From the Research
The primary treatment for dehydration with an elevated BUN level of 26.5 mg/dL is fluid rehydration, preferably with intravenous (IV) fluids such as balanced crystalloid solutions like lactated Ringer's solution, as they likely result in a slight reduction of the time in hospital compared to 0.9% saline 1.
Key Considerations
- For mild to moderate dehydration, initial IV fluid administration should be 1-2 liters over 2-4 hours, followed by maintenance fluids based on ongoing assessment.
- If IV access is unavailable or the dehydration is mild, oral rehydration with electrolyte solutions like Pedialyte or Gatorate can be effective, aiming for 200-500 mL per hour.
- The elevated BUN level indicates that the kidneys are retaining urea nitrogen due to decreased renal perfusion from volume depletion.
- As rehydration occurs, kidney function typically improves, allowing for better clearance of urea and normalization of BUN levels.
Monitoring and Adjustments
- During treatment, it's essential to monitor vital signs, urine output, electrolyte levels, and renal function.
- The underlying cause of dehydration should also be addressed, whether it's excessive fluid loss from vomiting, diarrhea, fever, or inadequate intake.
- Patients with comorbidities like heart failure or kidney disease may require more careful fluid administration to prevent fluid overload, as excessive fluid administration is associated with poor outcomes, including the development and progression of acute kidney injury (AKI) 2.
Additional Guidance
- Fluid administration should be individualized and take into account patient characteristics, nature of the acute illness and trajectories, and risks and benefits of fluids 2.
- Existing data support the preferential use of buffered solutions for fluid resuscitation of patients at risk of AKI who do not have hypochloremia 2.