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Posts Tagged ‘Dehydration’

Normally all people eliminate some of the water body through sweat, tears, urine and stools. Water also evaporates through the skin and leaves the body as vapor when you breathe. In general, we replace the body fluid and salts containing the water and salts which are incorporated in our diet.

Sometimes, however, children lose large amounts of water and salt when they have a fever (greater amount of body water evaporates when the temperature rises), diarrhea, vomiting, or when they do exercise for a long time and sweat excessively. In the case of some diseases may not be able to take fluids by mouth. If children are unable to adequately replace the fluids lost, dehydrated.
How to recognize dehydration

If your child has a fever, diarrhea or vomiting, or if you sweat excessively on a hot day or during intense physical activity develops, you should watch for signs of dehydration, among which are the following:
* Dry or sticky mouth
* Little or no tears when crying
* Eyes that appear sunken
* Fontanelle at the top of the baby’s head appears sunken
* Lack of urination or dry diapers for 6 to 8 hours in an infant (or only a very small amount of dark yellow urine)
* No urine for 12 hours in an older child (or only a very small amount of dark yellow urine)
* Dry skin and cold
* Lethargy or irritability
* Fatigue or dizziness in an older child

How to prevent dehydration

The best way to prevent dehydration is to ensure that children ingest plenty of fluids when sick or physically active, eat more fluid than you lose (if they have vomiting or diarrhea, or sweating).

The way to keep a child well hydrated depends on the circumstances. For example, a child with sore throat may become dehydrated due to difficulty drinking or eating. Give acetaminophen or ibuprofen to relieve pain may be of great help, while cold drinks and popsicles can soothe sore throat, and providing fluids.

In babies with nasal congestion have difficulty feeding, nasal drops can help place them with a saline drip and suction the mucus with a goatee.

The fever, which may be the cause of dehydration in any infectious disease can be controlled with medication or coated at room temperature with a sponge and clothing the child in light clothing.

It is important that children drink fluids frequently on hot days, dry and windy. Those who participate in sports or strenuous activities should drink an extra amount of fluid before beginning these activities. They should also drink fluids at regular intervals (every 20 minutes) for the duration of the activity and after it ends. Ideally, practices and athletic contests are scheduled for early morning or late evening, to avoid the heat of the day section.

Thirst is not an early indicator of dehydration. For the moment a child is thirsty, you may already be dehydrated. And thirst can be quenched before the necessary body fluids have been replaced. This is the reason why children should begin to drink fluids before you feel thirsty and consume more fluids even after thirst is quenched.

Children with mild gastroenteritis (also called “stomach foot,” which can cause nausea, vomiting and diarrhea) that are not dehydrated should continue to eat normally, but have to eat extra fluids to recover they have lost. According to the American Academy of Pediatrics (AAP in English), recent studies have shown that most kids with gastroenteritis can lead a regular diet appropriate to their age safe when they are sick. In fact, if a child with diarrhea has a regular diet can reduce the duration of the disorder, in addition to proper nutrition. Infants with mild gastroenteritis who are not dehydrated should continue breast-feeding or formula with a regular concentration. Older children may continue to drink raw milk.

Foods well tolerated by children with gastroenteritis who are not dehydrated include: complex carbohydrates (like rice, wheat, potatoes, bread and cereals), lean meats, yogurt, fruits and vegetables. Avoid fatty foods or those containing large amounts of simple sugars (including juices and sodas). If the child vomits and is not dehydrated, it is necessary to give fluids frequently, in small quantities.

Dehydration

This name is given to those clinical situations in which fluid and electrolyte losses exceed current spending.

The most common state of dehydration in children is due to acute gastroenteritis.

The determination of the degree of dehydration is mainly based on the clinic. The clinical estimate indicates the percentage of decrease in body weight loss due to acute water. Example: A 5% dehydration indicates that it has lost 5% of body weight, acute loss of fluid.

Depending on the degree of dehydration are divided into:

1. Mild Dehydration: Lack of 5%.

- Clinical signs: Characterized by the loss of interstitial fluid.

* Poor skin temperature.

* Sunken fontanelles.

* Sunken eyes.

* Dryness of mucous membranes.

These changes reflect important hemodynamic compromise, however, when there is significant ongoing losses and inability to take adequate fluid by mouth, these signs indicate a progressive deficit fluid therapy is necessary.

2. Deficit of 5% to 10%.

There are clinical signs of interstitial deficit but clinical signs of intravascular fluid deficits:

* Lethargy.

* Tachycardia.

* Low blood pressure.

* Decreased urine output.

All this reflects a significant hemodynamic compromise.

3. Deficit of 10% to 15%.

They are present all the signs of depletion of interstitial and intravascular spaces, plus signs as: pale, flabby, weak and rapid pulse, hypotension and oliguria, indicating intravascular collapse and shock.

CLASSIFICATION.

The type of dehydration is determined by the serum sodium concentration, which indirectly reflects the osmolarity.

1. Isotonic dehydration (most common).

Occurs when the acute loss of fluid intercellular fluid concentration (LIC) is proportional to the concentration of extracellular fluid (ECF).

The serum sodium is 130 to 150 mEq / l.

Because no osmolar gradients are created between the ICF and ECF will be minimal displacement of fluid and therefore the low incidence of shock, unless the degree of dehydration is very important.

In this case the estimated fluid deficit can be replaced within 24 hours of treatment.

2. Hypotonic dehydration.

The serum sodium is less than 130 meq / l.

There is loss of fluids and electrolytes, as in gastroenteritis and only replaces the water.

It also appears when sodium losses are greater than the water pudiéndiendose also develop in children with other chronic disorders of salt losers (cystic fibrosis, salt losing adrenogenital syndrome and renal disease are loss of salt).

Besides the loss of fluid in the extracellular space or hypoosmolar the ECF hypotonicity as a result of excessive loss of electrolytes, promotes water movement from the ECF to the ICF. Resulting in even higher concentration of the ECF and thus a higher incidence of shock.

In this case the shock will be discussed first and then replace the deficit in the first 24 hours of treatment.

3. Hypertonic dehydration.

Defined by a serum sodium exceeds 150 mEq / l.

Occurs when body water losses exceed the losses of salt.

Occurs most frequently in children with gastroenteritis for which administered oral solutions with high salt concentration.

The ECF hypertonicity and hyperosmolarity leads to a movement of water from the ICF to the ECF.

The subsequent intracellular dehydration produces a typical pasty texture of the skin.

In severe cases of this dehydration, intracellular dehydration and metabolic acidosis associated, can cause significant brain injury as a sequel.

Diabetes insipidus and diabetes insipidus may occur as hypertonic dehydration.

We must avoid rapid correction of hypernatremia.

The rapid filling of liquids can force a rapid re-expansion of the cells and produce convulsions during corrective fluid.

If there is shock will be treated first. After restoring the circulation phase begins replacement of the deficit, that must be changed slowly, even in 48 hours or 72 hours.

In the first 24 hours should be given maintenance fluids plus half of shortfall.

In this type of dehydration is frequently believed to hypocalcemia is associated with loss of potassium and total body potassium deficit. If the total serum calcium of 7 mg / dl or lower can add 1 vial of 10% calcium gluconate for every 500 ml of fluid IV tubing. Not taking baking because it could precipitate.

In these cases the fluid should have a base venoclisis lactate. With a base liquid bicarbonate will have to use another route for calcium.

For severe acidosis is necessary with bicarbonate therapy, but may add the sodium bicarbonate replacement therapy.

Administered as sodium as sodium bicarbonate (NaHCO3) must be included in the calculations of replacement of sodium.

TREATMENT.

a) First stage:

* Treatment of shock, if any:

- Restore the plasma volume to achieve an adequate cardiac output and a good organ perfusion.

And stabilize the movement:

b) Second stage:

* Correction of the deficit with the provision of maintenance fluids.

1. Blood drawn for determination of electrolytes, BUN (urea nitrogen), complete blood count, blood and other studies indicated clinically indicated.

Start with the administration of intravenous fluids.

2. If this is clinical shock or impending start venoclysis of isotonic saline or Ringer lactate at 20 ml / g for 1 hour. If not corrected within an hour, repeat the same volume infusion.

3. Estimating the need for maintenance of fluid and the estimated deficit, based on clinical assessment and determination of electrolytes. The amount of maintenance and the deficit is the amount of fluid infused in the first 24 hours, except in hypertonic dehydration, which maintain more than half of the deficit is the amount to be given within 24 hours.

4. Give half in all liquids calculated during the first 8 hours, during the second quarter and another 8 hours during the third quarter.

5. Add potassium chloride infusion has been identified on renal function is normal.

6. If acidosis is severe (plasma bicarbonate below 10 mEq / l) add sodium bicarbonate to the solution at a rate of 1 meq / kg, will increase serum bicarbonate 2 meq / l.

Dehydration is a more or less severe decrease in the amount of water in the body, which also affects the concentration of electrolytes. Children need special care, the elderly and the sick.

1. What is dehydration?
Water. Essential to life and proper functioning of the body.
Dehydration is the lack of water needed for the body. May be due to excessive loss of fluids through sweat, vomit, diarrhea, to excessive discharge of urine (diuretic drug or untreated diabetes) or a lack of fluid intake. As a result, alter the body’s functions and appear a number of clinical signs ranging from thirst or dry skin to coma and death in extreme cases.

Normally, you lose a certain amount of water daily through breathing, sweat (a pint a day) and urine, and tears, or feces.
But not infrequently occurring abnormal losses due to vomiting, diarrhea, fever, or dehydration from excessive heat. Excessive losses may also occur in the urine in certain diseases such as uncontrolled diabetes or intake of drugs called diuretics that promote urination.

In other cases there may be loss of fluid from burns or internal or external bleeding.

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