Presentation on "DEHYDRATION"

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

CONTENTS
3/10/2020|DEHYDRATION|
3
 OBJECTIVES OF THE STUDY
 INTRODUCTION
 CLINICAL FEATURES
 CAUSES/DETERMINANTS/RISK FACTOR
 NEPALESE CONTEXT
-NEPALESE CONTEXT DATA PRESENTATION
 FIRST AIDMANAGEMENT ABCD

CONTENTS
4
 EVALUATION THE DEGREE OF
DEHYDRATION
 THE ABCDE APPROACH – TRIAGE TREAT FIRST WHAT
KILLS FIRST
 CALCULATIONS
 TREATMENT
 COMPLICATION
 PROGNOSIS
 REFERENCES

OBJECTIVES OF THE STUDY
5
 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

INTRODUCTION
6
 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.

INTRODUCTION CONTINUE…..
8
 Although infants and children are at highest risk
for dehydration, many adults and especially the
elderly have significant risk factors.

CLINICAL FEATURES
9
 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

10
Sunken eyes Sunken eyes

CLINICAL FEATURES CONTINUE….
12
1. Abnormal skin turgor
2. Abnormal respiratory pattern

CLINICAL FEATURES CONTINUE…..
13
 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:

14
 dry mouth
 lethargy
 weakness in muscles
 headache
 dizziness

15
 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

CAUSES/DETERMINANTS/RISK FACTOR
16
 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

CAUSES/DETERMINANTS/RISK FACTOR
CONTINUE…..
17
 Vomiting or diarrhea
 Nasogastric drainage
 Excessive GI suctioning
 Diabetes mellitus with polyuria or diabetes insipidus
 Fistulas
 Excessive use of laxatives

Risk Factors for Dehydration
18
 Elderly residents
 Residents with chronic illnesses:
– Diabetes
– Kidney disease
– Cystic fibrosis
– Alcoholism
– Adrenal gland disorders

NEPALESE CONTEXT
19
 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

NEPALESE CONTEXT DATA
PRESENTATION
20

FIRST AIDMANAGEMENT ABCD
21
 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

EVALUATION THE DEGREE OF
DEHYDRATION
22
 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)

DEHYDRATION CONTINUE…..
23
 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,

DEHYDRATION CONTINUE
24
 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
 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
 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.

THE ABCDE APPROACH – TRIAGE
TREAT FIRST WHAT KILLS FIRST
27
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

THE ABCDE APPROACH – TRIAGE
TREAT FIRST WHAT KILLS FIRST
28
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

29
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

30
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

31
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

32
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

CALCULATIONS
33
 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.

TREATMENT
34
 WHO TREATMENT PLANS:

TREATMENT CONTINUE…
35

36

TREATMENT CONTINUE….
37

TREATMENT CONTINUE
38

39

40

41

42
PATIENT WITH DEHYDRATION & CHOLERA

COMPLICATION
43
 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

PROGNOSIS
44
 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.

REFERENCES
45
 https://www.slideshare.net/ahm732/dehydration-41899819
 https://www.slideshare.net/jaaber/dehydration-5570782
 https://www.medicalnewstoday.com/articles/153363#symptoms
 https://dohs.gov.np/wp-content/uploads/2019/07/DoHS-
Annual-Report-FY-2074-75-date-22-Ashad-2076-for-web-1.pdf
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450136/

REFERENCES
46
 https://healthinsight.org/tools-and-resources/send/128-educational-
resources/585-dehydration
 http://www.southsudanmedicaljournal.com/archive/may-2012/the-abcde-
approach-triage-and-treatment.html
 http://apps.who.int/medicinedocs/documents/s18015en/s18015en.pdf
 https://dohs.gov.np/wp-
content/uploads/2017/06/DoHS_Annual_Report_2072_73.pdf

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