DEHYDRATION

Dehydration is deficit of body fluids and is often accompanied by loss of electrolytes and change balance of basa acid in the body.

Loss of fluid that excessive will be occur because of polyuria, vomit, diarrhea, hyperhidrosis, haemorhage, dysphasia, disease and other causes related to a reduction in fluid intake.

Clinical signs of dehydration include :

• The decrease and loss of elasticity of the skin ( turgor).
• Mucous membranes that dry.
• Capillary refill time that be prolonged with the normal time <1.5>
• Weakness and depression.
• Cardiovasculer collapse.
• There are the increase in PCV, plasma protein, urinespecific gravity > 1.035.
• Levels of dehydration based on clinical signs that appearare :
• Level of dehydration <5%>
• Level of dehydration 5% ( mild ). The decrease of skin turgor, mucous membranes is dry.
• Level of dehydration 7 - 8% ( moderate ). Skin turgor is bad, capillary refill time 2 to 3 second, enopthalmus mild, the decrease oftemperature .
• Level of dehydration from 10 to 12% ( heavy ). Skin turgoris very bad, capillary refill time > 3 second, enopthalmus weight, debilitas, body temperature was decreased, pulsus weak.
• Level of dehydration from 12 to 15% ( very heavy ).
• Shock and death.

Correction of electrolyte imbalance and basa acid of body fluids can be done based on the following :

A. Evaluation on status of dehydration, balance of electrolyte and basa acid of body fluids.

Some important things that can be used as consideration for deciding whether or not be given fluid therapy, among others :

1. Depend on clinical signs and anamnesa.

2. Status balance of basa acid can be estimated on the basis of clinical symptoms that appear such :

• Diarrhe acute is condition of acidosis metabolic.
• The decrease of frequency respiratory is alkalo sismetabolic.
• Determination of status basa acid is very important to avoidoccur mistake when giving the type of fluid, example if the condition ofacidosis so that be given fluid is alkalinizer.

3. Status of plasma electrolytes, especially sodium ions, potassium ions andion Chlor.

The weakness of the extreme body condition is amanifestation of levels of potassium ions and calcium ions that low.

If there is hyperkalemia be given liquid that free potassiumions.

4. Degrees of dehydration.

Depend on clinical symptoms.

Overview of blood ( PCV, BUN, plasma protein concentration ) are changes that occur in relatively short intervals and showed a change from level of dehydration.

5. Osmotic pressure.Isotonisitas fluids is very important to guarantee the normal metabolism. 

Liquid distribution is can be affected by osmotic pressure on the extra cellular fluid, so that can be measured osmotic pressure on the extra cellular fluid by measuring the directly using osmometer or measured osmotic pressure of sodiumions. Hypoosmolaritas ( on condition of hyponatremia ) can cause the entry of water from extracellular to intracellular that be known as edema. Hyperosmolaritas ( on the condition of hypernatremia, hyperglycemia ) cause the exit of water from intracellular to extracellular.

6. Balance of basa acid.Process of normal metabolic depends on the stability pH of blood ( 7.4 ), ifthere is variation pH of blood is greater or smaller 0.3 ( 7.1<7.7>

Acidosis respiratory. Disease that be accompanied hypoventilasi can causes disruption ekshalasi CO2 ( increases pCO2 ) will result in the increase levels of H + and the decrease levels of HCO3- ( causingthe decrease pH of blood ). To compensate so that HCO3-absorption can be increased. The cause is anesthesia, pneumonia terminus.

Alkalosis respiratory. Ekshalasi excessive CO2 (hyperventilasi ) will cause the loss of ions H + and levels of HCO3 increased. To compensate so that excretion of HCO3-in the kidney can be increased ( occurthe increase pH of blood ). The cause is heat stroke, panting, hepaticencephalopathy.

Acidosis metabolic. Acidosis metabolic occurs due to the decrease levels of HCO3- in plasma caused by bonds of HCO3- with organic acids,loss of HCO3- excessive ( diarrhea, hypersalivasi ) and the inability of renalto reabsorbsi. Compensation that often occur is hyperventilasi so that HCO3-increase. The cause is diarrhea, shock, renal failure, uremia, diabetesmellitus, diabetic ketoacidosis.

Alkalosis metabolic. Alkalosis metabolic occurred because ofthe increase levels of HCO3- in plasma so that occur the increase pH of blood .Compensation that occur is hypoventilasi to maintain CO2 and the increase pH.Excretion of HCO3- through renal as a substitute for filtration of Cl-. Thecause is vomiting, hepatic failure, acute pancreatitis.

B. Requirement of body fluid. 

Planning for therapy of fluid that will be doneshould be consider some important things are :

• Correction of fluid deficit that occurred.
• The amount of fluid that be required as a fluid of maintenance/day.
• Fulfillment loss of fluid that be estimated is still continue. Deficit of fluid is determined at the time before therapy withconsideration of the degree anamnesa, physical examination and tests oflaboratory. The amount from fluid of maintenance is determined when the patientis not able to consume the necessary fluid of daily in lieu of the spent fluid.

C. Types of fluids that be given. 

Determination of fluid that be given depending on the abnormalities that occur. Generally, is otonicfluids is often given good as a acidifier or alkalinizer.

Types of fluid is often recommended as a therapy of fluid is:

• Dextrose 2,5 %. Hypotonic fluids be used in the conditiondehydrasi hypernatremia.
• Dextrose 5 %. 2. Isotonic fluids are used in conditionsdehydrasi hypernatremia.
• Dextrose 10%. Hypertonic fluids be used in the condition ofosmotic diuretics, hypoglycemia. 4. Dextrose 20%. Hypertonic fluids be used inthe condition of osmotic diuretics, hypoglycemia. 5. Lactated Ringer's. Isotonicfluid acts as alkalinizer.
• Ringer's. Isotonic fluid acts as acidifier.
• Saline 0,45 %. Hypotonic fluids be used in the condition dehydrasi hypernatremia.
• Saline 0,9 %. Isotonic fluids are used in conditionsdehydrasi hyponatremia.
• Sodium bicarbonat ( NaHCO3 ) 8,4 %. Hypertonic fluids are used as correction of acidosis metabolic heavy.
• Potassium chloride ( KCl ) 15 %. Hypertonic fluid is used as a correction of potassium deficiency. Calcium gluconate. Hypertonic fluid isused as correction hypocalcaemia.

D. The way of give therapy of fluid. 

The way of give therapy of fluid depends on several factors including the distribution velocity therapy of fluid in the body, the ability done restrain the patient and the type of disease that be encountered. The way of give therapy of fluid can be done is :

Per oral. Give therapy of fluid per oral is a safe way, process in normal physiological and not need equipment help that expensive. In the case of diseases related to digestion disorders and severe hypovolemia isunuseful way.

Sub cutan. Therapy of fluid that be given only isotonic fluids and nonirritant with the amount of fluid very small. Absorption anddistribution of the slow progress that is 6 to 8 hours after delivery, so beused if the correction fluid is not expected quickly.

Intravena. Benefits give therapy of fluid by intravenous is a lot of volume of fluid that can be given. Giving fluid quantities that uncontrolled will be cause overhydratasi is marked by restlessness, hyperpnoea, serous nasal discharge, edema conjuctiva.

Posted in: dehydration,health