What is the evident sign of chronic dehydration?

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Last updated: June 16, 2025View editorial policy

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From the Guidelines

Chronic dehydration is most evidently signified by sunken eyes, among other signs, as indicated by the presence of at least four specific symptoms including confusion, non-fluent speech, extremity weakness, dry mucous membranes, dry tongue, furrowed tongue, and sunken eyes 1. When considering the signs of chronic dehydration, it's crucial to look for a combination of indicators rather than relying on a single symptom. According to the ESPEN guideline on clinical nutrition and hydration in geriatrics 1, a person with at least four of the following seven signs is likely to have moderate to severe volume depletion:

  • Confusion
  • Non-fluent speech
  • Extremity weakness
  • Dry mucous membranes
  • Dry tongue
  • Furrowed tongue
  • Sunken eyes These signs are critical because they reflect the body's response to insufficient hydration, which can lead to serious health complications if not addressed. While muscle wasting can be a sign of various conditions, including malnutrition and chronic diseases, sunken eyes are specifically highlighted as a key indicator of chronic dehydration in the context of volume depletion following fluid and salt loss 1. It's also important to note that the sensation of thirst decreases with age, making older adults more susceptible to dehydration 1. Therefore, relying solely on thirst as an indicator of hydration status may not be sufficient, especially in older populations. Given the potential severity of dehydration, particularly in vulnerable populations like the elderly, it is essential to monitor for signs like sunken eyes, alongside other indicators, to promptly identify and manage chronic dehydration 1.

From the Research

Evident Signs of Chronic Dehydration

  • The evident sign of chronic dehydration is not explicitly stated in the provided studies as a single definitive answer.
  • However, according to the study 2, subjects with sunken eyes had higher C-reactive protein and lower albumin concentrations in plasma, which could be related to dehydration.
  • Another study 3 found that sunken eyes, along with skin elasticity, weak radial pulse, and general appearance, provided the best explanatory power for physical signs of dehydration in children.
  • Additionally, a study 4 found that parental report of sunken eyes and decreased tears were associated with hospital admission due to dehydration.
  • It is also worth noting that muscle wasting is not directly mentioned as a sign of chronic dehydration in the provided studies, but it could be a consequence of severe and prolonged dehydration 5.
  • Therefore, based on the available evidence, sunken eyes (option B) appear to be a more evident sign of chronic dehydration than muscle wasting (option A) 2, 3, 4.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Signs of Dehydration in Nursing Home Residents.

Journal of the American Medical Directors Association, 2018

Research

[Electrolyte and acid-base balance disorders in advanced chronic kidney disease].

Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia, 2008

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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