basic Survival Skills in the Wilderness (http://www.adventuresportsonline.com/5basic.htm)
27. Ellershaw JE, Sutcliffe JM, Saunders CM; Sutcliffe; Saunders (April 1995). "Dehydration and the dying
patient" (http://linkinghub.elsevier.com/retrieve/pii/0885-3924(94)00123-3). J Pain Symptom Manage 10 (3):
1927. doi:10.1016/0885-3924(94)00123-3 (https://dx.doi.org/10.1016%2F0885-3924%2894%2900123-3).
PMID 7629413 (https://www.ncbi.nlm.nih.gov/pubmed/7629413).

References
Ira R. Byock, M.D., "Patient Refusal of Nutrition and Hydration: Walking the Ever-Finer Line
(http://www.dyingwell.com/prnh.htm)." American Journal Hospice & Palliative Care, pp. 813.
(March/April 1995)

External links
Definition of dehydration by the U.S. National Institutes of
Health's MedlinePlus medical encyclopedia

Look up dehydration in
Wiktionary, the free
dictionary.

(http://www.nlm.nih.gov/medlineplus/ency/article/000982.htm#visualContent)
Rehydration Project at rehydrate.org (http://rehydrate.org/index.html)
Steiner, MJ; DeWalt, DA; Byerley JS (Jun 9, 2004). "Is this child dehydrated?". JAMA: the Journal of
the American Medical Association 291 (22): 274654. doi:10.1001/jama.291.22.2746
(https://dx.doi.org/10.1001%2Fjama.291.22.2746). PMID 15187057
(https://www.ncbi.nlm.nih.gov/pubmed/15187057).
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Categories: Dehydration Causes of death
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