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Dehydration, or exicosis, is quite common in the clinic. infectious diseases, and especially when it comes to acute intestinal infections in children and the elderly. Middle-aged people are prone to dehydration to a lesser extent due to well-developed compensatory fluid retention mechanisms. But even if an adult, healthy and strong person will meet, for example, cholera, then after two days, losing over 10% of its weight body, he can die very quickly. Dehydration reaches so much so that the blood begins to coagulate in the vessels, generalized thrombosis, peripheral veins occur start and fall, capillary blood flow practically stops, body temperature drops, and irreversible multiple organ failure. And cholera vibrio has no deadly poisons and toxins: all he can do is stretch all water from a person to multiply vibrios spread to the largest possible area.
It would seem simpler: the best remedy for dehydration is This is water. Unfortunately, this is not entirely true. Together with water loses a large amount of electrolytes, and mineral salts. If a make up for 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, which will lead to decompensated electrolyte imbalances. Consider how the water reserves in the human body are distributed. After this, dehydration development mechanisms will be more understandable, and its the reasons.
Water in the human body
Once upon a time, several hundred million years ago, we all (more precisely, our ancestors), lived in the water, and, going to land, they they took with them part of the external ocean environment in the form of water. It is a universal solvent and everything happens in it chemical reactions supporting homeostasis, or constancy internal environment.
In a healthy adult, water is almost 60% of the mass body, the rest falls on the dry residue. Who has the body contains more water, in men or in women? More water in the body of men, because they have more muscle tissue, and women usually developed more adipose tissue. But fat contains less water, than muscles, it is hydrophobic, and repels water. In women in an average of 53% of the body’s water, and about 60% in men.
Organisms of babies contain significantly more water, and especially newborns who consist of water by almost 70%. Than the older the person, the less water in the tissues of his body. This the phenomenon is reflected in age-related pathology, for example, in osteochondrosis, in which the intervertebral cartilage discs are gradually decrease in volume, lose their elasticity, dry out, and cause certain symptoms – back pain, and limitation range of motion.
The absolute amount of water in the body of a person who weighs about 70 kg, quite impressive: more than 42 liters of water. This is the volume a fairly large and roomy aquarium, in which not even very small fish will feel comfortable. From this volumes of about 28 liters are in the form of intracellular fluid, and interstitial, or intercellular and tissue fluid, will make up a volume of approximately 10.5 liters, together with lymph. Overall volume blood usually accounts for 8% of all body water, and for humans such a mass is quite “enough” about 3.5 liters of blood.
Naturally, a person receives water only orally, then eat by mouth, with drinking water and drinking fluids, contained in food. A certain amount of fluid a person is capable of absorb through the skin, but this volume is so small that is of only theoretical interest. So, after being in a bath or a sauna, having plunged into a cool pool, a person can absorb about 10 ml of water with the area of your skin.
Loss of excess fluid is mainly through the kidneys. Water is also lost due to sweat glands, evaporating through the surface of the skin, and with the lungs, during exhalation. Healthy human, all “planned losses” of water are strictly compensated by its consumption, the water balance is in equilibrium.
The usual amount of water needed by an adult who not in a hot climate and not engaged in heavy physical labor, is about 2 liters of fluid daily. If the temperature the environment rises or the level of physical load, the amount of water lost through the skin and lungs may double in size.
In a healthy adult in the intestines every day about 7-8 liters of fluid are secreted. Where does it come from? After all, with with food we get only 2 liters. Yes it is. Two liters of water ingested with food, but:
- about the same or even more, about 2.5 liters fall on gastric juice;
- 1 liter of water is contained in the daily volume of saliva;
- 1.5 l is intestinal juice;
- finally, 0.5 l is accounted for by bile.
Everyone can make sure that such a volume of fluid is not intestinal stands out. This is true, 75% of the fluid is absorbed back in the small intestine and 25% in the large intestine, and excreted in the feces a day only about 200 milliliters, or even less. So Thus, the body is very economical in spending water.
It follows that if you start the fight against dehydration when it hasn’t gone too far then excess fluid loss easy to compensate at the very beginning. But if the patient is already in in a state of deep dehydration, then fluid intake through the mouth is no longer enough. Oral rehydration may be inhibited impaired consciousness, fainting, or severe vomiting. In this case intravenous rehydration is needed, which will be briefly described said at the end of the article.
Causes of dehydration
When does dehydration develop? When water consumption cannot compensate for losses, or is it completely absent (for example, babies and babies themselves cannot take measures to find water, as adults). Most often, children and the elderly are dehydrated people. Kids lose water quickly because their compensation mechanisms still imperfect, and in older people is not good enough a thirst center located in the brain functions and therefore, many older people simply do not understand what they thirsty.
In fact, dehydration is true, to a degree, to all of us. very familiar, and we experience it regularly. Lung dehydration occurs every morning after our awakening. After all in a dream we spend a third of our life, and sometimes more, and if a person at night does not wake up, then he does not drink. At the same time, all systems our body continues to work at night, but the liquid is not arriving. That is why in the morning hours the blood is thicker, for oxygen transport and capillary gas exchange more pressure is required and the heart begins to work stronger. That is why in the early morning hours and often cardiovascular disasters, such as heart attacks, strokes, fatal arrhythmias, and other serious disorders in the work of the body, associated with hemoconcentration and hypertension.
That is why immediately after waking up, it’s very good to drink a glass or two of Pure water, I can with lemon juice. This simple a way to make up the volume of circulating fluid is also good for hypertensive, and after that the blood pressure is somewhat declining.
What are the main causes of fluid deficiency in human the body? Here they are:
- the most severe fluid loss leading to hypovolemic shock occurs with intestinal infections. This is a loss with profuse, without bills, watery diarrhea or diarrhea, with vomiting when gastroenteritis;
- excessive sweating, especially in hot and dry climates on background of increased physical activity. It should be noted that with significant dehydration; fluid loss with sweat decreases and the amount of urine removed decreases;
- extensive burns lead to a deficiency of fluid (and protein);
- the loss of large amounts of water is possible by the kidneys with sugar (insulin-dependent) and diabetes insipidus, Addison’s disease, other endocrine disorders;
- brain tumors affecting the center of thirst, loss of feeling water shortage (rarely);
- chronic renal failure – if the kidneys cannot concentrate urine, then they have to significantly increase urine volume, this condition is called isohypostenuria;
- overdose of diuretics, especially gross and strong – furosemide, torasemide.
Mild forms of dehydration often occur in the background active sports, and especially in the hot season. Dehydration increases dramatically with increasing body temperature. Therefore, a person who does not even experience physical activity, and at rest during a cold and flu should drink as more fluid is possible, but not only for the purpose of detoxification, and the removal of microbial or viral toxins, but also for the purpose of prevention dehydration.
It was said above that small children and elderly people are groups risk of dehydration. And if older people can still enter in contact with a doctor, answer questions, and this makes it possible to collect an anamnesis, and understand what happened to them, then to the kids, especially with babies, such verbal contact is impossible.
What are the vulnerabilities of babies, why are they more susceptible 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 infections diseases, with bronchitis and pneumonia, and even with infections urinary tract, for example, against the background of exacerbation pyelonephritis;
- the larger the volume of fluid in the body, the faster it is lost because it can leave the body more easily: it’s not so firmly bound to tissues;
- it should be remembered that if the body volume is small, then the ratio between the 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 compensatory organisms of moisture conservation in kids are not developed. A small child cannot do the same as adult, increase urine concentration since kidney tissue is still not fully matured;
- while thirsting, babies cannot drink on their own, nor ask for water, and are completely dependent on others. therefore parents, especially young ones, need to watch carefully kids, especially in hot weather, and watch if they appear signs of upcoming fluid deficiency.
What characteristic symptoms of dehydration can be noted in adults and toddlers?
Signs of Water Deficiency: Symptoms of Dehydration
What is the main symptom of dehydration? Anyone at it He will answer directly: this is thirst. This is true, but only for initial and middle stages of fluid deficiency, and for an adult middle-aged person. Only middle-aged people are good all interneuron connections that control the center of thirst work, located in the brain. In addition to the expressed desire to drink, which can be painful and unbearable, symptoms dehydration can be considered:
- low sweating and low production concentrated, dense and darkish urine containing large amount of salts. But unlike thirst, low sweating can be invisible to the patient himself, just like a small the amount of urine. Just by going to the toilet you can see this, and even then, paying attention. And when you don’t feel like going to the toilet, then somehow the attention is not paid;
- but a symptom such as dry mouth, lack of saliva, or a condition where saliva is viscous, white and foamy, it is difficult not to to notice;
- if dehydration progresses, then reduced turgor occurs skin, wrinkles that, when taken in a crease, do not straighten, or straighten out very slowly;
- general health worsens;
- there is cyanosis of the tip of the nose, lips, ears, fingers, in connection with slowing of capillary blood flow;
- blood pressure drops. After all, support hydrostatic pressure in the system is not possible if absent liquid. No increased vascular tone and increased work heart cannot be saved if in the hydraulic system there is no working fluid – water. The patient first develops signs of orthostatic hypotension when appears dizziness and fainting with a sharp rise in vertical position;
- confusion, drowsiness, and shock condition;
- with extremely rapidly developing dehydration of extreme degree (about 12% of body weight) blood coagulates in vessels, veins decrease, microcirculation is disturbed, rapidly falls Body temperature. Thrombosis develops, and a person dies with phenomena of hypovolemic shock.
In infants and toddlers, there are special symptoms of serious dehydration, which is not in adults. It:
- progressive pallor;
- fast-developing retraction of eyeballs, with pressure they feel their softness;
- the appearance of dark circles under the eyes;
- in infants, except sunken eyes, can be detected with palpations and sunken fontanelles, i.e. ungrown sutures between the bones skulls filled with temporary cartilaginous tissue;
- the cry of such a baby is dry, without tears, because it is tearful liquid is also not enough;
- vocal cords that can produce a loud cry in child, must have turgor, and be elastic. If a dehydration progresses, then the vocal cords become flabby and dry up, and the cry becomes hoarse and quiet, screaming Hardly ever.
These symptoms are enough to make a diagnosis and start urgent fluid replenishment, since the baby will not be for you complain of neither thirst nor lack of urination. Naturally, in babies with a severe, and even moderate degree dehydration is useless to inject fluid through the mouth, it is necessary massive rehydration intravenous therapy.
How to diagnose dehydration by blood tests?
If dehydration is severe, then blood, especially it is impossible to obtain from the peripheral ulnar vein for analysis. Due to lack of fluid, the vein drops and the needle does not penetrate into the lumen of the vein, but pierces it through, because the lumen is simply absent: in soft veins it is created by blood pressure. Therefore, the first laboratory sign of severe exicosis is inability to get blood from a peripheral vein.
If, however, there is blood, then it comes with difficulty, since very high hematocrit – the ratio between liquid plasma and blood cells. That is, there are much more shaped elements than liquid, or plasma. Such a phenomenon is relative, and if if there was the right amount of fluid in the blood, then all the cellular elements would be observed in normal concentration, distributed in a larger volume. And with dehydration, a relative erythrocytosis, leukocytosis, and thrombocytosis.
In biochemical analysis, an increase is primarily noticeable blood plasma sodium, and in the event that there are severe multiple vomiting, then chlorine is lost with it. The patient develops acidosis, the concentration of plasma bicarbonate decreases. If dehydration severe and acidosis progresses, there is an increase in ketone bodies and lactic acid as markers of decreased tissue perfusion.
The best remedies for dehydration
|Nomination||a place||Name of product||price|
|Oral rehydration solutions||1||Rehydron||396 rub|
Replenish water supplies
It was said above that it is necessary to replenish not only reserves liquids, but also lost electrolytes. All rehydration methods then there is fluid replenishment, can be divided into oral and infusion (intravenous).
Oral rehydration, in which you must drink very often and in small sips, possible in the initial stages of dehydration, as well as in the absence of vomiting. If there is severe vomiting and diarrhea, then then hospitalization is needed, and rehydration by intravenous infusion. If bouts of vomiting are rare, then perhaps orally replenishment of fluid if drunk in frequent sips approximately 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 volume lost liquid plus 10-20% of the approximate volume of watery stool. If a it’s about babies, it’s usually a solution to make up for losses liquid should be given at least 100 ml per each a kilogram of the child’s weight, but also not more than 160 ml. Therefore if speech is about ongoing diarrhea in a child, for example, weighing 9 kg, then for day he should drink from 900 ml to one and a half liters of liquid, with provided that diarrhea does not stop.
In general, a baby with a slight degree of dehydration is not going to a great desire to drink a brackish solution for oral administration rehydration. Therefore, if fluid replenishment is started early, then the child will drink light chicken broth with great pleasure, mineral not very salty water, or even juice, but always diluted with water. But if dehydration continues, then without compensation for the loss of salts is no longer necessary.
In adults, naturally, there is less fluid in the body, therefore with mild dehydration the amount of fluid is not more than 50 ml per kilogram of body weight, and about 80 ml per kilogram of weight with moderate dehydration when there is already a decrease in blood pressure and a deterioration in overall well-being. It is advisable to drink the solution often, after 15 minutes, but in case of nausea – no more than 100-150 ml. Accordingly, during hours you need to use a liter or a half.
What solutions are created specifically for fluid replenishment and salts, and sold in pharmacies?
Oral rehydration solutions
This section will not discuss drugs packaged in 200-400 ml glass bottles or plastic bags. it sterile solutions for intravenous administration. These are drugs “Disol”, “Trisol”, “Lactasol”, “Acesol” and others. No sense of buying them to take inside. Also categorically it is forbidden to fill the deficiency of liquid with energy drinks, tonic, carbonated sweet lemonades and pops, sweet juices without prior dilution with water, Coca-Cola, and others liquids. They contain a lot of carbohydrates and carbon dioxide, and they osmotic concentration can increase fluid loss, and only only worsen well-being.
If there is no way to get to the pharmacy, then the most a simple solution is one tablespoon of salt and two tablespoons of sugar per liter of water. The solution will be effective even more if you add one teaspoon of baking soda. Much it is better to take glucose instead of sugar if it is. Industrial solutions differ from home-made, home-made ones by the addition of additional ingredients.
Historically, all replenishment solutions liquid deficiency in the first place, except for table salt, contained an energy substrate, glucose, so they had high osmolarity – more than 310 mosmol. One of the first and main – this is a solution recommended by the World Organization Health, which is called the WHO solution.
This solution includes sodium chloride, potassium chloride and sodium bicarbonate, as well as glucose. Solution osmolarity was 331 mosmol. This solution has been used for a long time, and although he made up for the deficiency of ions and liquid, but the osmolarity was high, and diarrhea did not stop. Moreover, diarrhea has already been caused then by the solution itself, it acquired a hyperosmolar character, which, of course, unacceptable.
It turned out that the composition of WHO is good only in the case of cholera, since cholera vibrio specifically creates high osmolarity diarrhea fluid due to massive salt output and large loss sodium. With cholera, the loss of only one sodium can reach up to 120 millimoles per liter of diarrheal fluid. In the modern world, with common intestinal infections, such as rotavirus infection in European countries, diarrhea is not so massive and sodium is lost twice as slow, amounting to 55-60 millimoles per liter. therefore it was necessary to reduce the osmolarity of the solution, at least by a few dozens of units. Therefore, at present, one of the most known, effective and popular solutions is considered Rehydron, with decreased osmolarity.
This bright yellow sachet contains sodium chloride, potassium chloride, sodium citrate and dextrose (D-glucose). Osmolarity of Regidron ranges from 200 to 250 mosmol per liter. content between sodium and glucose in this powder is the best for absorption of water, and helps reduce the load of osmolarity for the intestine. Besides of this, this solution has a milder taste, and the presence of citrate sodium can improve energy metabolism, since citrate, or citric acid salt, is a substrate for the Krebs cycle – universal cycle of tricarboxylic acids. It flows almost into each 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 for recovery water-electrolyte, but also acid-base balance. Besides diarrhea, the drug can also be used with intense sweating, with vomiting, except persistent and debilitating, when necessary intravenous replacement of fluid deficiency. The medicine is needed dissolve in one liter of boiled cool water, and give in the above proportions until elimination of dehydration, cessation diarrhea and restoration of water-electrolyte balance.
Rehydron is produced by Orion Corporation, Finland. Powder for oral solution, each packet contains 18.9 g powder, in one package 20 packets. The cost of packaging is from 340 to 400 rubles, about 20 rubles for one package.
A bit about intravenous rehydration
As practice shows, about 80% of all cases of expressed liquid deficiency can be controlled with oral solutions. The remaining 10-15% of patients require intravenous the introduction of solutions.
Intravenous rehydration is carried out in two phases. Fast phase the beginning, or initiation, is the main replenishment of the fluid. The most the first portions of fluid are designed to increase blood volume in the vessels, normalize hemodynamics, capillary tissue respiration, and increase pressure in the arteries of the kidneys. This will lead to recovery diuresis, reducing tissue acidosis, and avoids progression of metabolic disorders.
It is advisable to drip to start filling up the fluid deficiency give the patient in the first and second hours the usual solution of chloride sodium, which is called isotonic, or physiological, 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 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 potassium and bicarbonates.
In the case of very severe, threatening dehydration, when the patient is in a coma, for example, in severe cases cholera, useless to use intravenous infusion in ordinary veins, for example, in the elbow. It was said above that on background of low pressure and blood thickening all peripheral veins are dormant, and the blood flow in them practically stops. Such an infusion will do nothing but worsen the condition.
Therefore, a catheter should be urgently placed on the patient into the large vein – the subclavian vein, as anesthetists do in resuscitation departments, and even put a subclavian catheter from two sides, right and left. The patient is injected jet or very quickly. drip sterile solution for intravenous rehydration, about which was written above. It is very important that the solution is warmed up to body temperature and even a little higher, up to 37 degrees, because with dehydration coma, body temperature declining. And the additional introduction of a large number of cold solutions can even cause reflex cardiac arrest.
After the blood pressure has stabilized, increased oxygen saturation in the capillaries, it is necessary to fight intravascular thrombosis, with a shift in acid-base balance towards metabolic acidosis, and fight the main a disease. This should be done by specialists. resuscitation anesthetists who can treat this kind of severe dehydration, and deal with the cause of dehydration – for example, salmonellosis, should an infectious disease doctor, or others specialists.
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