What are the treatment options for dehydration-induced hypotension?

From the Guidelines

Dehydration can cause low blood pressure, and the primary treatment for dehydration-induced hypotension is fluid resuscitation to restore intravascular volume. This is based on the strongest and most recent evidence from the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope, which recommends fluid resuscitation via oral or intravenous bolus in patients with syncope due to acute dehydration 1.

Treatment Options

The treatment options for dehydration-induced hypotension include:

• Oral rehydration with water or electrolyte solutions like Pedialyte or sports drinks for mild to moderate cases
• Intravenous (IV) fluid therapy with isotonic crystalloids such as normal saline (0.9% sodium chloride) or lactated Ringer's solution at an initial rate of 500-1000 mL over the first hour, adjusted based on patient response, for more severe cases requiring medical intervention
• Addressing underlying causes of dehydration, such as treating vomiting with antiemetics like ondansetron 4-8 mg or treating diarrhea with appropriate medications
• Monitoring vital signs, urine output, and clinical improvement to guide therapy
• In elderly patients or those with cardiac or renal issues, fluid administration should proceed more cautiously with careful monitoring to prevent fluid overload

Additional Considerations

In selected patients with syncope due to dehydration, it is reasonable to encourage increased salt and fluid intake 1. However, this treatment option is not appropriate for patients with cardiac dysfunction or HF, uncontrolled hypertension, or chronic kidney disease. Vasopressors like norepinephrine (starting at 0.1-0.5 mcg/kg/min) may be temporarily needed in severe cases while fluid resuscitation is ongoing.

Recent Guidelines

Recent guidelines, such as the 2022 review on travelling with heart failure, also emphasize the importance of fluid intake and monitoring for signs and symptoms of volume depletion and dehydration-associated electrolyte or acid–base disorders in patients with heart failure 1. However, the most recent and highest quality study relevant to the treatment of dehydration-induced hypotension is the 2017 ACC/AHA/HRS guideline 1, which provides the basis for the recommended treatment approach.

From the FDA Drug Label

Blood volume depletion should always be corrected as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, LEVOPHED can be administered before and concurrently with blood volume replacement

Dehydration can cause low blood pressure (hypotension) due to blood volume depletion. The treatment options for dehydration-induced hypotension include:

• Correcting blood volume depletion as fully as possible before administering any vasopressor
• Administering a vasopressor, such as norepinephrine, before and concurrently with blood volume replacement 2
• Using fluid intake and vasopressors to maintain adequate blood pressure and tissue perfusion 2 Key points to consider are blood volume replacement, vasopressor administration, and fluid management.

From the Research

Dehydration and Low Blood Pressure

Dehydration can cause low blood pressure, as the loss of body water can lead to a decrease in blood volume, which in turn can cause a drop in blood pressure.

• Dehydration is a condition where the body loses more fluids than it takes in, causing an imbalance in the body's water and electrolyte levels 3.
• This imbalance can lead to a range of symptoms, including low blood pressure, also known as hypotension.

Treatment Options for Dehydration-Induced Hypotension

The treatment options for dehydration-induced hypotension typically involve replenishing the body's fluids and electrolytes.

• Intravenous fluid therapy is often used to treat dehydration, especially in severe cases where oral hydration is not possible 4, 5.
• The type and amount of fluid used will depend on the individual's condition and the severity of their dehydration.
• In some cases, medications such as vasopressors may be used to help increase blood pressure 4.
• Subcutaneous infusion of fluids, also known as hypodermoclysis, can be used to treat mild to moderate dehydration, especially in long-term care facilities 6.

Diagnosis and Assessment of Dehydration

Diagnosing and assessing dehydration can be challenging, as the symptoms can be subtle and non-specific.

• Plasma osmolality is a valuable marker of dehydration, and can be used to diagnose and monitor the condition 3.
• Clinical assessment and laboratory testing are also important in diagnosing and assessing dehydration 6.
• Nurses play a critical role in identifying and treating dehydration, and should be aware of the signs and symptoms of the condition, as well as the treatment options available 5.