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Dehydration, or exicosis, is quite common in the clinic of infectious diseases, and especially when it comes to acute intestinal infections, in children and the elderly. Middle-aged people are less prone to dehydration, due to well-developed compensatory mechanisms for retaining fluid. But even if an adult, healthy and strong person encounters, for example, cholera, then after two days, having lost more than 10% of his body weight, he can very quickly die. Dehydration reaches such a degree that blood begins to coagulate in the vessels, generalized thrombosis occurs, peripheral veins become empty and collapse, capillary blood flow practically stops, body temperature drops, and irreversible multiple organ failure occurs. And the cholera vibrio does not have any deadly poisons and toxins: all it can do is to 'pull' all the water out of a person so that the multiplying vibrios spread over the largest possible area.
It would seem that it is simpler: the best remedy for dehydration is water. Unfortunately, this is not entirely true. Together with water, a person loses a large amount of electrolytes and mineral salts. If you replenish only the loss of water, without worrying about the ionic composition, then nothing good will come of it. Serious shifts in the concentrations of sodium, potassium, magnesium, bicarbonate will occur, which will lead to decompensated electrolyte imbalance. Let's consider how the water reserves in the human body are distributed. After that, the mechanisms of dehydration development and its causes will be clearer.
Water in the human body
Once upon a time, several hundred million years ago, all of us (more precisely, our ancestors) lived in water, and when they came out on land, they took with them a part of the outer, oceanic environment in the form of water. It is a universal solvent, and all chemical reactions that maintain homeostasis, or the constancy of the internal environment, take place in it.
In a healthy adult, water makes up almost 60% of body weight, the rest is dry residue. Which body contains more water, men or women? More water in men, as they have more muscle tissue, and women usually have more fatty tissue. But fat contains less water than muscle, is hydrophobic, and repels water. Women have an average of 53% water in the body, while men have about 60%.
Organisms of babies, and especially newborns, contain significantly more water, which consists of almost 70% water. The older a person is, the less water is in the tissues of his body. This phenomenon is reflected in age-related pathology, for example, in osteochondrosis, in which the intervertebral cartilage discs gradually decrease in volume, lose their elasticity, dry out, and cause certain symptoms – back pain, and limitation of range of motion.
The absolute amount of water in the human body, which weighs about 70 kg, is quite impressive: more than 42 liters of water. This is the volume of a fairly large and roomy aquarium, in which even not very small fish will feel comfortable. Of this volume, about 28 liters are in the form of intracellular fluid, and the interstitial, or intercellular and tissue fluid, will make up a volume of approximately 10.5 liters, together with lymph. The total blood volume is usually 8% of the total body water, and for a person of this mass, about 3.5 liters of blood is quite 'enough'.
Naturally, a person receives water only orally, that is, through the mouth, with drinking water and drinking the liquid contained in food. A person is able to absorb a certain amount of liquid through the skin, but this volume is so insignificant that it is only of theoretical interest. So, after being in a bath or sauna, having plunged into a cool pool, a person can absorb about 10 ml of water with the entire area of his skin.
The loss of excess fluid is mainly carried out through the kidneys. Also, water is lost due to the work of sweat glands, evaporating through the surface of the skin, and from the lungs, during exhalation. In a healthy person, all the 'planned losses' of water are strictly compensated by its consumption, the water balance is in equilibrium.
The usual amount of water required for an adult who is not in a hot climate and is not engaged in heavy physical labor is about 2 liters of liquid per day. If the ambient temperature rises, or the level of physical activity rises, then the amount of water lost through the skin and lungs can double.
In a healthy adult, about 7-8 liters of fluid are secreted into the intestines every day. Where does it come from? After all, with food we get only 2 liters. Yes it is. Two liters of water is ingested with food, but:
- about the same or even more, about 2.5 liters are in gastric juice;
- 1 liter of water is contained in the daily volume of saliva;
- 1.5 l is intestinal juice;
- finally, 0.5 liters is bile.
Everyone can make sure that such a volume of fluid is not excreted by the intestines. This is really so, 75% of the liquid is absorbed back in the small intestine and 25% in the large intestine, and only about 200 milliliters or even less are excreted in the feces for a day. Thus, the body is very economical in the use of water.
It follows that if you start fighting dehydration before it has gone too far, then excess fluid loss can be easily compensated for at the very beginning. But if the patient is already in a state of deep dehydration, then oral fluid intake is no longer sufficient. Oral rehydration can be prevented by impaired consciousness, fainting, or severe vomiting. In this case, intravenous rehydration is necessary, which will be briefly discussed at the end of the article.
Causes of dehydration
When does dehydration develop? When water consumption cannot compensate for losses, or it is absent at all (for example, babies and infants themselves cannot take measures to find water, like adults). Babies and the elderly are most likely to be dehydrated. Babies lose water quickly because their compensation mechanisms are still imperfect, and in older people the thirst center located in the brain is not functioning well enough, and therefore many older people simply do not understand that they are thirsty.
In fact, dehydration, however mild, is very familiar to all of us, and we experience it regularly. Mild dehydration occurs every morning after we wake up. Indeed, in a dream we spend a third of our lives, and sometimes more, and if a person does not wake up at night, then he does not drink. At the same time, all the systems of our body continue to work at night, but the liquid does not flow. That is why the blood is thicker in the morning hours, more pressure is required to transport oxygen and carry out capillary gas exchange, and the heart begins to work harder. That is why, in the early morning hours, cardiovascular accidents often occur, such as heart attacks, strokes, fatal arrhythmias, and other severe disorders in the body's work associated with hemoconcentration and arterial hypertension.
That is why, immediately after waking up, it is very good to drink a glass or two of Pure water, I can with lemon juice. This simple way to replenish the circulating fluid volume is also good for hypertensive patients, and after that the blood pressure decreases slightly.
What are the main causes of fluid deficiency in the human body? Here they are:
- the most severe loss of fluid, leading to hypovolemic shock, occurs with intestinal infections. It is loss with profuse, uncountable, watery diarrhea or diarrhea, with vomiting in gastroenteritis;
- excessive sweating, especially in hot and dry climates with increased physical activity. It should be noted that with the onset of significant dehydration, the loss of fluid with sweat decreases, and the amount of urine excreted decreases;
- extensive burns lead to fluid (and protein) deficiency;
- the loss of a large amount of water is possible by the kidneys with sugar (insulin-dependent) and diabetes insipidus, Addison's disease, and other endocrine disorders;
- brain tumors affecting the center of thirst, loss of feeling of lack of water (rare);
- chronic renal failure – if the kidneys cannot concentrate urine, then they have to significantly increase the volume of urine, this condition is called isohypostenuria;
- overdose of diuretic drugs, especially rough and strong – furosemide, torasemide.
Mild forms of dehydration quite often occur against the background of active sports activities, and especially in the hot season. Dehydration increases dramatically with an increase in body temperature. Therefore, a person, even without physical exertion, and at rest, during a cold and flu, should not drink as much liquid as possible, but not only for the purpose of detoxification and removal of microbial or viral toxins, but also in order to prevent dehydration.
It was stated above that young children and the elderly are at risk for dehydration. And if older people can still come into contact with a doctor, answer questions, and this makes it possible to collect anamnesis and understand what happened to them, then with babies, especially with infants, such verbal contact is impossible.
What are the vulnerabilities of babies, why are they more susceptible to the rapid development of dehydration? First of all:
- babies are much more likely than adults to suffer from infectious diseases that cause fever, diarrhea and vomiting. But in young children, fluid deficiency can be not only with intestinal infection, but even with colds and respiratory diseases, with bronchitis and pneumonia, and even with urinary tract infections, for example, against the background of exacerbation of pyelonephritis;
- the greater the volume of fluid in the body, the faster it is lost, since it can more easily leave the body: it is not so strongly associated with tissues;
- it should be remembered that if the volume of the body is small, then the ratio between body area and its mass increases, which means that the child loses water through the skin and mucous membranes through evaporation more than an adult;
- it has already been said that the compensatory organisms for retaining moisture in babies are not developed. A small child cannot, like an adult, increase the concentration of urine, since the kidney tissue has not yet fully matured;
- when thirsty, babies can neither drink nor ask for water on their own, and are completely dependent on others. Therefore, parents, especially young ones, need to watch the babies very carefully, especially in hot weather, and watch if they show signs of an impending fluid deficiency.
What are the typical symptoms of dehydration in adults and babies?
Signs of Water Deficiency: Symptoms of Dehydration
What is the main symptom of dehydration? To this any person will answer directly: it is thirst. This is true, but only for the initial and middle stages of fluid deficiency, and for a middle-aged adult. Only in middle-aged people do all the interneuronal connections that control the center of craving located in the brain work well. In addition to the expressed desire to drink, which can be painful and unbearable, the symptoms of dehydration can be considered:
- low sweating, and the production of small amounts of concentrated, dense and darkish urine, containing a large amount of salt. But, unlike thirst, low sweating can be invisible to the patient himself, just like a small amount of urine. Only by going to the toilet can you be convinced of this, and even then by paying attention. And when you don’t want to go to the toilet, you don’t even pay attention;
- but a symptom such as dry mouth, lack of saliva, or a condition where saliva is viscous, white and frothy, is difficult to miss;
- if dehydration progresses, then there is a reduced turgor of the skin, wrinkles, which, being taken into a fold, do not straighten, or straighten very slowly;
- general health worsens;
- cyanosis of the tip of the nose, lips, ears, fingers appears, due to a slowdown in capillary blood flow;
- blood pressure drops. After all, maintaining the hydrostatic pressure in the system is impossible if there is no liquid. No increased vascular tone and increased work of the heart can save it if there is no working fluid in the hydraulic system – water. The patient first develops signs of orthostatic hypotension, when dizziness and lightheadedness appear with a sharp rise to an upright position;
- later on there is confusion, drowsiness, and shock;
- with extremely rapidly developing extreme dehydration (about 12% of body weight), the blood thickens in the vessels, the veins collapse, microcirculation is disturbed, and the body temperature drops rapidly. Thrombosis develops, and a person dies with symptoms of hypovolemic shock.
Babies and toddlers have special symptoms of severe dehydration that adults do not. It:
- progressive pallor;
- rapidly developing retraction of the eyeballs, when pressed on them, their softness is felt;
- the appearance of dark circles under the eyes;
- in infants, in addition to sunken eyes, sunken fontanelles can also be detected on palpation, that is, non-overgrown seams between the bones of the skull, filled with temporary cartilaginous tissue;
- crying in such a baby is dry, without tears, since there is also not enough tear fluid;
- the vocal cords, which can produce a loud cry in a child, must be turgid and elastic. If dehydration progresses, then the vocal cords become flabby and shrink, and the crying becomes hoarse and quiet, there is practically no cry.
These symptoms will be enough to make a diagnosis and start urgent fluid replacement, since the baby will not complain to you either of thirst or lack of urination. Naturally, in babies with severe and even moderate dehydration, it is useless to inject liquid through the mouth; massive intravenous rehydration therapy is needed.
How do you diagnose dehydration with blood tests?
If dehydration has reached a severe degree, then blood, especially from the peripheral ulnar vein, cannot be obtained for analysis. Due to the lack of fluid, the vein collapses, and the needle does not penetrate into the lumen of the vein, but pierces it through, since the lumen is simply absent: after all, in soft veins it is created by blood pressure. Therefore, the first laboratory sign of severe exicosis is the inability to obtain blood from a peripheral vein.
If, after all, there is blood, then it goes with difficulty, since a very high hematocrit is the ratio between liquid plasma and blood cells. That is, there are much more shaped elements than liquids or plasma. This phenomenon is relative, and if there was the right amount of fluid in the blood, then all cellular elements would be observed in normal concentration, distributed in a larger volume. And with dehydration, one can note relative erythrocytosis, leukocytosis, and thrombocytosis.
In biochemical analysis, first of all, an increase in blood plasma sodium is noticeable, and in the event that there is severe repeated vomiting, then chlorine is also lost with it. The patient develops acidosis, and the plasma bicarbonate concentration decreases. If dehydration is severe and acidosis progresses, then there is an increase in ketone bodies and lactic acid as markers of decreased tissue perfusion.
The best remedies for dehydration
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Replenishing water supplies
It was said above that it is necessary to replenish not only fluid reserves, but also lost electrolytes. All methods of rehydration, that is, fluid replacement, can be divided into oral and infusion (intravenous).
Oral rehydration therapy, in which you need to drink very often and in small sips, is possible during the initial stages of dehydration, as well as in the absence of vomiting. If there is severe vomiting and diarrhea, then hospitalization is necessary, and rehydration by intravenous infusion. If bouts of vomiting are rare, then oral fluid replacement is also possible if you drink frequent sips about every 10 minutes.
If there is no vomiting, but there is diarrhea, then you can give more fluid and less often, after each bowel movement, approximately in the amount of lost fluid plus 10-20% of the approximate volume of watery stools. If we are talking about infants, then usually the solution to replenish fluid loss should be given at the rate of at least 100 ml for each kilogram of the child's weight, but not more than 160 ml. Therefore, if we are talking about continuing diarrhea in a child, for example, weighing 9 kg, then he should drink from 900 ml to one and a half liters of liquid per day, provided that the diarrhea does not stop.
In general, a baby with a mild degree of dehydration is not going to drink salty oral rehydration solution with great desire. Therefore, if fluid replenishment is started early, then the child will be happy to drink light chicken broth, mineral not very salty water, or even juice, but always diluted with water. But if dehydration continues, then one cannot do without compensation for the loss of salts.
In adults, naturally, there is less fluid in the body, therefore, in the presence of a mild degree of dehydration, an amount of fluid of no more than 50 ml per kilogram of body weight is sufficient, and about 80 ml per kilogram of body weight with an average degree of dehydration, when there is already a decrease in blood pressure and a deterioration in general well-being. It is desirable to drink the solution often, after 15 minutes, but in case of nausea – no more than 100-150 ml. Accordingly, within an hour it is necessary to consume a liter or one and a half.
What solutions are created specifically to replenish fluid and salts, and are sold in pharmacies?
Oral rehydration solutions
This section will not cover preparations packaged in glass bottles of 200-400 ml, or plastic bags. These are sterile solutions for intravenous administration. These are the preparations 'Disol', 'Trisol', 'Lactasol', 'Acesol' and others. There is no point in buying them to take inside. It is also strictly forbidden to replenish the liquid deficit with energy drinks, tonics, carbonated sweet lemonades and fizzy drinks, sweet juices without prior dilution with water, Coca-Cola, and other liquids. They contain a lot of carbohydrates and carbon dioxide, and their osmotic concentration can increase fluid loss, and only worsen well-being.
If there is no way to get to the pharmacy, then the simplest solution is one tablespoon of table salt and two tablespoons of sugar per liter of water. The solution will be even more effective if you add one teaspoon of baking soda. It is much better to take glucose instead of sugar, if you have one. Industrial solutions differ from homemade, homemade ones by adding additional ingredients.
Historically, all solutions for replenishing the liquid deficiency, first of all, except for table salt, contained an energy substrate, glucose, so they had a high osmolarity – more than 310 mosmol. One of the first and most important is the solution recommended by the World Health Organization, which is called the WHO solution.
This solution includes sodium chloride, potassium chloride and sodium bicarbonate, as well as glucose. The osmolarity of the solution was 331 mOsm. This solution was used for a long time, and although it compensated for the deficiency of ions and fluid, the osmolarity was high, and the diarrhea did not stop. Moreover, diarrhea was then caused by the solution itself, acquired a hyperosmolar character, which, of course, is unacceptable.
It turned out that the composition of the WHO is good only in the case of cholera, since Vibrio cholerae deliberately creates a high osmolarity of the diarrheal fluid due to the massive release of salts and a large loss of sodium. With cholera, the loss of only one sodium can reach 120 millimoles per liter of diarrheal fluid. In the modern world, with ordinary intestinal infections, for example, with rotavirus infection in European countries, diarrhea is not so massive, and sodium is lost twice as slowly, amounting to 55-60 millimoles per liter. Therefore, it was necessary to reduce the osmolarity of the solution, at least by several tens of units. Therefore, at present, one of the most famous, effective and popular solutions is Regidron, with a reduced osmolarity.
This bright yellow sachet contains sodium chloride, potassium chloride, sodium citrate and dextrose (D-glucose). The osmolarity of Regidron is between 200 and 250 mOsm per liter. the content between sodium and glucose in this powder is best for water absorption, and helps to reduce the osmolarity load for the intestine. In addition, this solution has a milder taste, and the presence of sodium citrate improves energy metabolism, since citrate, or citric acid salt, is a substrate for the Krebs cycle, a universal tricarboxylic acid cycle. It runs in almost every cell of the body, and serves as a source of energy, being an essential element of the process of cellular respiration.
The medicine is used not only to restore water-electrolyte, but also acid-base balance. In addition to diarrhea, the remedy can also be used with intense sweating, with vomiting, with the exception of persistent and exhausting, when intravenous fluid deficiency is needed. The medicine must be dissolved in one liter of boiled cool water, and given in the proportions indicated above until the elimination of dehydration, the cessation of diarrhea and the restoration of the water-electrolyte balance.
Rehydron is produced by Orion Corporation, Finland. Powder for oral solution, each bag contains 18.9 g of powder, 20 bags in one package. The cost of packaging is from 340 to 400 rubles, about 20 rubles per package.
A little about intravenous rehydration
As practice shows, about 80% of all cases of severe fluid deficiency can be stopped with the help of oral solutions. The remaining 10-15% of patients require intravenous fluids.
Intravenous rehydration is performed in two phases. The rapid onset phase, or initiation, is the main fluid replenishment. The very first portions of fluid are designed to increase the volume of blood in the vessels, normalize hemodynamics, capillary tissue respiration, and increase the pressure in the arteries of the kidneys. This will lead to restoration of urine output, decrease in tissue acidosis, and avoid the progression of metabolic disorders.
To start replenishing the fluid deficit, it is advisable to drip and give the patient in the first and second hours an ordinary sodium chloride solution, which is called isotonic, or physiological, a concentration of 0.9%. The specific volume of administration should be 20 ml per 1 kg of body weight per hour. Such an introduction should be carried out 2-4 times, in portions for half an hour, followed by an assessment of the condition. Then they switch to a slower, 'planned' rate of introduction of more perfect solutions with the presence of potassium and bicarbonates.
In the case of very severe, threatening dehydration, when the patient is in a coma, for example, with severe cholera, it is useless to use intravenous infusions into ordinary veins, for example, in the elbow bend area. It was said above that against the background of low pressure and blood thickening, all peripheral veins are collapsed, and the blood flow in them practically stops. Such an infusion will do nothing, except for a worsening of the condition.
Therefore, the patient should urgently be placed a catheter in a large vein – the subclavian vein, as anesthesiologists do in intensive care units, and even put a subclavian catheter on both sides, right and left. A sterile solution for intravenous rehydration, which was described above, is injected into the patient in a stream or very quickly dropwise. It is very important that the solution is warmed up to body temperature and even slightly higher, up to 37 degrees, since with a dehydration coma, body temperature decreases. And the additional introduction of large quantities of cold solutions can even cause reflex cardiac arrest.
After the blood pressure has stabilized, the oxygen saturation in the capillaries has increased, it is necessary to fight intravascular thrombosis, with a shift in acid-base balance towards metabolic acidosis, and fight the underlying disease. This should be done by specialists anesthesiologists-resuscitators who are able to treat such severe dehydration, and the infectious disease doctor or other specialists should deal with the cause of dehydration – for example, salmonellosis.
Attention! This rating is subjective and does not constitute an advertisement and does not serve as a purchase guide. Before buying, you need to consult with a specialist.