Desiccosis

Classification according to ICD-10
E86	Lack of volume Dehydration
ICD-10 online (WHO version 2019)

As Exsikkose ( lat. Ex "off" and siccus "dry"), formerly also thirst disease called, in the medicine dehydration through loss of body water , respectively. It is the result of (severe) dehydration .

The term desiccosis is also used for the clinical signs of body water deficiency and synonymously for dehydration, especially the hypertonic form.

causes

The cause of desiccosis is dehydration: either insufficient or missing fluid intake or increased fluid loss without adequate compensation.

Risk groups and factors

Infants and young children as well as elderly or obese people are particularly at risk . All forms of diarrhea can lead to desiccosis at any age, but especially in infancy and small children due to a high fluid turnover and insufficient reserves. A lack of thirst or insufficient fluid intake is a main cause of people who are in need of support who are consciously or perceptually impaired or who have dementia . The feeling of thirst can also be impaired with regular alcohol consumption. In addition, restricted mobility can lead to a person not being able to obtain sufficient fluids on their own. Some people who are affected by urinary incontinence consciously limit their fluid intake for fear of involuntary wetting. In addition, physical exertion and profuse sweating lead to increased fluid requirements.

Taking diuretic drugs such as diuretics or laxatives can lead to increased excretion of fluids, as can certain infectious diseases that include vomiting or fever. Desiccosis occurs as a result of polyuria in diabetes insipidus or diabetes mellitus ; in the latter, triggered by significantly increased blood sugar levels, which can lead to a diabetic coma . Kidney disease, extensive burns, and dysphagia can also be the cause of desiccosis.

Symptoms

Signs of dehydration include:

• Thirst (may be absent in elderly patients, taking certain drugs, cerebral disorders or impaired consciousness, and hypotonic or isotonic dehydration)
• dry mucous membranes
• lack of saliva pool under the tongue
• increasing tiredness, lethargy or confusion
• Weight loss
• decreased excretion of highly concentrated urine ( oliguria , anuria )
• constipation
• a headache
• Muscle cramps (usually indicating hyponatremia ), cerebral seizures
• Lingering folds of skin are a sign of dehydration only in babies. This symptom rarely occurs in desiccated obese people, while in old people there can be such skin folds even without dehydration.

In severe desiccosis there are symptoms of shock .

Diagnosis

There are some clinical signs but no single parameter that indicates dehydration.

• Blood sodium level increased
• Hematocrit increased
• Collapsed jugular veins
• ZVD low: <5 cm water column
• Inferior vena cava narrow on ultrasound
• Increased body temperature (thirsty fever )
• Increased levels of aldosterone and ADH in the blood

consequences

The consequence of desiccosis is always a combined disturbance of the water-electrolyte balance . This can lead to changes in the flow properties of the blood .

In elderly patients, the main clinical consequences of desiccosis are one

• Reduction of the general condition and consequent bed rest,
• Somnolence (drowsiness with abnormal sleepiness as a mild form of clouding of consciousness)
• possible agitation as long as the lack of water persists: confusion ,
• Oliguria with the consequent accumulation of substances which have to be eliminated,
• Dryness of the skin and mucous membranes as well
• orthostatic hypotension and the associated risk of falling.

The desiccosis can lead to symptoms similar to the passage syndrome (see there); Such a desiccosis is (sometimes controversially) sometimes referred to as a passage syndrome.

The decline in general condition is often incorrectly explained by the age of the patient himself or by existing comorbidities. Desiccosis can appear very quickly in old patients on hot summer days. As a caregiver, you should definitely keep an overview of what was actually drunk by taking notes (drinking plan) or markings. If necessary, it must be urged that beverages brought are actually drunk. Urine production is a good way of checking; a decrease in the amount of excrement should be a warning.

therapy

Treatment for desiccosis is to restore and maintain a physiological fluid balance so that symptoms usually resolve within hours or days:

Preferably, people are instructed to drink independently. If the patient is too weak or if he cannot follow the instructions, liquid or food with a high water content (such as fresh fruit, soups, porridge, yoghurt or pudding) is given orally, in small amounts by spoon or sip. In the event of swallowing difficulties or impaired consciousness, the fluid is supplied via an infusion , whereby electrolyte controls should be carried out. In some cases, artificial feeding is also an option , either via a nasogastric tube or a percutaneous endoscopic gastrostomy (PEG tube).

However, this is not always unproblematic in practice, since desiccated patients can refuse treatment or behave in a challenging manner due to their impaired condition. It can therefore happen that patients tear out the infusion cannula or probe. Therefore, these patients were often restrained ; which is now very controversial.

It is noticeable that shortly after the start of rehydration , some of the previously cognitively impaired patients cleared up again.

Prevention

The key protective measure is to ensure regular and adequate hydration. The amount depends, among other things, on age. As a guideline, for example, a liquid volume of 1.3 to 1.5 liters is given for senior citizens. In some patients, however, the amount they drink is limited for medical reasons, e.g. B. in heart failure or kidney weakness.

If a so-called drinking log is kept over a certain period of time, it can be determined when particularly well and which drinks were particularly enjoyed. Fresh fruit (e.g. melon, peach, applesauce), vegetables (tomato, cucumber), soups or other water-rich products (jellies, yoghurt, quark) can be an alternative to drinks; Thickened liquids make it easier to drink if you have difficulty swallowing.

People in need of care may need support with fluid intake, for example with the provision of drinks in adapted drinking vessels or direct assistance with drinking.

Problem

Volume deficiency is one of the main causes of confusion and hospitalization in Germany. In 2000, 21,529 people over 65 years of age were hospitalized for volume depletion (ICD-10 E86), and by 2010 the number rose to 76,958. The diagnosis of desiccosis can be an indication of care deficits, especially in old people's homes, but also in home care.

Individual evidence

1. ↑ Joachim Frey : Diseases of the kidneys, the water and salt balance, the urinary tract and the male sexual organs. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid 1961, pp. 893-996, here: pp. 907-910.
2. ↑ ^{a b} Care Today. 5th edition. Elsevier, Urban & Fischer, 2011, ISBN 978-3-437-26773-4 , p. 1071.
3. ↑ ^{a b} Care Today. 5th edition. Elsevier, Urban & Fischer, 2011, ISBN 978-3-437-26773-4 , p. 419.
4. ↑ Care Today. 5th edition. Elsevier, Urban & Fischer, 2011, ISBN 978-3-437-26773-4 , p. 831.
5. ↑ Jörg Braun, Arno J. Dormann (Ed.): Clinic Guide for Internal Medicine. 13th edition, Elsevier, Munich 2016, p. 414.
6. ↑ Marcus Sefrin: Does the patient need fluids? Desiccosis is a diagnostic challenge. In: Geriatrics Report (2018) 13:27; Springer Medizin , doi : 10.1007 / s42090-018-0076-4 , accessed June 30, 2019
7. ↑ Sylke Werner: Professional care for people with dementia. In: Fachkompetenz Pflege: S.118 ; accessed on June 28, 2019
8. ↑ Guidelines of the Bavarian State Care Committee: Artificial nutrition and hydration. 2008 ; P. 29.
9. ↑ ^{a b} J. M. Wenderlein: Elderly Care: Deficits - and no end? Deutsches Ärzteblatt 2005; 102 (37): A-2448 ; accessed on June 30, 2019
10. ↑ ^{a b} German Society for Nutrition e. V .: DGE practical knowledge - drinking in old age. As of 2012, p. 8; accessed on June 30, 2019
11. ↑ Ruth Mamerow, Arne Schäffler: Ausrocknung. 2018 ; accessed on June 30, 2019
12. ↑ German Society for Nutrition e. V .: DGE practical knowledge - drinking in old age. P. 14; accessed on June 30, 2019
13. ↑ German Society for Nutrition e. V .: DGE practical knowledge - drinking in old age. P. 26; accessed on June 30, 2019
14. ^ Center for Quality in Care (ed.): Eating and drinking. Practical tips for everyday care. 6th edition, Berlin 2018; accessed on June 30, 2018
15. ↑ ^{a b} Care Today. 5th edition. Elsevier, Urban & Fischer, 2011, ISBN 978-3-437-26773-4 , p. 1072.
16. ↑ H. Ramroth et al .: Use of inpatient hospital services by nursing home residents. In: Deutsches Ärzteblatt 2006; 103 (41): A 2710-3; accessed on June 30, 2019
17. ↑ Christoph Petri: Subcutaneous hydration for mild to moderate dehydration of people in need of care. Fulda Information Service for Applied Health Sciences and Clinical Practice, 2012 ; accessed on June 30, 2019

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !