Water is the most abundant constituent of the human body comprising for about 60% of the total body weight. Majority (2/3) of this is inside the cells, while the rest lies in plasma and interstitial fluid (around the cells). The water content in the body is subjected to tight regulation by various mechanisms that control the dissolved electrolyte contents in body water ( mainly Na+ and K+ – which takes water along them), thirst and water excretion by kidneys. Under normal conditions these mechanisms balance the water intake and the output maintaining the exact amount of water in a given time for the optimal function of the systems.
When the water loss exceeds the intake and the total water content falls below the normal required range, it is called dehydration. Common causes of dehydration are;
• Severe diarrhea
• Severe vomiting
• Excessive sweating
• Inadequate intake of fluids
• Excess urination (e.g. Diabetes Insipidus)
Infants, children, older adults, chronically ill and debilitated individuals are more at risk of getting dehydrated. However, anyone who is lost at desert, sea, in places where there is no access to safe water and who are working or exercising in hot humid weather can go in to dehydration irrespective of health condition.
Severe dehydration is a medical emergency and as invariably fatal outcome if not properly intervened; also it is fairly a common condition where any child can go into severe dehydration with improperly managed episode of viral diarrhea frequently seen in childhood, within very short time. Therefore it is of vital importance acquire skills during first aid training, to identify a severe dehydration prompting treatment, as well as to prevent a victim to go into severe dehydration by proper management of oral fluid replacement at initial stages.
Signs and symptoms
• Mild to moderate dehydration
- Decreased urine output
- Passage of dark colored urine
- No tears when crying
- Irritability and confusion
- Dry mouth
- Dry skin
• Severe dehydration
- Altered level of consciousness – thirst may be absent
- Absent urination
- Sunken eyes
- Loss of skin turgor – doesn’t bounce back when pinched to a fold
- Sunken fontanels in infants
- Very slow capillary refill – on pinching a nail.
- Rapid heartbeat
- Low blood pressure
- Loss of consciousness
- It has to be kept in mind that thirst is not a reliable gauge indicating the level of dehydration. Though thirst increases with mild to moderate stages of dehydration, at severe stage patient may not indicate any thirst at all due to delirium.
First aid management
1. Carry out a quick overview survey of the patient to identify his/her situation. To identify these symptoms/sign accurately, get exposed to those during first aid courses and training.
2. Call for emergency services if above mentioned signs of severe dehydration are present.
3. If the patient is unconscious quickly assess airway, breathing (look, listen and feel) and circulation (pulse).
4. If not breathing attend to basic life support; establish the airway by head tilt, chin lift maneuvers and commence CPR.
5. If the patient is vomiting, turn the victim to him/her side to prevent aspiration.
6. Be careful on administering oral fluids in severely dehydrated victims as these may cause aspiration due to altered level of consciousness.
7. For mild/moderate dehydration; give as much as fluids to drink, water is preferable to fruit juices or carbonated beverages in adults.
8. For infants and children; use an oral rehydration solution like Pedialyte as these supply water plus electrolytes in optimal amounts to replenish loses as well as to enhance the water absorption from gut.
9. If these are unavailable in an emergency, make your own rehydration solution by mixing carefully measured ½ teaspoon of salt, 6 level teaspoons of sugar and 1 liter of safe drinking water to use on older children and adults.
10. In all cases keep records of how much fluid given and how much were the losses (volume of urine passed, vomited, stools).
11. In vomiting patients; give small amount of fluid at a time and wait for few minutes.
12. Urine output and its color is a good indicator of hydration status specially in children.
13. Continue to breastfeed the sick infants/children.