Dehydration

This article is about excessive loss of body water. For Neurological complications can occur in hypotonic and
other uses, see Dehydration (disambiguation).
hypertonic states. The former can lead to seizures, while
the latter can lead to osmotic cerebral edema upon rapid
[6]
In physiology and medicine, dehydration (hypohydra- rehydration.
tion) is the excessive loss of body water,[1] with an accompanying disruption of metabolic processes. The term
dehydration may be used loosely to refer to any condition
where uid volume is reduced; most commonly, it refers 2 Signs and symptoms
to hypernatremia (loss of free water and the attendant excess concentration of salt), but is also used to refer to Symptoms of dehydration include thirst, headache, genhypovolemia (loss of blood volume, particularly plasma). eral discomfort, loss of appetite, dry skin, decreased
Dehydration occurs when water loss exceeds water in- urine volume, confusion, unexplained tiredness, and
[7][8][9]
More prolonged or severe dehydratake, usually due to exercise or disease. Most people can irritability.
tolerate a three to four percent decrease in body water tion leads to abnormally dark urine, rapid breathing,
without diculty. A ve to eight percent decrease can constipation, decreased blood pressure (hypotension),
cause fatigue and dizziness. Over ten percent can cause dizziness or fainting when standing up due to orthostatic
physical and mental deterioration, accompanied by se- hypotension, listlessness, insomnia, and loss of skin
[7]
[10]
vere thirst. A decrease more than fteen to twenty-ve elasticity. Athletes may suer a loss of performance
[2]
percent of the body water is invariably fatal. Mild dehy- and experience ushing, low endurance, rapid heart
dration is characterised by thirst and general discomfort rates, elevated body temperatures, and rapid onset of
fatigue. Untreated dehydration generally results in
and usually resolves with oral rehydration.
delirium, extreme lethargy, seizures, sunken fontanelle
(soft spot of the skull) in infants, fainting, sunken
eyes, unconsciousness, swelling of the tongue and,
1 Denition
in extreme cases, death.[7][11] Blood tests may show
hyperalbuminemia, an overabundance of protein in the
Dehydration occurs when water intake is insucient to blood plasma, poor kidney function, or excess concenreplace free water lost due to normal physiologic pro- tration hemoglobin; urinalysis may show concentrated
cesses (e.g. breathing or urination) and other causes (e.g. urine.[7][11] Dehydration symptoms generally become nodiarrhea or vomiting). Hypovolemia is specically a de- ticeable after 2% of normal euhydration water volume
crease in volume of blood plasma - isotonic intravascular has been lost.[12]
volume depletion, whereas the loss of intracellular pure
water in dehydration results in an increase in salt concen- The symptoms of dehydration become increasingly setration, hypernatremia.[3][4] Some authors have reported vere with greater water loss. Heart and respiration rates
three types of dehydration based on serum sodium levels: begin to increase to compensate for decreased plasma
hypotonic or hyponatremic (referring to this as primarily volume and blood pressure, while body temperature may
a loss of electrolytes, sodium in particular), hypertonic or rise because of decreased sweating. At around 5% to 6%
hypernatremic (referring to this as primarily a loss of wa- water loss, grogginess or sleepiness, severe headaches or
ter), and isotonic or isonatremic (referring to this as equal nausea, and a tingling in the limbs (paresthesia) may all be
loss of water and electrolytes).[5] The terms hyponatremic experienced. With 10% to 15% uid loss, muscles may
and eunatremic dehydration refer to hypovolemia. In hu- become spastic, skin may shrivel and wrinkle (decreased
mans, it is thought that the most commonly seen type of skin turgor), vision may dim, urination will be greatly redehydration by far is isotonic (isonatraemic) dehydration, duced and may become painful, and delirium may begin.
are usually fatal as organs fail,
but this eectively refers to hypovolemia. Dehydration, Losses greater than 15% [2]
starting
with
the
kidneys.
is thus a term that has loosely been used to mean loss
of water, regardless of whether it is as water and solutes In people over age 50, the bodys thirst sensation dimin(mainly sodium) or as free water. Hypotonic dehydration ishes and continues diminishing with age. Many senior
refers to solute loss, and thus loss of intravascular volume, citizens suer symptoms of dehydration. Dehydration
but in the presence of exaggerated intravascular volume along with hyperthermia results in the elderly dying suddepletion for a given amount of total body water gain. denly during extreme hot weather.
1

PREVENTION

In studies of terminally ill patients who have chosen to

Inability to swallow (obstruction of the esophdie, deaths by terminal dehydration are generally peaceful
agus)
and are not associated with suering when supplemented
with adequate pain medication.[13][14]
Other causes of obligate water loss

Cause

Water leaves the body in many ways, categorized into either sensible water loss or insensible water loss depending on whether the loss can be perceived by the
senses. Sensible water loss includes such processes
as sweating and vomiting. Insensible water loss occurs mainly through the skin and respiratory tract.[15] In
humans, dehydration can be caused by a wide range of
diseases and states that impair water homeostasis in the
body. These include the following:
External or stress-related causes
Prolonged physical activity with sweating
without consuming adequate water, especially
in a hot or dry environment

Severe hyperglycemia, especially in diabetes mellitus

Glycosuria
Uremia
Diabetes insipidus
Acute emergency dehydration event
Foodborne illness
Crohns disease
Likelihood of dehydration increases with consumption of
diuretics, including caeinated or alcoholic beverages.[12]

4 Prevention

Prolonged exposure to dry air, e.g. in high- Dehydration is avoided by drinking sucient water;
ying airplanes (5%12% relative humidity)
adults require 23 L of uid per day (including water con Blood loss or hypotension due to physical tent of food).[11] Drinking water beyond the needs of the
body entails little risk when done in moderation, since the
trauma
Loss of uid through weeping burns or other kidneys will eciently remove excess water through the
urine with a large margin of safety.
injury
Crying
Diarrhea
Fever
Hyperthermia
Shock (hypovolemic)
Vomiting or nausea

For routine activities, thirst is normally an adequate guide

to maintain proper hydration. With exercise, exposure to
hot environments, or a decreased thirst response, additional water may be required. An accurate determination
of uid volume lost during a workout can be made by performing weight measurements before and after a typical
exercise session.[16][17][18][19]

Normal water loss occurs through the lungs as water

vapor (about 350ml), through the skin by perspiration
Infectious diseases
(100ml) and by diusion through the skin (350ml), or
through the kidneys as urine (10002000ml, about 900ml
Cholera
of which is obligatory water excretion that gets rid of solutes). Some water (about 150200ml, in the absence of
Gastroenteritis
diarrhea) is also lost through the feces.[20] In warm or hu Shigellosis
mid weather or during heavy exertion, however, the wa Yellow fever
ter loss can increase by a factor of 10 or more through
perspiration; all of which must be promptly replaced. In
extreme cases, the losses may be great enough to exceed
Malnutrition
the bodys ability to absorb water from the gastrointesti Electrolyte disturbance
nal tract; in these cases, it is not possible to drink enough
Hypernatremia (also caused by dehydra- water to stay hydrated, and the only way to avoid dehydration is to either pre-hydrate[17] or nd ways to reduce
tion)
perspiration (through rest, a move to a cooler environ Hyponatremia
ment, etc.)
Fasting
When large amounts of water are being lost through per Recent rapid weight loss
spiration and concurrently replaced by drinking, main Patient refusal of nutrition and hydration
taining proper electrolyte balance becomes an issue.

3
Drinking uids that are hypertonic or hypotonic with
respect to perspiration may have grave consequences
(hyponatremia or hypernatremia, principally) as the total volume of water turnover increases.

Treatment

Main article: Management of dehydration

The treatment for minor dehydration, often considered
the most eective, is drinking water and stopping uid
loss. Plain water restores only the volume of the blood
plasma, inhibiting the thirst mechanism before solute levels can be replenished.[21] Solid foods can contribute to
uid loss from vomiting and diarrhea.[22] Urine concentration and frequency will customarily return to normal
as dehydration resolves.[11]

7 Notes
[1] Denition of dehydration at medicine net
[2] Ashcroft F, Life Without Water in Life at the Extremes.
Berkeley and Los Angeles, 2000, 134-138.
[3] MedicineNet > Denition of Hypovolemia Retrieved on
July 2, 2009
[4] TheFreeDictionary.com --> hypovolemia Citing Saunders
Comprehensive Veterinary Dictionary, 3 ed. Retrieved on
July 2, 2009
[5] Fleisher, Gary Robert; Ludwig, Stephen (2010). Textbook
of Pediatric Emergency Medicine. Lippincott Williams &
Wilkins. p. 811. ISBN 978-1-60547-159-4.
[6] Dehydration at eMedicine
[7] Kaneshiro, Neil K. Dehydration. National Library of
Medicine. Retrieved 10 June 2014.
[8] Shirres SM, Merson SJ, Fraser SM, Archer DT; Merson;

Fraser; Archer (June 2004). The eects of uid restricIn more severe cases, correction of a dehydrated state
tion on hydration status and subjective feelings in man.
is accomplished by the replenishment of necessary waBr. J. Nutr. 91 (6): 9518. doi:10.1079/BJN20041149.
ter and electrolytes (through oral rehydration therapy or
PMID 15182398.
uid replacement by intravenous therapy). As oral rehydration is less painful, less invasive, less expensive, and [9] Dehydration Aects Mood, Not Just Motor Skills /
easier to provide, it is the treatment of choice for mild
November 23, 2009 / News from the USDA Agricultural
Research Service. Ars.usda.gov. Retrieved 2012-11-09.
dehydration. Solutions used for intravenous rehydration
must be isotonic or hypotonic. Pure water injected into
[10] Bean, Anita (2006). The Complete Guide to Sports Nuthe veins will cause the breakdown (lysis) of red blood
trition. A & C Black Publishers Ltd. pp. 8183. ISBN
cells (erythrocytes).
0-7136-7558-6.

When fresh water is unavailable (e.g. at sea or in a desert),

[11] Wedro, Benjamin. Dehydration. MedicineNet. Reseawater and alcohol will worsen the condition. Urine
trieved 10 June 2014.
contains a similar solute concentration to seawater, and
numerous guides advise against its consumption in sur- [12] Kleiner, SM (February 1999). Water: an essential
but overlooked nutrient. Journal of the American Divival situations.[23][24][25][26]

etetic Association 99 (2): 2006. doi:10.1016/S0002-

For severe cases of dehydration where fainting,

8223(99)00048-6. PMID 9972188.
unconsciousness, or other severely inhibiting symptom is
present (the patient is incapable of standing or thinking [13] Printz LA (April 1992). Terminal dehydration, a compassionate treatment. Archives of Internal Medicine 152
clearly), emergency attention is required. Fluids con(4): 697700. doi:10.1001/archinte.152.4.697. PMID
taining a proper balance of replacement electrolytes are
1373053.
given orally or intravenously with continuing assessment
of electrolyte status; complete resolution is the norm in [14] Sullivan RJ (April 1993). Accepting death without articial nutrition or hydration. Journal of General Interall but the most extreme cases.
nal Medicine 8 (4): 220224. doi:10.1007/BF02599271.

Some research indicates that articial hydration to alleviPMID 8515334.

ate symptoms of dry mouth and thirst in the dying patient
[15] Alok K. Maintenance Fluid Therapy in Children
may be futile.[27]
[Online].
University of Texas Medical Branch.
http://www.utmb.edu/pedi_ed/CORE/Fluids&
Electyrolytes/page_02.htm[16 March,2014]

See also
Hydrational uids
Terminal dehydration
Dryness (medical)

[16] Water, Water, Everywhere. WebMD.

[17] Sawka MN, Burke LM, Eichner ER, Maughan RJ,
Montain SJ, Stachenfeld NS; Sawka; Burke; Eichner; Maughan; Montain; Stachenfeld (February 2007).
American College of Sports Medicine position stand.
Exercise and uid replacement. Med Sci Sports Exerc
39 (2): 37790. doi:10.1249/mss.0b013e31802ca597.
PMID 17277604.

[18] Nancy Cordes (April 2, 2008). Busting The 8-GlassesA-Day Myth. CBS.
[19] ""Drink at Least 8 Glasses of Water a Day Really?".
Dartmouth Medical School.
[20] Major Minerals. SparkNotes.
[21] Murray, Robert; Stofan, John (2001). Ch. 8: Formulating carbohydrate-electrolyte drinks for optimal ecacy.
In Maughan, Ron J.; Murray, Robert. Sports Drinks: Basic
Science and Practical Aspects. CRC Press. pp. 197224.
ISBN 978-0-8493-7008-3.
[22] Healthwise Handbook, Healthwise, Inc. 1999
[23] water
[24] Tracker Trail - Mother Earth News - Issue #72
[25] EQUIPPED TO SURVIVE (tm) - A Survival Primer
[26] Five Basic Survival Skills in the Wilderness
[27] Ellershaw JE, Sutclie JM, Saunders CM; Sutclie; Saunders (April 1995). Dehydration and the dying patient. J
Pain Symptom Manage 10 (3): 1927. doi:10.1016/08853924(94)00123-3. PMID 7629413.

References
Ira R. Byock, M.D., "Patient Refusal of Nutrition and Hydration: Walking the Ever-Finer Line.
American Journal Hospice & Palliative Care, pp. 8
13. (March/April 1995)

External links
Denition of dehydration by the U.S. National Institutes of Healths MedlinePlus medical encyclopedia
Rehydration Project at rehydrate.org
Steiner, MJ; DeWalt, DA; Byerley, JS (Jun 9, 2004).
Is this child dehydrated?". JAMA: the Journal of the
American Medical Association 291 (22): 274654.
doi:10.1001/jama.291.22.2746. PMID 15187057.

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