Dehydration and IV Fluids

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Many illnesses can deplete the body fluid volume and can lead to dangerous complications like coma and death.

Volume depletion results from loss of sodium and water from the following anatomic sites :

Gastrointestinal losses, including vomiting, diarrhea, bleeding, and external drainage

Renal losses, including the effects of diuretics, osmotic diuresis, salt-wasting nephropathies, and hypoaldosteronism

Skin losses, including sweat, burns, and other dermatological conditions

Third-space sequestration, including intestinal obstruction, crush injury, fracture, and acute pancreatitis

Hypovolemic patients may present with a variety of symptoms, physical examination findings, and laboratory abnormalities.

Symptoms may be related to the volume depletion itself, such as lassitude and postural dizziness, or to the underlying cause of volume depletion, such as vomiting, diarrhea, or polyuria. The physical examination may reveal decreased skin turgor, low arterial blood pressure or postural hypotension, and reduced jugular venous pressure. Patients with hypovolemia may present with a variety of laboratory abnormalities, including an elevated serum creatinine and blood urea nitrogen (BUN), hypernatremia or hyponatremia, hyperkalemia or hypokalemia, and metabolic alkalosis or metabolic acidosis.

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As the degree of hypovolemia becomes more severe, there is a marked reduction in tissue perfusion, resulting in a clinical syndrome referred to as hypovolemic shock. This syndrome is associated with a marked increase in sympathetic activity and is characterized by tachycardia, cold, clammy extremities, cyanosis, a low urine output, and agitation and confusion due to reduced cerebral blood flow.

Unlike in younger individuals, excessive fluid loss in older individuals often presents with nonspecific signs and symptoms. The most specific for hypovolemia is acute weight loss; however, obtaining an accurate weight over time may be difficult in older adults. Many clinical signs and symptoms that would suggest volume depletion in a younger individual may be unreliable in older adults. Postural hypotension, for example, is not uncommon in euvolemic older adult patients as a result of sympathetic dysfunction and poor physical conditioning.

In almost all cases, hypovolemia is a clinical diagnosis based upon the characteristic manifestations mentioned above and confirmed by a low urine sodium concentration.

If you are dehydrated, please call our clinic for further guidance.

 

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