Module 6. Dehydration

Transcription

1 Module 6 Dehydration

2 MODULE 6 INTRODUCTION Introduction We naturally lose water every day in the form of water vapor in the breath we exhale and in our excreted sweat, urine, and stool 1. When there is not enough water in our bodies, or more water is leaving the body than what is being taken in, we become dehydrated 2. Electrolytes On a chemical level, an electrolyte is a substance that becomes an ion in a solution and can conduct electricity 4. Electrolytes are also present in our bodies and they need to be balanced for cells and organs to function normally 4. Electrolytes play an important role in the amount of water present in the body, the acidity of the blood (ph), muscle function and other essential processes 5. MODULE 6 introduction How dehydration occurs 2 Step 1: Our bodies recognize dehydration when the thirst centre of the brain sends out messages to drink more water. Step 2: If the fluid intake that occurs cannot keep up with the loss of fluids, dehydration will become more severe. At this stage, the person sweats and urinates less. Step 3: To keep blood volume and pressure at healthy levels, water from inside the cells migrate to the bloodstream. Step 4: If dehydration continues, body tissue starts to dry out, which leads to cells shrinking and no longer functioning normally. Water is essential for the body to keep performing its everyday functions 1 which is why it is so important to stay hydrated. To replace our natural bodily fluid loss, we need to take in an adequate amount of water each day 1. The electrolytes of the human body There are six major electrolytes present in the human body calcium, chloride, magnesium, phosphorous, potassium and sodium 5 and each of them performs its own important role: Electrolyte Function Intake Sodium (Na+) Chloride (Cl-) Potassium (K+) Sodium controls the total amount of water in the human body. It regulates blood volume and maintains healthy muscle and nerve function 6. Chloride works with sodium to ensure proper balance and pressure of the fluid compartments between and inside cells. It also maintains proper acidity in the body 6. Potassium is important for regulating heartbeat and muscle function. A feedback loop between sodium and potassium is critical to neuron transmission 6. The major source of sodium for most humans is table salt. The recommended amount should not exceed 2.3 g per day any more can lead to hypertension 6. Chloride is also obtained from salt in the diet 6. Meat, milk, fruits and vegetables are rich in potassium. An imbalance between potassium and sodium can increase the risk of hypertension, heart disease and strokes 6. Fast fact Magnesium (Mg++) Magnesium helps maintain normal nerve, muscle and immune functions, maintains a stable heart rate, stabilises blood sugar and promotes the formation of bones 6. Nuts, spices, leafy green vegetables, coffee and tea are all generally good sources of the mineral 6. 75% of the body s weight consists of water 3. Calcium (Ca++) Calcium is necessary for the formation of healthy bones and teeth, and critical for healthy nerve impulses, blood clotting and muscle contraction 6. An intake of 1000 to 1500 mg per day is necessary to maintain suitable levels in the bloodstream and to avoid the weakening of bones 6. % Water in the human body: Brain 75% water. Blood 92% water. Bones 22% water. Muscles 75% water. Phosphate (HPO4 ) Phosphate works with calcium to strengthen bones and teeth, is essential for energy production within cells, tissue growth and repair, and is a building block for cell membranes and DNA 6. Fast fact The majority of people get the necessary amount of phosphorus through their diets 6. Electrolytes can be acids, bases and salts

3 MODULE 6 CAUSES Causes 2, 7 Symptoms Depending on how severe the fluid loss is and how long the process above lasts, Vomiting or diarrhoea or both as in the case of gastroenteritis dehydration can be anywhere from mild or moderate to severe 2. MODULE 6 SYMPTOMS Excessive sweating, as experienced during heat waves or prolonged physical exertion Use of diuretics diuretic medications, and beverages that increase urination such as coffee, tea, fruit juices and alcohol Disorders, such as diabetes and Addison disease, that lead to increased excretion of urine Burns, including sunburns Inability or unwillingness to drink or eat, due to cold sores, nausea and a sore throat 3b, such as associated with pharyngitis Fever or a variety of serious illnesses Bonus section: Home-care tips for the patient during exercise Proper hydration is important before, during and after exercising, especially in the case of prolonged or profuse exertion or when it is very hot 8. During exercise, it is recommended to drink 120 to 240 ml of fluid every 15 to 20 min, depending on how Those at risk of dehydration Infants and young children: Dehydration is common in infants and children with diarrhoea or who are vomiting as they may lose a higher percentage of fluids than older children or adults 2. hot the environment is and how difficult the exercises are 8. Consuming enough water is usually sufficient, but drinking fluids that contain electrolytes are more likely to be beneficial when an individual is exercising in high heat and humidity 8. Older people: Since older peoples thirst centres do not work as well as those of younger people, they may not realise they are becoming dehydrated 2. Mild to moderate dehydration Symptoms of mild to moderate dehydration include 2,10 : Increased thirst Less sweating Reduced skin elasticity Decreased urine production Dry or sticky mouth Sleepiness or tiredness No wet diapers for three hours for infants Few or no tears when crying Headache Constipation Severe dehydration Symptoms of moderate to severe dehydration may also include 2,7,10 : Very dry mouth, skin and mucous membranes Little or no urination any urine that is produced will be darker than normal Decreased blood pressure hypotension may cause light-headedness or fainting upon standing Confusion a good indication that dehydration has become severe, since brain cells are being affected Faster than normal heart rate tachycardia Increased or rapid breathing Lethargy Sunken eyes Sunken fontanelles the soft spot at the top of the baby s head Fast fact The area of the brain known as the hypothalamus controls thirst, appetite, body temperature and sleep 9. If dehydration worsens, the internal organs, such as the kidneys, brain and liver, may go into severe shock 2. Extremely severe dehydration can lead to the patient falling into a coma

4 MODULE 6 DIAGNOSIS Diagnosis Dehydration can easily be diagnosed by: Doing a pinch test (skin turgor test) - Grab a roll of skin on the back of your hand. Pull the skin up to about 1cm high and then let it go. If the skin bounces back to its original position slowly, you might be dehydrated 11. Treatment The common treatment for dehydration is oral replacement therapy, in other words the replacement of fluids by consuming them orally. However, in the case of severe dehydration, it might be necessary for a doctor to administer an intravenous (IV) solution to the patient. This same treatment is used for patients who are unable or unwilling to drink, such as children, or those suffering from repeated vomiting 7 who are unable to keep fluids down. Mild Dehydration Moderate Dehydration Severe Dehydration MODULE 6 TREATMENT Checking your urine - A well-hydrated body produces mostly clear urine with a tinge of yellow. When urine is noticeably yellow, your body is 3% dehydrated 13. Dark yellow or amber urine is an indication of 5% dehydration. Orange is indicative of more than 5% dehydration severe dehydration 11. Certain foods can colour your urine, eg. beetroot can cause it to darken. Various vitamins and some medications may brighten it. Drinking more fluids, such as water and herbal teas, may be enough to treat the condition 2. Replacement of fluid and electrolytes is required. This can be achieved with oral rehydration solutions (ORS) that contain the right amounts of electrolytes 2. Replacement of fluid and electrolytes (sodium and potassium in particular) is required 2. In extremely severe cases patients may need to be treated with IV fluid. Testing for bad breath - Breath into your cupped hands and inhale through your nose to check for bad breath. Saliva has antibacterial properties, but dehydration can prevent your body from producing enough saliva which leads to a bacteria overgrowth, resulting in bad breath 11. Note Sometimes an underlying disorder or cause of dehydration, such as diarrhoea, may also need to be treated to ensure swift and complete recovery 2. A craving for sweets - The liver slows down its production and release of glycogens and other energy components when the body is dehydrated 13. This leads to intense cravings for food, especially sweets

5 MODULE 6 OTC TREATMENT Urgent assistance Customers need to seek immediate attention in the case of 13 : Increased or constant vomiting for more than a day Visit a hospital or emergency room in case of 13 : Fever over 39,5 C MODULE 6 OTC TREATMENT Fever over 38,5 C Seizures Diarrhoea for more than 2 days Difficulty breathing Weight loss Chest or abdominal pains Decreased urine production Fainting Over the counter (OTC) treatment Oral rehydration solutions (ORS) Oral rehydration solutions (ORS) are available from pharmacies without a prescription 2. These solutions work effectively for all patients who are suffering from dehydration regardless of their age, and the cause or type of electrolyte imbalance 12. Severe kidney dysfunction is however, a contra-indication, and ORS should be avoided in these cases 12. In the case of moderate to severe dehydration, sports drinks, canned cold drinks and juices do not meet the same necessary oral rehydration criteria as ORS, since they often contain too little sodium and too many carbohydrates 12. An effective ORS usually contains a balanced combination of the following substances 12 : Glucose with or without complex carbohydrates Sodium Potassium Chloride Citrate buffer Confusion Sluggishness (lethargy) Tips for pharmacy staff: Advising your customers on dehydration prevention No urine production in the last 12 hours The foremost treatment for dehydration is prevention. Remind your customers to 13 : 1. Plan ahead and take extra water and ORS sachets to outdoor events and work where increased sweating will increase fluid loss. 2. Encourage athletes and those doing manual work to replace fluids at the same rate that they are lost. 3. Avoid exercise on days with a high heat index. Advise customers to listen to weather forecasts and the weather forecaster s recommendations for sweltering days. Consider postponing events until it is cooler. 4. Ensure that older people, infants and children have adequate water and ORS available. 5. Avoid alcohol consumption when it is hot, because alcohol increases water loss and weakens the ability to recognise early warning signs associated with dehydration. 6. Advise customers to wear light-coloured and loose-fitting clothing when outside on a hot day. 7. Carry a hand fan, electronic fan or water mister to stay cool. 8. Reduce temperature stress by breaking up exposure to heat. Allow the body to recover by finding air-conditioned or shady areas

6 MODULE 6 REHIDRAT Rehidrat offers two oral rehydration solutions (ORS), Rehidrat and Rehidrat Sport. These products come in a range of delicious flavours. Rehidrat is available in Blackcurrant, Orange and Vanilla while Rehidrat Sport is available in Naartjie and Lemon & Lime. The Rehidrat Range How it can help your patients Rehidrat Rehidrat is available in three delicious flavours: Blackcurrant, Orange and Vanilla. It s perfect for travelling, or to keep in your medicine cabinet at home. Benefits: Optimal balance of sugars, Rehidrat Indication: salts and minerals For the treatment of dehydration No artificial preservatives, and electrolyte loss due to sweeteners or colourants gastroenteritis and diarrhoea. Suitable for children under 1 year 3 palatable flavours: Dosage: Blackcurrant, Orange and Vanilla Dissolve 1 sachet in 250 ml of Available in convenient 6 packs freshly boiled and cooled water. and single sachets MODULE 6 REHIDRAT Rehidrat Rehidrat Sport Perfect for treating dehydration and electrolyte loss due to gastroenteritis and diarrhoea. Ideal for replenishing electrolytes after exercise or while on the go. Maintenance Therapy: < 1 year old: ml after every bowel movement. 1 5 years old: 200 ml after every bowel movement. Older children and adults should drink enough Rehidrat to quench their thirst and replace the fluid lost in every stool. Mild Dehydration: 50 ml / kg body mass for first 6 hours, followed by maintenance therapy. Moderate to Severe Dehydration: 100 ml / kg body mass for first 6 hours, followed by maintenance therapy. Rehidrat Sport Rehidrat Sport, available in Naartjie and Lemon & Lime flavours is ideal to take in your sports bag to replenish electrolytes after exercise and assist with recovery. Benefits: Optimal balance of sugars, salts and minerals No artificial preservatives, sweeteners or colourants 2 palatable flavours: Lemon & Lime and Naartjie Available in convenient 6 packs and single sachets Rehidrat Sport Indication: Supports optimal hydration before, during and after exercise to assist with recovery. Dosage: Dissolve 1 sachet in 250 ml of cold water

7 Quick Question In which part of the body is the hypothalamus found, and what is its function? MODULE 6 REFERENCES References 1. MedicineNet. Dehydration. Available at Accessed on 3 April Porter RS (Ed). Dehydration: Water balance. The Merck Manual Home Health Handbook. Available at Accessed on 3 April Kaneshiro, N.K. Dehydration. National Library of Medicine. Available at Accessed on 3 April MedicineNet. Electrolytes. Available at Accessed on 3 April MedlinePlus. Electrolytes. Available at Accessed 3 April BuiltLean. What Are Electrolytes And Why Are They So Important? Available at Accessed 3 April Porter RS (Ed). Dehydration and Fluid Therapy in Children: Dehydration in Children. The Merck Manual of Diagnosis and Therapy. Available at Accessed on 3 April Porter RS (Ed). Exercise and Fitness: Overview of Exercise. The Merck Manual of Diagnosis and Therapy. Available at professional/special-subjects/exercise/overview-of-exercise. Accessed on 3 April BrainFacts.org. The Neural Regulation of Thirst. A public information initiative of The Kavli Foundation, Gatsby, and Society for Neuroscience. Available at Accessed on 3 April Mayo Clinic. Dehydration. Available at Accessed 3 April Everydayhealth. 6 Unusual Signs of Dehydration. Available at Accessed on 3 April Porter RS (Ed). Dehydration and Fluid Therapy in Children: Oral Rehydration. The Merck Manual of Diagnosis and Therapy. Available at www. msdmanuals.com/professional/pediatrics/dehydration-and-fluid-therapy-in-children/oral-rehydration. Accessed on 3 April WebMD. Dehydration in Adults. Available at Accessed on 3 April S0 REHIDRAT ORANGE. Reg. No. Y/24/181. S0 REHIDRAT BLACKCURRANT. Reg. No. Y/24/214. S0 REHIDRAT VANILLA. Reg. No. N/24/103. Each 14 g sachet of powder contains: Sodium Chloride 0,44 g, Potassium Chloride 0,38 g, Sodium Bicarbonate 0,42 g, Glucose 4,1 g, Sucrose. 8,1 g