Dehydration occurs when the body loses more water and electrolytes than are taken in, usually through vomiting, diarrhea, excessive sweating, or inadequate fluid intake. It can range from mild to severe. Mild dehydration involves a 1-2% loss of body weight, while severe dehydration is a weight loss of 8% or more and involves electrolyte imbalances. Symptoms include thirst, lethargy, sunken eyes, and decreased skin elasticity. Treatment focuses on oral or IV fluid replacement depending on severity to replace fluid and electrolyte losses. Complications can include shock, seizures or brain damage if severe dehydration is left untreated.

3. Dehydration
pure (tissue) water loss and hypovolemia
to sodium loss and thus loss of blood
volume.
Loss of water from the extracellular fluid
volume, vascular and interstitial fluids.
It is literally the removal of water or
deficiency of fluid within an organism.
Extracellular Fluid Volume Deficit
(ECFVD)
 Intracellular fluid Volume
Deficit (ICFVD)

4. Losses can be :
1. Mild – loss of 1 to 2 L of water (2% of
body weight is lost).
2. Moderate – loss of 3 to 5 L of water (5% of
body weight is lost).
3. Severe – loss of 5 to 10 L of water (8% of
body weight is lost).
Fluids are normally found in three spaces:
 Inside the cells (Intracellular)
 Around the cells (Interstitial)
 In the bloodstream (Intravascular)

5. Pathophysiology
Dehydration is seen when the normal
compensation for fluid in the bloodstream
cannot be corrected by stored fluid elsewhere.
When fluids are lost from the intravascular
spaces because of lack of intake or excess loss,
interstitial fluids move in to restore vascular
volume. Because the actual volume of fluid in
the interstitial space limited, other
compensation systems are initiated to restore
fluid volume.
If the dehydration is not corrected, fluid is
shifted from the cells into the vascular system.

6. Cellular Dehydration
The loss of cellular fluid is dangerous because the
cells need fluid for cellular function.
 Intracellular fluid Volume Deficit (ICFVD)
 Less fluid is available for temperature regulation via
sweating, and lowered blood volume decreases the
body’s ability to transport core heat to the
periphery for conducive loss.
 There is cerebrospinal fluid and less fluid in fat pads
around the eyes. If cerebral cells become
dehydrated, thought processes may be impaired.

7. Causes of dehydration in children
Common viral infections causing vomiting and diarrhea include
rotavirus or winter vomiting disease (norovirus).
Common bacterial infections include Salmonella, E coli,
Campylobacter and C.difficile.
Parasitic infections such as Giardia lamblia cause the condition
known as giardiasis.
Dehydration can be caused by losing too much fluid, not
drinking enough water or fluids, or both.
Your body may lose too much fluids from:
Excessive sweating
Excessive urine output
Fever
Vomiting or diarrhea
Exercise during high heat and humidity

8. Clinical Manifestations of Dehydration
Clinical
Manifestations
Mild
Dehydration
Moderate
Dehydration
Severe Dehydration
Level of
consciousness
Alert Lethargic Obtunded
Capillary refill time 2 seconds 2-4 seconds
Greater than 4 seconds,
cool limbs
Mucous membranes Normal Dry Parched, cracked
Heart rate
Slight
increase
Increased Very increased
Respiratory rate Normal Increased
Increased and
hyperpnea
Blood pressure Normal
Normal, but
orthostatic
Decreased
Pulse Normal Thready Faint or impalpable
Skin turgor Normal Slow Tenting
Eyes Normal Sunken Very sunken
Urine output Decreased Oliguria Oliguria/anuria

9. √ Three types of dehydration based on serum sodium
levels:
1.hypotonic or hyponatremic (referring to this as primarily
a loss of electrolytes, sodium in particular)
2.hypertonic or hypernatremic (referring to this as
primarily a loss of water)
3.isotonic or isonatremic (referring to this as equal loss of
water and electrolytes).
Differential Diagnosis:
External or stress-related causes
Infectious diseases
Malnutrition

10. Signs :
dry or sticky mouth
few or no tears when crying
eyes that look sunken into the head
soft spot (fontanels) on top of head that looks sunken
lack of urine or wet diapers for 6 to 8 hours in an infant (or only
a very small amount of dark yellow urine)
lack of urine for 12 hours in an older child (or only a very small
amount of dark yellow urine)
dry, cool skin (poor skin turgor)
Symptoms:
excessive loss of fluid from vomiting or diarrhea
 if the child refuses to eat or drink.
lethargy or irritability
fatigue or dizziness in an older child
thirst and discomfort
loss of appetite

11.  Skin turgor assessment – this
assessment can be done on the
forearm. Skin that does not flatten
immediately after release is called
“tenting”, an example of fluid
volume deficit.
 Dry and cracked lips
Sunken eyes
 Thirst and discomfort

12.  Examinations and tests
Delayed capillary refill
Low blood pressure
Poor skin turgor -- the skin may not be as elastic as normal
and sag back into position slowly when the health care
provider pinches it up into a fold (normally, skin springs right
back into place)
Rapid heart rate
Shock (hypovolemic)
Complete blood count (CBC)
Blood chemistries (to check electrolytes, especially
sodium, potassium, and bicarbonate levels)
Blood urea nitrogen (BUN)
Creatinine
Urine specific gravity
Other tests may be done to determine the cause of the
dehydration (for example, blood sugar level to check for
diabetes).

13. Management
Mild and Moderate Dehydration:
1. Fluid Restoration
 Oral Rehydration
› Oral Rehydration Solution “ORS”
› Standard home solutions
 Intravenous Rehydration
 Monitoring for complications of fluid
restoration
 Monitor Intake and Output for fluid
replacement
 Nutritious food and supplements

14. Severe Dehydration:
1. Laboratory evaluation and intravenous rehydration
are required. The underlying cause of the
dehydration must be determined and appropriately
treated.
 Phase 1 focuses on emergency management. Severe
dehydration is characterized by a state of
hypovolemic shock requiring rapid treatment.
o IV fluid
o Tachycardia, capillary refill, urine output, and mental status
all should improve.
 Phase 2 focuses on deficit replacement, provision of
maintenance fluids, and replacement of ongoing
losses.
 Maintenance fluid requirements are equal to
measured fluid losses

15. Solution Contents Uses Comments
Hypotonic
5% dextrose in water
(D5W)
50g dextrose
No electrolytes
Replaces deficits of
total body water.
Not used alone to
expand ECF volume
because dilution of
electrolytes can occur.
Supplies 170 kcal/L and free
water
Distilled water cannot be given
IV because it would cause
hemolysis of RBCs.
Dextrose is metabolized on first
pass through liver, leaving a
solution of water but without
hemolytic problems.
Isotonic
0.9% NaCl (normal saline
olution, NS, 0.9% NS)
154 mEq/L Na and Cl ECF deficits in clients
with low serum levels
of Na or Cl and
metabolic alkalosis
Before and after
infusion of blood
products
Not used for routine
administration of IV fluids
because it contains more
sodium than ECF
Expands plasma and interstitial
volume and does not enter cells
Lacteted Ringers
Solution (LR)
130 mEq/L Na
4 mEq/L K
3 mEq/L Ca
109 mEq/L Cl
28 mEq/L lactate
ECF deficits, such as
fluid loss with burns
and bleeding and
dehydration from loss
of bile or diarrhea
Solution is roughly isotonic to
plasma but does not contain
magnesium or phosphate
Lactate is equivalent to
bicarbonate and solution can be
used to treat many forms of
acidosis
Cannot be used in people with
alkalosis
Intravenous Water and Electrolyte Solutions

16. Hypertonic
Lactated Ringer’s
Solution with 5% dextrose
(D5/LR)
5o g dextrose
130 mEq/L Na
4 mEq/L K
3 mEq/L K
109 mEq/L Cl
28 mEq/L lactate
FCF deficits, such as fluid
loss with burns and
bleeding and dehydration
from loss of bile or
diarrhea
Provides modest calories
(170 kcal)
Solution hypertonic because it is
combination of two solutions
(D5W and LR)
5% dextrose and normal
saline (D5/o.9 NS)
50g dextrose
154 mEq/L Na and Cl
ECF deficits in clients
with low serum levels of
Na or Cl and metabolic
alkalosis
Before and after infusion
of blood products
Provides modest calories
(170 kcal)
Solution is hypertonic because it
is combination of two solutions
(D5W and NS)
5% dextrose and 0.45%
normal saline (D5/0.45 NS;
D5/1/2 NS)
50g dextrose
77 mEq/L Na and Cl
Can be used as an initial
fluid for hydration
because it provides more
water than sodium
Provides modest calories
(170 kcal)
Commonly used as a maintenance
fluid
5% dextrose and 0.225%
normal saline
(D5/0.2 NS; D5/1/4 NS)
50g dextrose
34 mEq/L Na and Cl
Can be used as an initial
fluid for hydration
because it provides more
water than sodium
Provides modest calories
(170 kcal)
Commonly used as a maintenance
fluid

17. Nursing Management
Keep fresh water or other fluids in an easily
accessible location.
Provide fluids of choice
Encourage family members to assist the
client
Provide oral care every 2 hours to help
decrease discomfort from dry mucous
membranes
Record intake and Output of the client
Educate client how to self-care at home
Monitor for signs of Hypovolemic shock

18.  Preventive measures
 Even when you are healthy, drink plenty of fluids every
day. Drink more when the weather is hot or you are
exercising.
 Carefully monitor someone who is ill. If you believe that
the child is getting dehydrated, call your health care
provider before the person becomes dehydrated. Begin
fluid replacement as soon as vomiting and diarrhea
start -- DO NOT wait for signs of dehydration.
 Always encourage a child who is sick to drink fluids.
Remember that fluid needs are greater with a fever,
vomiting, or diarrhea. The easiest signs to monitor are
urine output (there should be frequent wet diapers or
trips to the bathroom), saliva in the mouth, and tears
when crying.
 Encourage adequate rest balanced with moderate
 activity.
 Promote adequate nutritional intake.

19. Treatment
Oral re-hydration solutions (ORS)
Fluid replacement
Intravenous rehydration therapy
Alternative therapies
Proper food intake
Adequate rest and sleep pattern
Monitor intake and output
Severe cases: IVF/ NGT
Medical treatment:
In cases of severe dehydration, admission to
hospital may be required. Fluid may be given
through a tube through the nose or saline drip
intravenously.

20.  Complications
Untreated severe dehydration may lead
to:
Death
Permanent brain damage
 Seizures
 Cholera
 Gastroenteritis
 Shigellosis
 Fever
 Electrolyte disturbance
Hypernatremia (also caused by dehydration)
Hyponatremia, especially from
restricted salt diets

21. Thank you and God
Bless 