From the Guidelines
Severe dehydration treatment should prioritize intravenous fluid replacement with isotonic crystalloids like normal saline or Ringer's lactate at 20-30 mL/kg in the first hour, followed by reassessment and continued fluid replacement based on clinical response, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.
Key Considerations
- Severe dehydration constitutes a medical emergency and requires immediate attention.
- Treatment should begin with rapid IV fluid resuscitation using isotonic crystalloids.
- Children require 20 mL/kg boluses repeated up to three times if needed, while adults should receive 20-30 mL/kg in the first hour.
- Vital signs, including blood pressure, heart rate, and urine output, should be monitored continuously.
- Laboratory tests, such as electrolytes, BUN, creatinine, and glucose, are essential to guide treatment.
Oral Rehydration
- Once the patient is stabilized, oral rehydration with solutions containing appropriate electrolytes can begin if the patient can tolerate it, as suggested by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.
- The remaining deficit can be replaced using oral rehydration solutions (ORS).
Underlying Causes
- Underlying causes, such as diarrhea, vomiting, or heat illness, must be addressed simultaneously.
- Potassium replacement may be necessary after initial rehydration and urine flow is established.
Severe Cases
- Severe cases may require central venous pressure monitoring or vasopressors if hypotension persists despite fluid resuscitation.
- This aggressive approach is necessary because severe dehydration can lead to organ failure, shock, and death if not treated promptly and effectively, as emphasized by the Centers for Disease Control and Prevention guidelines 1.
From the Research
Severe Dehydration Treatment
- Severe dehydration can be treated with intravenous fluids, such as Normal Saline (NS) or Ringer Lactate (RL) 2
- The choice of fluid depends on the patient's condition and the severity of dehydration
- NS and RL are equivalent in terms of change in serum sodium from baseline for intravenous rehydration in children with acute diarrhea and severe dehydration 2
Types of Dehydration
- There are two types of dehydration: water loss dehydration (hyperosmolar) and salt and water loss dehydration (hyponatremia) 3
- Water loss dehydration can be caused by increased sodium or glucose levels
- Salt and water loss dehydration can be caused by hyponatremia
Treatment Options
- Maintenance fluid therapy with saline, dextrose-supplemented saline, or lactated Ringer can be used to treat mild to moderate dehydration in children 4
- Subcutaneous infusion of fluids (hypodermoclysis) can be used to treat mild to moderate dehydration in nursing homes and at home 3
- Intravenous fluid therapy can be used to treat severe dehydration, with the goal of replenishing fluid volumes and restoring homeostasis 5, 6
Nursing Role
- Nurses play an important role in assessing patients' fluid status and administering and monitoring intravenous fluid therapy 5, 6
- Nurses should be aware of the principles and aims of intravenous fluid therapy, as well as the potential risks and complications 6
- Nurses should also be able to identify and treat dehydration, which can occur as a result of many different conditions 5