Dehydration (medicine)
| Classification according to ICD-10 | |
|---|---|
| E86 | Volume depletion dehydration |
| ICD-10 online (WHO version 2019) | |
Dehydration (in ancient Greek ὕδωρ hydor , German ` ` water '' ; synonyms dehydration , desiccosis , dehydration , hypohydration , dehydration ; antonym overhydration ) in medicine describes a loss of fluid or a lack of volume of the extracellular fluid , which also includes the blood plasma . The cause is a disruption of the volume balance (loss of sodium and water) or osmoregulation (isolated water loss ).
The colloquial term “dehydration”, on the other hand, describes a certain chemical reaction .
causes
Fluid is released through the gastrointestinal tract ( stool ), the lungs ( breathing air ), the kidneys ( urine ), through the skin ( perspiration ) and from the mammary glands ( lactation ). Illnesses (for example of the kidneys), symptoms such as fever and vomiting, vigorous physical exertion, breastfeeding or medication for dehydration can lead to increased fluid loss and thus to fluid imbalance if the lost fluid volume is not appropriately replaced. An excessive decrease in body fluid - either through pathologically reduced fluid intake, through insufficient fluid intake (in the event of unavailability of drinking water and other beverages), with abnormally increased fluid loss or during lactation - leads to desiccosis .
- Classification
There are three types of dehydration:
- Isotonic dehydration: With this dehydration, the osmotic pressure of the extracellular space does not change because the loss of water and salt ions ( sodium + , chloride - ) occurs in the same ratio to each other. This is particularly the case with insufficient water and sodium intake, but also with vomiting or diarrhea .
- Hypertonic dehydration: occurs when you lose water without losing salt. This can be the case with diabetes insipidus or with high blood sugar levels in the context of diabetes mellitus .
- Hypotonic dehydration: If too much salt is excreted in relation to the water loss, hypotonic dehydration occurs. It is a complication of burns or a symptom of adrenal insufficiency , but can also occur, for example, with profuse sweating and water balance with low-salt fluids (pure water), so that the balance of salt excretion is higher than the water excretion. In the latter case, mineral water or so-called iso drinks, which are isotonic (compared to blood plasma), are sufficient to compensate for this. It is not necessary to drink hypertonic fluids as the body can excrete excess water through the kidneys if necessary.
Symptoms
Diagnosis
The diagnosis is made on the basis of the clinical picture, an examination of the blood serum and urine (in particular for the sodium content, hematocrit and creatinine values as well as the serum or urine osmolality ).
therapy
The most important therapeutic measure of any rehydration is the replacement of the lost water. In the case of mild dehydration, this is done either orally or via a feeding tube with drinks, or parenterally with a suitable infusion solution . Depending on the severity, sometimes several liters of liquid must be infused . The infusion solution differs depending on the type of dehydration: In the case of isotonic dehydration, a simple Ringer's solution can be given. In the case of hypotonic dehydration, sodium ions sometimes also have to be replaced, but this compensation must take place very slowly so as not to provoke severe cerebral side effects. Hypertonic dehydration is treated , for example, by infusing a five percent glucose solution .
End-of-life dehydration can cause distressing symptoms, but treatment for it can also be detrimental. Therefore, a systematic catalog of questions is worked through in palliative medicine in order to arrive at an appropriate decision for the individual patient based on the established advantages and disadvantages.
Dehydration in children
Especially in infants and young children, dehydration arises due to gastroenteritis with vomiting and diarrhea with simultaneous refusal to eat. In infants, 5% weight loss is considered to be mild dehydration, 10% significant, and 10–15% severe dehydration. Older children are less sensitive to fluid loss.
- Symptoms in the infant
Signs of dehydration in infants include gray skin and rapid breathing; the eyeballs and fontanels have sunken. In addition, restlessness, but also tiredness, and in severe dehydration also apathy , lethargy and unconsciousness can occur.
See also
Individual evidence
- ↑ Peter Reuter: Springer Lexicon Medicine. Springer, Berlin a. a. 2004, ISBN 3-540-20412-1 .
- ↑ MSD Handbook Health. 2007, ISBN 978-3-89905-394-4 .
- ↑ dehydration. Species. In: PflegeFakten. Urban & Fischer, Munich 2009, p. 148
- ↑ Entry on dehydration in Flexikon , a wiki from DocCheck , accessed on November 25, 2015.
- ↑ H. Neuenschwander, Ch. Chappuis: Fluid supply at the end of life. (PDF) In: Newsletter Palliative Medicine SGIM , March 2008; accessed on June 30, 2019
- ↑ Lentze et al .: Pediatrics. Basics and practice. Springer Verlag, Berlin / Heidelberg / New York 2003.
- ↑ dehydration. Infant: symptoms. In: PflegeFakten. Urban & Fischer, Munich 2009, p. 149.
- ^ Jost Kaufmann, Michael Laschat, Frank Wappler: Preclinical care of child emergencies. In: Anaesthesiology & Intensive Care Medicine. Volume 61, 2020, pp. 26–37, here: p. 30.
