Dehydration

When the body loses fluid more than it takes in, dehydration sets in which when severe may ultimately lead to complications and possibly death. ^[1] The body loses water daily in quite a lot of forms including sweat, urine and stool. Some minerals go alongside water hence when there is too much losing, imbalance can occur and dehydration ensues. ^[2]     

Epidemiology

Dehydration resulting from diarrheal diseases causes about four million deaths among pediatric patients annually. Majority of these mortality cases occur in developing countries. Morbidity and death depend by and large on the severity of dehydration and the rapidity of medical intervention. ^[3]

Causes

Dehydration can be caused by several entities. The body may lose a great deal of fluid during extreme sweating such as in strenuous activities and exercises, fever, vomiting and diarrheal illnesses. Patients may also develop dehydration by having disproportionate urine output. This may result by taking diuretic medicines and as consequence of diseases like uncontrolled diabetes. Children are at higher risk mainly due to larger body water content and immature kidneys.  Skin injuries such as in burns and infectious illnesses may cause the condition. ^{[1] [3] [4]}

Medical conditions that are common causes of dehydration are gastroenteritis, stomatitis, diabetic ketoacidosis, pharyngitis and febrile illnesses. ^[3]

Signs and Symptoms

The manifestations range from mild to severe. These may include increased thirst, fatigue, dizziness, dry mouth, increased heart rate, altered mental status, reduced urine output, darkening of urine and loss of consciousness. Infants may have sunken fontanelles. ^[4]

Emergency

Included in the symptoms whereby a person should be taken to the emergency department are seizures, loss of consciousness, sluggishness, no urine output in the last twelve hours and difficulty of breathing. The decision should be done on a case to case basis. ^[4]

Diagnosis

The patient’s medical history is obtained and a physical exam is performed. Laboratory exams that may be done include complete blood count, urinalysis and obtaining the levels of electrolytes, Blood Urea Nitrogen (BUN) and creatinine. ^{[1] [3]} 

Treatment

Drugs like loperamide, opiates and bismuth subsalicylate are generally not recommended due to unverified effectiveness and likely adverse effects. For mild cases, drinking fluids is sufficient which should be done by drinking small amounts of fluid on a frequent basis. Some may need oral rehydration solutions. Moderate and severe dehydration may require hospitalization to institute intravenous fluid to the patient. ^{[1] [3]}

References:

1.      http://www.nlm.nih.gov/medlineplus/ency/article/000982.htm

2.      http://www.nhs.uk/Conditions/Dehydration/Pages/Introduction.aspx

3.      http://emedicine.medscape.com/article/906999-overview#a0199

4.      http://www.webmd.com/a-to-z-guides/dehydration-adults