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Nanagement of Dehydration.pdf
1. PRESENTATION ON “DEHYDRATION”
PRESENTED BY: RAJESH CHHETRI(18) & RAHAMAT
KHAN(17)
ROLL NO: EIGHTEEN(18) & SEVENTEEN(17)
SUBJECT: PUBLIC HEALTH PHARMACY
FACULTY: B.PHARM
LEVEL: BACHELOR
COLLEGE: SHREE MEDICAL AND TECHNICAL COLLEGE
PRESENTED TO: JIWAN POUDYAL
3. CONTENTS
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OBJECTIVES OF THE STUDY
INTRODUCTION
CLINICAL FEATURES
CAUSES/DETERMINANTS/RISK FACTOR
NEPALESE CONTEXT
-NEPALESE CONTEXT DATA PRESENTATION
FIRST AIDMANAGEMENT ABCD
5. OBJECTIVES OF THE STUDY
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Define dehydration
Identify causes and risk factors
Become familiar with medications that may exacerbate
dehydration
Identify signs and symptoms of dehydration
Understand measures to prevent dehydration
Treatment of the dehydration
6. INTRODUCTION
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Dehydration is a condition that occurs when an individual has
lost so much fluid that the body can no longer function normally
and develops signs and symptoms due to the loss of fluid.
Mostly water, exceeds the amount that is taken in. With
dehydration
More water is moving out of individual cells and then out of the
body than the amount of water that is taken in through drinking.
9. CLINICAL FEATURES
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Signs & Symptoms of dehydration in children:
Signs of Dehydration:
1. Sunken eyes
2. Decreased frequency of urination or dry nappies
3. Sunken soft spot on the top of the head in babies (called the
fontanels)
4. No tears when the child cries
5. Dry or sticky mucous membranes (the lining of the mouth or
tongue)
6. Lethargy (less activity than normal)
7. Irritability (more crying, fussiness)
8. Abnormal capillary refill time
13. CLINICAL FEATURES CONTINUE…..
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The first symptoms of dehydration include thirst, darker urine, and
decreased urine production. In fact, urine color is one of the best
indicators of a person’s hydration level – clear urine means you are well
hydrated and darker urine means you are dehydrated.
However, it is important to note that, particularly in older adults,
dehydration can occur without thirst. This is why it is important to drink
more water when ill, or during hotter weather.
As the condition progresses to moderate dehydration, symptoms include:
15. CLINICAL FEATURES CONTINUE….
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Severe dehydration (loss of 10-15 percent of the body’s water)
may be characterized by extreme versions of the symptoms
above as well as:
lack of sweating
sunken eyes
shriveled and dry skin
low blood pressure
increased heart rate
fever
delirium
unconsciousness
16. CAUSES/DETERMINANTS/RISK FACTOR
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Some of the following causes are listed below:
Excessive fluid loss
Reduced fluid intake
Other causes of fluid loss include:
Hemorrhage
Excessive perspiration
Acute renal failure with polyuria
Abdominal surgery
19. NEPALESE CONTEXT
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In 2072/73, 1,248,093 cases of diarrhoea were reported
of which 0.2 percent suffered from severe dehydration (a
decrease from 0.3 percent the previous year).
% of children under five years with diarrhoea suffering
from dehydration (facility, outreach & community level)
-2070/2071: Not defined
-2071/72: 21
-2072/73: 20
21. FIRST AIDMANAGEMENT ABCD
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First aid treatment for dehydration
There are some simple first aid steps you can take if you
suspect someone is suffering from dehydration.
Assist the casualty into a cool, shaded place
Encourage them to sit down and stop any physical activity
Provide plenty of water or Oral Rehydration Solution (ORS) to
drink
If the patient is suffering from cramp, stretch and massage the
affected muscles
Monitor and record vital signs (eg: pulse / respiratory rate) if
trained
22. EVALUATION THE DEGREE OF
DEHYDRATION
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Mild dehydration (<5% in an infant; <3% in an older child or adult):
Normal or increased pulse
decreased urine output
Thirsty
Normal Physical findings
Moderate dehydration (5-10% in an infant; 3-6 in an older child or adult):
Tachycardia, little or no urine output, irritable/lethargic, sunken eyes and fontanel,
decreased tears, dry mucous membranes, mild delay in elasticity (skin turgor)
23. EVALUATION THE DEGREE OF
DEHYDRATION CONTINUE…..
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Severe dehydration (>10% in an infant, >6% in an older
child or adult):
Peripheral pulses either rapid and weak or absent
Decreased blood pressure
No urine output
Very sunken eyes and fontanel , no tears,
24. EVALUATION THE DEGREE OF
DEHYDRATION CONTINUE
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The ABCDE Approach Treatment Chart (Chart 2)
This gives practical advice on emergency management of unwell patients.
Using the ABCDE approach
Airway assessment is always the first as it is imperative that the airway is not
obstructed. For detailed advice on management of the airway see the WHO
ETAT course (1).
Breathing should be adequate; if breathing assistance is required use a bag
valve mask device or give oxygen if available. Only when problems with
airway and breathing are addressed should the clinician move onto
circulation.
25. EVALUATION THE DEGREE OF
DEHYDRATION CONTINUE
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Circulation. The chart gives guidance on the use of
fluids. It is important to recognise malnutrition at this
stage, as rapid infusion of intravenous fluids to a
malnourished child can be very dangerous. Depending
upon measurement of capillary refill, heart rate and
blood pressure, give fluids: rapidly IV, slowly IV, or
orally.
26. EVALUATION THE DEGREE OF
DEHYDRATION CONTINUE
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Disability. If the patient shows signs of disability (either coma or
convulsion) airway and breathing management are top priority. It
is then appropriate to insert an IV cannual and measure the
blood sugar if possible. These patients are at risk of low blood
sugar and often it is safer to give glucose as soon as possible.
Dehydration - is so common in tropical countries that checking
for signs of dehydration should be routine. The signs of shock
have already been looked for while assessing circulation but
specific examination for loose skin, lethargy and sunken eyes
should occur.
Exposure. Finally it is important to look at the whole patient, to
look for signs of a rash, trauma or swollen abdomen.
27. THE ABCDE APPROACH – TRIAGE
TREAT FIRST WHAT KILLS FIRST
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Emergency Priority Queue
Airway Obstructed At risk Clear
Breathing
Rate
>40 or <10 30 -40 10-30
Breathing
Colour
Blue (Cyanosis) Pink or Pale Pink
Breathing
Effort
Distressed using accessory
muscles
Mild distress No distress
Circulation
Capillary Refill
>3 second (shock) >2 seconds <2 seconds
Circulation
Pulse rate
>150 (<40) >130 (<60) 60-100
Circulation
Temperature
Low (Shock) Normal or High Normal or High
28. THE ABCDE APPROACH – TRIAGE
TREAT FIRST WHAT KILLS FIRST
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Disability
Coma
Unresponsive Pain
response
Voice Response Alert
Disability
Blood sugar
<2 2-3 >3
Dehydration Skin pinch
>2 seconds
Lethargic
Skin pinch
<2 seconds,
Alert Malnourished
Mild
Alert and well
nourished
Exposure Major Trauma
Florid total skin rash
Minor injury
Mild total skin rash
Nothing evident or
limited rash
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The ABCDE Approach - Treatment
Emergency Treatment of Children
and Adults
Airway – (Care with
Cervical Spine in Trauma)
Clear airway
Suction – If necessary
Breathing
Give assisted ventilation if
not breathing adequately
Use oxygen if available
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Malnourished Well Nourished
Capillary Refill
>3 seconds
Fluids IV Slowly Fluids IV rapidly
Capillary Refill
2-3 seconds
Oral Fluids Fluids IV
HR >150 Fluids IV Slowly Fluids IV Rapidly
HR 130-150 Oral Fluids Fluids IV
Low Blood Pressure Fluids IV Slowly Fluids IV Rapidly
Circulation – Child
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A B C D
Coma Clear/support Recovery
Position
IV Cannula Blood sugar
Convulsion Clear/support Recovery
Position
IV Cannula Blood
sugar/Drugs
Circulation – Adult – Unwell.
If Blood pressure <100 and Pulse > 100 give Normal Saline 500 mls.
Reasses and Repeat if still abnormal and patient unwell
Disability
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Malnourished Well nourished
Signs of Shock Fluids IV Slowly Fluids IV Rapidly
Skin Pinch >2 seconds Fluids IV Slowly Fluids IV Rapidly
Lethargic Try oral fluids first IV Fluids
Sunken Eyes Try oral fluids first IV Fluids
Dehydration
33. CALCULATIONS
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Calculation of the deficit:
Determining the fluid deficit necessitates clinically
determining the percent dehydration and multiplying this
percentage by the patient’s weight; a child who weights
10kg and is 10% dehydrated has a fluid deficit of 1L.
10kg×10/100=1L
CALCULATION OF MAINTENANCE:
100 ml/kg for the first 10 kg body wt. = 1000 ml
50 ml/kg for the second 10 kg body wt. = 500 ml
25 ml/kg for the third 10 kg body wt. = 250 ml
TOTAL FLUID REQUIREMENT: equal to
Fluid deficit + maintenance within 24 hrs.
43. COMPLICATION
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Complications include:
1. Hypotension
2. Risk of falls related to hypotension
3. Decreased cardiac output and perfusion to tissues and
organs
4. Severe dehydration can progress to hypovolemic shock
Other complications include :
Renal failure & Death
44. PROGNOSIS
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What Is the Prognosis of Dehydration in Adults?
When dehydration is treated and the underlying cause
identified, most people will recover normally.
Dehydration caused by heat exposure, too much exercise,
or decreased water intake is generally easy to manage,
and the outcome is usually excellent. However, the
prognosis worsens as the severity of dehydration
increases and also depends on how well the underlying
cause responds to appropriate treatment.
