| Dehydration occurs when an individual's water output exceeds water intake, leaving the body with less water than is needed to sustain life. This water deficit can be accompanied by an imbalance in the electrolytes sodium, potassium, and chloride, which must be maintained within narrow limits for proper body functioning.
The normal water content of the adult body is 40% to 65% of total body weight. The volume and composition of body fluid is usually maintained by the kidneys in spite of wide fluctuation in dietary intake and metabolic activity. However, a lack of normal intake or an increase in normal output of water can upset this balance.
Intake of water may decrease when the individual is unconscious, delirious, or unable to take fluids due to nausea or injury to the mouth or gastrointestinal (GI) tract. Water loss may be increased when fever, profuse sweating, diarrhea, vomiting, or burns are present. Excess water may also be lost due to diuretic therapy, dialysis, tube feedings without adequate water replacement, or movement of water into tissues such as the skin or lungs. Fluid losses up to 5% are considered mild, up to 10% are considered moderate, and up to 15% are considered severe.
Diseases such as diabetes mellitus, diabetes insipidus, kidney failure, or adrenal insufficiency will also upset the normal fluid balance of the body.Risk: Dehydration most often occurs in the very young and in the elderly. Additionally, those who live and work in warm, humid environments are at greater risk of developing dehydration. |
Source: Medical Disability Advisor
| History: The history may include an injury or illness that prevents the normal intake of water. The individual will complain of weight loss within a short period and dryness of the mouth and skin. A feeling of faintness accompanied by dizziness may be present, especially upon arising. Physical exam: The individual will have dry mucous membranes and decreased skin elasticity. Upon arising from a lying or sitting position, the individual's blood pressure will drop and pulse will rise (orthostatic hypotension). Central venous pressure and intraocular pressures will be decreased, and the pulse pressure will be narrowed.
Signs of electrolyte imbalance that may accompany dehydration include changes in mental status and personality, heart irregularities (arrhythmia), muscle rigidity, tremors, spasticity, seizures, or coma. The urine will be concentrated, darker and stronger smelling than usual. Tests: The urinalysis will show an increased specific gravity (except in the case of diabetes insipidus) and decreased sodium and other electrolytes content. The hematocrit may be increased from the normal baseline. There may be a mild-to-moderate increase in the blood urea nitrogen (BUN) and creatinine. Plasma concentration of a solution of substances (osmolality) will be elevated, and serum electrolytes may be abnormal. Other tests may be done to determine the specific cause of the dehydration (for example, a blood sugar test to check for diabetes). |
Source: Medical Disability Advisor
| Water will be replaced by mouth in mild dehydration and/or via intravenous fluid replacement in more severe cases. The type of intravenous fluid therapy depends on electrolyte levels and the concentration in solution of the substances of the individual's blood (osmolality) and may include saline (sodium chloride), with or without electrolytes added. Blood pressure, pulse, hematocrit, and central venous pressure may be monitored during fluid replacement therapy.
The speed of replacement will depend in part on the severity of the dehydration and kidney and heart functioning. Half of the fluid deficit may be replaced in the first 24 hours of treatment and the remainder given more slowly after that. The underlying cause of the dehydration will be determined and treated as well. |
Source: Medical Disability Advisor
| Rapid recognition and treatment of dehydration will result in a successful outcome. In the absence of complications, fluid balance is usually restored. If not treated quickly, severe dehydration can result in cardiovascular collapse, seizures, permanent brain damage, or death. |
Source: Medical Disability Advisor
| The presence of electrolyte imbalances will complicate fluid replacement therapy, requiring close calculation of content according to the individual's needs. Fluid loss that cannot be stopped will threaten the outcome. |
Source: Medical Disability Advisor
| Water intake will need to be maintained during working hours. The individual may need to be advised on the proper precautions to take to avoid excessive fluid loss and electrolyte imbalance. The individual may be in a weakened state from severe loss of fluids and should avoid strenuous activities and activities that produce excessive sweating. Work in hot and humid environments should be avoided until fluid levels and electrolyte balances have been re-established. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have a fever or profuse sweating? Diarrhea or vomiting? Nausea?
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Did individual have a severe burn?
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Is individual on diuretic therapy, dialysis, or tube feedings?
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Has water moved into the skin or lungs?
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Does individual have diabetes? Kidney failure? Adrenal insufficiency?
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Is there an injury to the mouth or GI tract?
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On exam, does individual have dry mucous membranes? Decreased skin elasticity?
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Is there evidence of orthostatic hypotension?
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Are the central venous and intraocular pressures decreased?
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Is there a narrowed pulse pressure? Arrhythmias?
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Have any changes in mental status occurred?
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Does individual have any muscle rigidity, tremors, spasticity, seizures, or coma?
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Is the urine dark and concentrated?
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Were CBC and urinalysis performed? Electrolytes? BUN? Creatinine? Was an osmolality test done?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Has individual had fluid replacement either orally or intravenously?
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Is underlying cause also being treated?
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Was the dehydration recognized and treated promptly?
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Were electrolytes monitored during replacement?
Regarding prognosis:
- Can individual's employer accommodate any necessary restrictions?
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Were individual, family, and/or caretaker educated in the early symptoms of dehydration and the necessary interventions? Are preventive measures being taken?
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Does individual have any conditions that may affect ability to recover?
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Is individual continuing to lose fluid? Does individual have an electrolyte imbalance?
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Source: Medical Disability Advisor
| Salomone, Joseph A. "Dehydration in Adults." eMedicine Consumer Health. Eds. Scott Plantz, Francisco Talavera, and Steven L. Bernstein. 10 Aug. 2004. Medscape. 20 May 2005 <http://www.emedicinehealth.com/articles/6098-1.asp>. |
Source: Medical Disability Advisor
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