The development of dehydration, as a concomitant syndrome "weighting" during the main disease in children, especially young children - the problem is quite common.
The reasons leading to the lack of fluid in the body of a child are diverse. These include
- impaired fluid intake due to severe pain when swallowing (ARVI, aphthous stomatitis),
- various options for narrowing the esophagus (pyloric stenosis, pylorospasm) with the frequent development of vomiting syndrome and regurgitation,
- intestinal obstruction with fluid sequestration in the "third space",
- feverish conditions with large perspiration losses,
- endocrine system pathology (congenital dysfunction of the adrenal cortex, diabetic ketoacidosis, diabetes insipidus, thyrotoxicosis),
- cystic fibrosis (excessive loss of sodium and chlorine from sweat),
- introduction to the diet of concentrated artificial mixtures, etc.
Knowledge of the main pathogenetic mechanisms leading to the development of dehydration will quickly and effectively correct this pathological condition.
Every day a healthy child eats with food from 110 to 140 ml / kg of water, depending on age, eating behavior, environmental features, etc. In addition, a sufficiently large amount of endogenous fluid, which is part of the digestive secrets: saliva , bile, gastric, pancreatic and intestinal juices - on average 70 - 75 ml / kg.
Only about 1-2% of the total amount of ingested fluid is excreted in the composition of feces, the rest of the water is absorbed in the intestine. Most of it (about 90%) is in the small intestine. Of the remaining volume, about 90% is absorbed in the colon and only 20-50 ml is lost with feces.
The total amount of water in the human body averages 60-80% of the total body weight and depends on age, sex, physiological features, etc. The maximum amount of total water is in the newborn. With age, it decreases to 60%, and in older persons it reaches 40-50%. Adipose tissue contains little water, so people with obesity, this figure is lower than in the general population.
Water and electrolyte balance of a person is quite stable. It is regulated by several mechanisms, which allows the body to quickly and effectively respond to changes that lead to an imbalance of water and the main electrolytes (Na +, K + and Cl-). Normally, these indicators are controlled by two main components: a feeling of thirst (with water deficiency) and increased secretion of vasopressin or an antidiuretic hormone (with increasing hypernatremia).
In addition, the regulation of water-electrolyte metabolism is influenced by renin-angiotensin-aldosterone and sympathetic nervous systems (contribute to sodium retention) and natriuretic peptides (contribute to the excretion of sodium).
The total water in the human body is distributed between two main sectors: extracellular (30-40%) and intracellular. The main ions of extracellular fluid are sodium, calcium, chlorine, bicarbonates. Intracellular fluid contains a greater amount of potassium ions, phosphates and magnesium.
Cell membranes maintain this ratio at the same level, since, being freely permeable to water, they interfere with the transmembrane movement of electrolytes. In this way, not only the composition, but also the volume of fluids in the human body is kept constant.
Violations of water and electrolyte metabolism may be associated with external and internal causes of fluid loss. Internal movement of fluid is possible with its accumulation in the abdominal, pleural cavities, with the development of edema, internal bleeding, etc. This is the so-called. internal sequestration in the "third space". It must be remembered that with such a variant of the redistribution of fluid, and accordingly the development of water and electrolyte disorders, body weight is preserved.
In children, the main causes of violations of water-salt metabolism include external fluid loss. They are most often associated with diarrhea, vomiting, high fever, etc. That is, dehydration develops in a situation where the rate of loss of extracellular fluid exceeds the rate of its replenishment.
The risk of developing hypovolemia, i.e., a decrease in the volume of intravascular fluid in children is higher than in adults. This is due to their anatomical and physiological features (greater surface area of the body), frequent diarrheal diseases and conditions associated with vomiting (acetonemic syndrome, pyloric stenosis, etc.). In addition, young children are not always able to get independent access to water, they poorly differentiate the feeling of thirst.
As mentioned above, the causes of dehydration in children are quite diverse. But the main etiological cause of dehydration in children, especially young children, of course, are acute intestinal infections. About 8,000 children in the world still die every day from diarrhea with dehydration.
To date, four main pathogenetic mechanisms of diarrhea are distinguished: intestinal secretion, intestinal exudation, increased osmotic pressure in the intestinal lumen and impaired transit of intestinal contents. Obviously, only the secretory component of diarrhea forms pronounced dehydration.
Violation of water and electrolyte balance in secretory diarrhea develops due to the active secretion of sodium and water into the intestinal lumen. The main activators of this process are: bacterial toxins (cholera toxin, cholera-like toxins of enterotoxigenic Escherichia, etc.) and viruses (rota-, noro-). The leading etiological cause of the development of OCI occurring with the dehydration clinic in children in our country is rotaviruses.
There are specific clinical characteristics of OCI occurring with dehydration. Exicosis is significantly more often detected in severe forms of acute diarrhea. The frequency of development and severity of dehydration is influenced by the level of gastrointestinal lesions: exicosis is more often recorded with lesions of the upper GI tract (gastritis, gastroenteritis, gastroenterocolitis).
The leading symptom of acute diarrhea occurring with dehydration is vomiting. Its severity correlates with the degree of exsiccosis (r = 0.13, p
Signs of dehydration with diarrhea
A very alarming diagnostic symptom is rapid weight loss. It can be several kilograms in 3-4 days. Dropping weight by more than 10% of the original is considered very difficult. The main manifestations of dehydration in diarrhea are signs of a lack of moisture in the body. Severe dehydration can lead to an imbalance in the body, kidney failure and other serious consequences that pose a danger to health and life.
The first symptoms of dehydration are usually weakness, dry mouth, increased viscosity and anchoring of saliva, and discoloration of urine.
With mild to moderate pathology The following symptoms may occur:
- increased thirst
- reducing the amount of tear fluid,
- dry skin and mucous membranes,
- lethargy, drowsiness, apathy,
Symptoms of severe dehydration similar but more pronounced:
- strong, unbearable thirst,
- children may experience excessive fussiness or, conversely, drowsiness,
- drying of mucous membranes and skin,
- "Dry" crying
- eye recession
- urine becomes dark in color, its amount significantly decreases,
- babies have a fontanel,
- blood pressure drops noticeably,
- heartbeat and respiratory rate increase,
- sweat is reduced, which can lead to an increase in temperature,
- quite often patients become irritable, their consciousness may be confused,
- in severe cases, loss of consciousness and death may occur.
In the early stages, in addition to thirst and other subjective sensations, the development of dehydration may be indicated by a change in the color of urine, that is, its darkening. With obvious symptoms of dehydration, especially against the background of diarrhea, fever and vomiting, it is imperative that you seek medical help.
Dehydration with diarrhea in a child
Dehydration with diarrhea is especially dangerous for young children, as babies have all the symptoms develop very quickly. A baby under 6 months should consume about a liter of water per day. This amount includes not only liquid in the form of juices, teas and other drinks, but also water present in fruits, vegetables and other products. A healthy child should be offered water periodically.
But diarrhea and vomiting can cause rapid dehydration, because with the feces and vomit comes a large amount of fluid. A high temperature may aggravate the situation. Therefore, in any disease, young children require increased attention. If a child has dark urine, a decrease in its quantity, drying of lips and skin, then you should call your doctor. Severe reusable vomiting and diarrhea alone are a reason to call in specialists.
To prevent the development of dehydration with diarrhea will help regular infusion into the baby's mouth a small (1-2 spoons) of water. This should be done every 10 minutes. Such measures compensate for the loss of fluid and do not provoke repeated vomiting. Lactating women can be advised to apply the baby to the breast as often as possible even if the mother also shows signs of the disease. After all, while in the breast milk there will be antibodies against pathogenic microorganisms. After an attack of vomiting, the baby’s breast can only be given after some time, so as not to cause a new attack. For the period of treatment with diarrhea, exclude dairy products, prunes, beets and other similar products from the diet.
An ambulance call is necessary if the following signs of dehydration are observed with diarrhea:
- diarrhea and vomiting last more than 5-6 hours,
- the baby cries a lot, is capricious, while becoming sleepy, apathetic,
- baby's lips become dry and cracked
- skin dries out and loses its normal elasticity,
- the number of urination is significantly reduced.
How to avoid dehydration with diarrhea
In order to prevent the development of dehydration, it is necessary at the first signs of its appearance to begin the introduction of fluid into the body. In the conditions of a medical institution, special droppers may be placed to replenish the amount of fluid in the body. At home, you should try to give the sick person plenty of fluids, but when vomiting, single servings should be very small. When vomiting and diarrhea as a prevention of dehydration, you can give a person a water-salt solution. It is easy to cook at home. This will require salt and sugar, which is added to pure water. In this case, water can be mixed 1: 1 with orange juice. Pharmacies also sell special powders for preparing such a solution, for example, rehydron.
Cure for Diarrhea Dehydration
Treatment of dehydration with diarrhea consists in replenishing the amount of fluid in the body and restoring the water-salt balance. The treatment regimen may be adjusted depending on the severity of the pathology, its causes and the age of the patient.
The most common and effective drug prescribed for rehydration is Regidron and its analogues. The composition of this solution contains potassium and sodium, contributing to the normalization of the electrolyte balance in the body. You can prepare a similar solution yourself at home. To do this, in a liter of pure water you need to dissolve 6 small spoons of sugar and 1 spoon of salt. When taking the solution should be at room temperature. Water a child every few minutes on a small spoon. If it vomits, then you need to pause, and give the next portion of the solution only after 30-45 minutes. A solution of rehydron or salt and sugar can not be stored for a long time. Do not stop breastfeeding with dehydration in young children. In addition, be sure to revise the diet.
Treatment of dehydration in adults includes fluid replenishment, while it is better to give preference to plain water. In case of diarrhea and diarrhea, the use of a rehydrating solution is also recommended. Severe forms of dehydration in both adults and children are treated in a hospital setting by intravenous fluids.
Diarrhea is a protective reaction of the body, frequent defecation with liquid stools helps to remove toxic substances in the shortest possible time. For rarefaction of feces in the intestinal lumen, large volumes of water are released. Dehydration for diarrhea is the result of illiterate detoxification of the body. Lack of fluid is undesirable for adults, and extremely dangerous for the child.
Danger of dehydration from diarrhea
Man is 70–80% water. It participates in all metabolic processes - respiration, digestion and splitting of food, removal of toxic substances from the body.
In case of poisoning, infection of the gastrointestinal tract system with pathogenic flora, viruses, the release of water into the rectum lumen increases. This contributes to an increase in fecal mass, their softening and the speedy evacuation of pathogens and the results of their vital activity from the body.
But with diarrhea, the body loses significant amounts of water and minerals. If the fluid is not filled, dehydration occurs. For ICD 10, this status is assigned the code E86.
What is dangerous hypovolemia:
- Violation of the production of hormones.
- There is a death of brain cells.
- Reducing the speed of transportation of nutrients, toxins through the digestive tract.
- Decrease in the body's immune defense.
- Violation of higher mental activity.
- With the loss of 10-12% of the total volume of fluid occurs fatal.
- With the elimination of dehydration, some functions of the body are not restored.
Symptoms of dehydration during diarrhea depend on the severity of the pathological process.
Symptoms of dehydration during diarrhea
There are 3 degrees of pathological imbalance of micronutrients and body fluids.
Signs of dehydration during mild diarrhea mild:
- dry skin,
- dark urine
- in children - crying without tears,
- weakness and drowsiness
- increased saliva viscosity.
With moderate hypovolaemia, the current symptoms increase and a new symptom is added:
- pallor of the skin,
- reduction of skin elasticity,
- rare urination. In children, the absence of diuresis for more than 6 hours is a reason for emergency hospitalization,
- the allocation of small portions of light feces.
A similar condition develops against the background of an increase in temperature, which accompanies intestinal infections and intoxication. With this form of hypovolemia, children refuse food and water.
Signs of severe form:
- facial features sharpen
- disturbance of consciousness
- no urination
- tachycardia due to low blood pressure.
Overview of medications for treating condition
Treatment of hypovolemia is to compensate for the lost fluid, preventing its further loss in case of nausea or vomiting, diarrhea.
Therapeutic measures are divided into 2 phases:
- Replenishment of water in the body.
- Supportive and symptomatic treatment of the underlying disease.
For the relief of mild form in adults, it is enough to drink pure, non-distilled water.When treating children, rehydration solutions are shown.
Overview of fluid replenishment drugs:
Hydrovit - powder from dehydration in sachets for solution preparation. Indicated for oral rehydration. The composition of the chlorides of sodium and potassium, dextrose, sodium hydroxide. The contents of 1 sachet dissolve in 200 g of water.
- children under 3 years old - 3-5 packages per day,
- children from 3 years old - the liquid obtained at dilution of 1 sachet should be drunk after each defecation act,
- adults - 1–2 sachets after each episode of loose stools.
Glukosolan - the composition is similar to Hydrovita. But instead of dextrose, glucose is used. Available in tablets and powder for solution.
To prepare the solution, the contents of the sachet are dissolved in 1 liter of water, the pill is dissolved in 100 g of liquid. The drug is taken orally or injected into the stomach with a probe.
Acesol is a means for infusion administration when an organism is dehydrated in an adult. As part of sodium and potassium chlorides, sodium acetate. In severe forms of dehydration, a jet injection is indicated, with an average - drip.
Orsol - granules for solution preparation. Contents 1 Sachet dissolve in 1 glass of water. The effective dosage for children older than 3 years and adults is 50-100 ml per 1 kg of body weight for 4-6 hours.
Sodium chloride, glucose solution - shown for infusion. The total daily dosage is up to 3 liters.
The tool from the home kit:
- salt - 1 tsp,
- sugar - 4 tablespoons,
- water - 1 l.
It is used when it is impossible to purchase specialized medicine for oral rehydration. This compound is prohibited for administration by infusion.
When comes with diarrhea
The rate of fluid loss depends on the frequency of the stool and the age of the patient. For adults, the first signs of a lack of fluid are already observed after 4 acts of abundant diarrhea.
In children, body area is significant in relation to body weight. The dehydration rate is 2-4 times higher.
In addition, the rate of development of hypovolemia is affected by:
- the presence or absence of vomiting,
- increased body temperature
- rejection of oral fluid and food intake,
- patient status - weakened, after illness, newborn baby, premature baby,
- the conditions in which the patient is - the temperature and humidity in the room.
How to avoid dehydration
Ways to introduce fluids into the body before hospitalization:
- Baby, baby - with a syringe without a needle on the cheek mucous membrane every 10 minutes and after each bowel movement.
- Children from a year old and older - from a teaspoon every 5-10 minutes and after each bowel movement, an episode of vomiting.
- Adult - from the cup.
During the day, an adult should take at least 1.5-2 liters of water. The child - at the rate of 50 ml per 1 kg of weight.
If there are signs of dehydration or the impossibility of oral fluid replacement, when the body temperature rises to critical values, signs of confusion should be called a doctor. Until the ambulance crew arrives, continue to try to give water or a solution for hydration.
Possible complications from lack of fluid
Hypovolemia is a dangerous condition. It is easier to avoid than to treat the effects of water-salt imbalance.
Possible complications of diarrhea dehydration:
- convulsions and high convulsive readiness in the future,
- reduced immune defense of the body
- development of pathologies of the heart, blood vessels,
- violation of intestinal motility,
- chronic renal failure
- coma, death.
Do not ignore the risk of dehydration in intestinal disorders of various origins. The task of parents with diarrhea in a child is to prevent manifestations of hypovolemia. An adult should independently prevent excessive fluid loss in order to avoid complications.
What is a adult dehydration? This is an excessive loss of body fluid. A similar situation arises due to high temperature, diarrhea, increased sweating.
Dehydration can occur in people of any age, but the effects of diarrhea in children and older individuals are very dangerous.
All human organs and systems require a constant amount of fluid, and if this does not happen, the whole body suffers. The need for the amount of water consumed depends on the activity, but the daily rate should not be less than one and a half liters.
From dehydration with diarrhea, there is a violation of all functions that are aimed at eating and there are problems with the delivery of nutrients to the cells and removal from the body.
The degree of dehydration can be determined on the basis of the following indicators
- Grade 1 is mild and is present in 9 out of 10 cases of diarrhea. A clear sign is an attack of thirst, which occurs when you lose two percent in weight.
Eyes and mucous membranes of the mouth are wet. Vomiting is not observed (or rare), stools every 5 hours. Weight loss is no more than 5%.
2 degree is observed when weight loss is from 6 to 9% by weight. Toilet trips are becoming frequent (six times a day), stools are mushy with undigested food particles.
The patient has dry mucous membranes, anxiety and heart palpitations. If a person's condition worsens - viscous saliva is present, the skin is less elastic.
Such a situation is dangerous and requires the application of appropriate actions that will be aimed at restoring a person’s water balance. The most dangerous is the 3 degree, which is characterized by the serious condition of a person: stools more than 10 times a day, severe weight loss (10%), oral mucosa dry, skin not elastic, limbs cold.
It requires an appeal to the doctor, who, based on the individual characteristics of the person, will take all necessary actions to improve the condition of the person.
Symptoms of dehydration with diarrhea
- Increased thirst, a person feels a constant desire to drink, as the human body makes with the help of these desires clues that he, for normal functioning, does not have enough liquid.
Similar processes are observed in people who suffer from dehydration in the domestic environment due to the presence of diarrhea.
Consequence of dehydration
As water is lost, the body reduces the volume of fluid in the cells (66%), after that - the intercellular space (26%), and then - from the blood (8%).
Such actions are made in order to carry out the flow of water into the brain, which is 85% fluid. The loss of one percent entails serious changes that are dangerous to health.
In order for the brain to function properly, it is necessary to supply it with 20% of all blood, although its mass is only 2% of body weight. It is not for nothing that nature has provided for the location of the child inside the mother upside down - this is how he receives more blood to the brain, because the supply of necessary substances determines the whole subsequent life.
With an insufficient amount of water, the blood thickens and the activity of its main cells decreases. The immune system is also subject to threats - there is a decrease in the amount of nutrients in the body.
The cure for dehydration depends on the degree of dehydration. When 1 or 2 degrees of fluid loss is assigned, the intake of glucose-saline solutions, which include the means of dehydration Oralit or powder from dehydration Regidron.
Their composition includes boiled water (the drug content is dissolved in it), dextrose, sodium chloride, potassium chloride and baking soda. 75 ml of solution per kilogram of weight is injected into the human body.
The use of such drugs is effective - dextrose stimulates the transportation of electrolytes sodium and potassium, so that such treatment is very effective.
In addition to the above drugs, to prevent dehydration with diarrhea you can take water, stewed fruit, tea, fruit juices or decoctions of cereals.
If diarrhea occurs (especially if it occurs for a long time), the risk of dehydration is possible. This is due to the large loss of fluid that is excreted by the body along with feces.
Such a state is dangerous to human health, therefore it is necessary to ensure that the water balance is at the required level. For this you need take clean water regularlywhich is able to normalize the general condition of the body.
Taking coffee or carbonated drinks is contraindicated, as they provoke the rapid elimination of water from the body. After taking the necessary drugs and the receipt of the required amount of fluid - the patient's condition stabilizes.
In the opposite case, a visit to the doctor is an urgent measure that will help not only to normalize the state of health, but also to save a person’s life. The doctor, after the diagnosis, will prescribe the necessary treatment and the patient should recover, in the absence of comorbidities.