BAB I

PENDAHULUAN
Definisi
Dehidrasi adalah kondisi di mana tubuh kehilangan lebih banyak cairan daripada cairan yang
masuk dalam tubuh. Ketidakseimbangan ini juga mengganggu kadar garam, mineral, dan gula
dalam darah, yang dapat mengganggu fungsi tubuh dan menyebabkan efek yang berbahaya.

Seberapa umumkah dehidrasi?

Dehidrasi sangat umum terjadi. Kondisi ini dapat terjadi pada pasien dengan usia berapa saja.
Setiap hari, kadar air pada tubuh berkurang dengan napas yang dihembuskan, pada keringat,
urin, dan kotoran. Jika tidak memberi asupan air atau cairan yang cukup untuk menggantikan
cairan yang hilang, Anda dapat mengalami dehidrasi.

Dehidrasi dapat ditangani dengan mengurangi fator-faktor risiko. Diskusikan dengan dokter
untuk informasi lebih lanjut.

Tanda-tanda & gejala

Apa saja tanda-tanda dan gejala dehidrasi?
Dehidrasi memiliki efek yang tampak pada tubuh Anda. Beberapa gejala umum dari dehidrasi
adalah:

Merasa sangat kehausan

Merasa pusing
Palpitasi (merasa jantung berdebar kencang)
Urin yang dihasilkan sedikit
Mulut kerng
Urin pekat dan berwarna kuning gelap
Otot yang melemah
Kulit kering
Kemungkinan ada tanda-tanda dan gejala yang tidak disebutkan di atas. Bila Anda memiliki
kekhawatiran akan sebuah gejala tertentu, konsultasikanlah dengan dokter Anda.

Kapan saya harus periksa ke dokter?

Walau umum terjadi, dehidrasi dapat menjadi sangat berbahaya apabila tidak ditangani. Segera
hubungi dokter bila Anda mengalami gejala-gejala berikut ini:

Demam
Diare lebih dari 2 hari
Produksi urin berkurang
Kebingungan
Kelemahan
Tidak dapat berkonsentrasi
Pingsan
Nyeri dada atau perut.
Jika Anda memiliki tanda-tanda atau gejala-gejala di atas atau pertanyaan lainnya,
konsultasikanlah dengan dokter Anda. Tubuh masing-masing orang berbeda. Selalu
konsultasikan ke dokter untuk menangani kondisi kesehatan Anda.

Penyebab
Apa penyebab dehidrasi?
Dehidrasi biasanya disebabkan oleh asupan cairan yang kurang. Faktor lainnya meliputi iklim,
aktivitas fisik, dan diet. Selain itu, dehidrasi dapat disebabkan oleh penyakit yang
mengakibatkan kehilangan cairan seperti diare, muntah, dan diabetes.

Faktor-faktor risiko
Apa yang meningkatkan risiko saya untuk dehidrasi?
Bayi memiliki risiko yang lebih besar terhadap dehidrasi, akibat berat badan yang rendah
membuat mereka sensitif terhadap kehilangan cairan meski sedikit.

Lansia juga berada dalam risiko yang lebih besar, karena mereka mungkin lupa atau tidak
menyadari bahwa mereka perlu minum cairan.

Orang-orang dengan penyakit kronis, seperti diabetes, penyakit ginjal, alkoholisme juga dapat
menderita dehidrasi.
Atlet, terutama pada acara yang memerlukan ketahanan seperti maraton, triatlon, dan turnamen
dapat terpengaruh akibat jumlah cairan tubuh yang hilang melalui keringat.

Orang-orang dengan profesi yang melakukan pekerjaan berat, seperti pekerja bangunan,
terekspos sinar matahari secara reguler, dan kehilangan banyak cairan dari keringat.

Obat & Pengobatan

Informasi yang diberikan bukanlah pengganti nasihat medis. SELALU konsultasikan pada
dokter Anda.

Bagaimana cara mendiagnosis dehidrasi?

Dokter dapat melakukan beberapa tes atau mengirimkan sampel darah atau urin ke
laboratorium.

Ada beberapa gejala fisik yang dokter dapat digunakan dokter untuk mendiagnosis, seperti
disorientasi, tekanan darah rendah, debaran jantung cepat (palpitasi) demam dan kulit yang
tidak elastis.
Tes darah digunakan untuk mengetahui apakah ginjal berfungsi dengan baik atau tidak dan
untuk melihat kadar sodium, potasium, dan elektrolit lain pada tubuh.
Urinalisis sangat berguna untuk diagnosis dehidrisi, karena urin orang yang mengalami
dehidrasi akan tampak lebih gelap dan pekat.
Untuk menentukan dehidrasi pada bayi, dokter biasanya memeriksa soft spot (bagian yang
lunak) pada tengkorak, keringat, dan karakteristik otot tertentu.

Bagaimana cara mengobati dehidrasi?

Tentunya, untuk menggantikan kehilangan cairan pada tubuh, Anda perlu minum banyak
cairan, seperti air dan jus, namun hindari minuman berkafein dan soda.

Bayi dan anak-anak kecil dengan dehidrasi tidak boleh diberi air karena dapat mencairkan
kadar elektrolit dan mineral pada tubuh yang sudah rendah. Organisasi Kesehatan Dunia
(WHO) merekomendasi penggunaan cairan rehidrasi oral yang mengandung campuran
potassium, garam, dan gula untuk mengembalikan keseimbangan cairan tubuh.
Pada kasus dehidrasi yang parah, Anda perlu segera datang ke rumah sakit atau menghubungi
dokter untuk mendapatkan pengobatan yang tepat. Hal ini dapat meliputi pengobatan anti diare,
anti muntah, dan anti demam.

Pengobatan di rumah
Apa saja perubahan gaya hidup atau pengobatan rumahan yang dapat dilakukan untuk
mengatasi dehidrasi?
Berikut adalah gaya hidup dan pengobatan rumahan yang dapat membantu Anda mengatasi
dehidrasi:

Minum air dengan kadar yang sedikit-sedikit

Minum minuman berkarbon atau elektrolit
Makan es loli yang terbuat dari jus dan minuman energi
Minum melalui sedotan
Pediatric Dehydration
Roy M. Vega; Usha Avva.

Author Information

Last Update: February 3, 2019.

Go to:

Introduction
The World Health Organization defines dehydration as a condition that results from excessive
loss of body water. The most common causes of dehydration in children are vomiting and
diarrhea.
Go to:

Etiology
Infants and young children are particularly susceptible to diarrheal disease and dehydration.
Reason include higher metabolic rate, inability to communicate their needs or hydrate
themselves, and increased insensible losses. Other causes of dehydration may be the result of
other disease processes resulting in fluid loss which includes: diabetic ketoacidosis (DKA),
diabetes insipidus, burns, excessive sweating, and third spacing. Dehydration may also be the
result of decreased intake along with ongoing losses. In addition to total body water losses,
electrolyte abnormalities may exist. Infants and children have higher metabolic needs and that
make them more susceptible to dehydration.[1]
Go to:

Epidemiology
Dehydration is a major cause of morbidity and mortality in infants and young children
worldwide. Each year approximately 760,000 children of diarrheal disease worldwide. Most
cases of dehydration in children are the consequence of acute gastroenteritis.
Acute gastroenteritis in the United States is usually infectious in etiology. Viral infections,
including rotavirus, norovirus, and enteroviruses cause 75 to 90 percent of infectious diarrhea
cases. Bacterial pathogens cause less than 20 percent of cases. Common bacterial causes include
Salmonella, Shigella, and Escherichia coli. Approximately 10 percent of bacterial disease occurs
secondary to diarrheagenic Escherichia coli. Parasites such as Giardia and Cryptosporidium
account for less than 5 percent of cases.
Go to:

Pathophysiology
Dehydration causes a decrease in total body water in both the intracellular and extracellular fluid
volumes. Volume depletion closely correlates with the signs and symptoms of dehydration. The
total body water (TBW) in humans is distributed in two major compartments. 2/3rd the of TBW
is in the intracellular compartment and the other 1/3rd is distributed between interstitial space
(75%) and plasma (25%). The total body water is higher in infants and children as compared to
the adults. In infants, it is 70% of the total weight, whereas it is 65% and 60% respectively in
children and adults. As indicated earlier dehydration is total water depletion with respect to the
sodium and volume depletion is the decrease in the circulation volume. Volume depletion is seen
in acute blood loss and burns, whereas distributive volume depletion is seen in sepsis and
anaphylaxis. In much of the literature, the distinction between dehydration and volume depletion
is a blur.
Metabolic acidosis is seen in infants and children with dehydration, the pathophysiology of
which is multifactorial.
1. excess bicarbonate loss in the diarrhea stool or in the Urine is certain types of renal tubular
acidosis
2. Ketosis secondary to the glycogen depletion seen in starvation which sets in infants and
children much earlier when compared to adults.
3. Lactic acid production secondary to poor tissue perfusion
4. Hydrogen ion retention by the kidney from decreased renal perfusion and decreased
glomerular filtration rate.
In children with pyloric stenosis have very unique electrolyte abnormalities from the excessive
emesis of gastric contents. This is seen mostly in the older children. They loose chloride, sodium,
potassium in addition to volume resulting in hypochloremic, hypokalemic metabolic alkalosis.
Kidney excretes base in the form of Hco3 ion to maintain acid-base balance of loss of Hydrogen
ion in the emesis in the form of hydrogen chloride. It is interesting to note that kidney also
excretes hydrogen ion to save sodium and water, which could be the reason for aciduria.
Recently published article has shown that many children with pyloric stenosis may not have
metabolic alkalosis.
Go to:

History and Physical

Various sign and symptoms can be present depending on the patient's degree of dehydration.
Dehydration is categorized as mild (3% to 5%), moderate (6% to 10%), and severe ( more than
10%). The table below can assist with categorizing the patient's degree of dehydration. The
degree of dehydration between an older child and infant are slightly different as the infant could
have total body water (TBW) content of 70%-80% of the body weight and older children have
TBW of 60% of the body weight. An infant has to lose more body weight than the older child to
get to the same level of dehydration.[2]
Dehydration% Mild 3% to 5% Moderate 6% to 10% Severe >10%
Mental status Normal Listless, irritable Altered mental
Heart rate Normal Increased Increased
Pulses Normal Decreased Thready
Capillary refill Normal Prolonged Prolonged
Blood pressure Normal Normal Decreased
Respirations Normal Tachypnea Tachypnea
Eyes Normal Slightly sunken Fewer tears
Fontanelle Normal Sunken Sunken
Urine output Normal Decreased Oliguric
(see image below)
Go to:

Evaluation
Dehydration could be associated with hypo or hyper or isonatremia. Most cases of dehydration
are hyponatremic. In selected cases, electrolyte abnormalities may exist. This includes
derangements in sodium levels, acidosis characterized by low bicarbonate levels or elevated
lactate levels. For patients with vomiting, who have not been able to tolerate oral fluids
hypoglycemia may be present. Evaluation of urine specific gravity and the presence of ketones
can assist in the evaluation of dehydration.[3]
Children who were given free water when they have ongoing diarrhea disease can present with
hyponatremic dehydration, the excess of free water concurrent to excess sodium and bicarbonate
loss in diarrhea. This is also seen in the syndrome of inappropriate secretion of antidiuretic
hormone (SIADH). In these cases, the children appear to be more dehydrated and could also
present with hyponatremic seizure activity.
Similarly, infants who are fed oral rehydration solution prepared from excess salt or who lost
excess free water as in diabetes incipidus could have hypernatraemic dehydration
End-tidal carbon dioxide measurements have been studied in an attempt to assess degrees of
dehydration greater than five percent in children. This non-invasive approach has promise, but as
of now has not proven to be an effective tool in determining the degree of dehydration in
children. [4]
Go to:

Treatment / Management
Priorities in the management of dehydration include early recognition of symptoms, identifying
the degree of dehydration, stabilization, and rehydration strategies.
Symptoms include vomiting, diarrhea, fever, decreased oral intake, inability to keep up with
ongoing losses, decreased urine output, progressing to lethargy, and hypovolemic shock.
Mild Dehydration
The American Academy of Pediatrics recommends oral rehydration for patients with mild
dehydration. Breastfed infants should continue to nurse. Fluids with high sugar content may
worsen diarrhea and should be avoided. Children can be fed age-appropriate foods frequently but
in small amounts.
Moderate Dehydration
The Morbidity and Mortality Weekly Report recommends administering 50 mL to 100 mL of
oral rehydration solutions per kilogram per body weight during two to four hours to replace the
estimated fluid deficit, with additional oral rehydration solution, administered to replace ongoing
losses.
Severe Dehydration
For patients who are severely dehydrated, rapid restorations of fluids are required.
Patients who are severely dehydrated can present with altered mental status, lethargy,
tachycardia, hypotension, signs of poor perfusion, weak thread pulses, and delayed capillary
refill.
Intravenous fluids, starting with 20 ml/kg boluses of normal saline are required. Multiple boluses
may be needed for children in hypovolemic shock. Additional priorities include obtaining a point
of care glucose test, electrolytes, and urinalysis assessing for elevated specific gravity and
ketones. [5]
Hypoglycemia should be assessed at the point of care testing via glucometer, and venous blood
gas with electrolytes or serum chemistries. It should be treated with intravenous glucose. The
dose is 0.5 gm/km to 1 gm/km. This translates to 5 ml/kg to 10 ml/kg of D10, 2ml/kg to 4 ml/kg
of D25, or 1 ml/kg to- 2 ml/kg of D50. The use of D50 is usually reserved for an adolescent or
adult-sized patients using a large bore intravenous line.[6]
Replacement of Fluids
An assessment of the degree of dehydration will determine the fluid replacement. Using tables
that can predict the degree of dehydration is helpful. If a previous "well weight" is available, that
can be subtracted from the patient's "sick weight" to calculate total weight loss. One kilogram
weight loss equates to one liter of fluid lost.
The rate of replacement is based on the severity of the dehydration. Patients with hypovolemic
shock need rapid boluses of isotonic fluid either normal saline or ringer lactate at 20ml/kg body
weight. This could be repeated 3 times with reassessment in-between the boluses. Ringer lactate
is superior to normal saline in hemorrhagic shock requiring rapid resuscitation with isotonic
fluids.[7] This difference is not found in the children with severe dehydration from acute
diarrheal disease. In these children, the replacement with normal saline and ringer lactate did
show similar clinical improvement.[8]
Rapid infusion can cause cardiac insufficiency, congestive heart failure, and pulmonary edema.
Rapid correction in patients with diabetic ketoacidosis can cause cerebral edema in adolescent
and children.
The rate of replacement fluids is calculated after taking into account for the maintenance,
replacement and deficit requirement of the patient. Sodium requirements of the children in the
hospital are higher than that of the adults. The children have high metabolic needs, has higher
insensible lose as they have a higher body surface area. They also have higher respiratory and
heart rates, requiring the use of an intravenous solution containing high sodium like D5NS. The
deficit is determined by the degree of dehydration as outlined earlier. The second phase of fluid
replacement therapy lasts for 8 hours, during which the child requires 1/2 of the remaining deficit
in addition 1/3rd of the maintenance fluid. The remaining half of the deficit and the 2/3rd of the
daily maintenance therapy is given during the third phase of the therapy which spans the
following 16 hours.
Holliday-Segar calculation is used for calculation of maintenance fluid in children, which is
100ml/kg/day for first 10 kg body weight (BW), then 50 ml/kg/day for the next 10 kg BW and
then 20 ml/kg /day for any BW over and above.[9]
For patients where intravenous access can not be achieved or maintained, other methods can be
employed. They include continuous nasogastric hydration and subcutaneous hydration.[10]]
Hypodermoclysis refers to hydrating the subcutaneous space with fluid which can be absorbed
systemically. Hypodermoclysis is best reserved for the stable child or infant with mild to
moderate dehydration who either fails a trial of fluids by mouth or who needs some degree of
rehydration to facilitate gaining intravenous access after a slow subcutaneous fluid bolus has
been given.
The process begins with:
The placement of topical anesthetic cream, such as EMLA, cover with an occlusive dressing,
wait for 15 to 20 minutes.“Pinch an inch” of skin anywhere, but the most practical site for young
children is between the scapulae.Insert a 25-gauge butterfly needle or 24-gauge
angiocatheterInject 150 units hyaluronidase SC (if available).Infuse 20 mL/kg isotonic solution
over one hour, repeat as needed or use this technique as a bridge to intravenous access.
Go to:

Pearls and Other Issues

Once the patient’s condition has stabilized, hydration therapy continues to replace existing and
ongoing losses. Fluid therapy should include maintenance fluids plus replacement of the existing
fluid deficit.
Deficit calculation can be determined in several ways. If the patient's weight before the illness is
known, it can be subtracted from the current weight. Each kilogram lost would be equivalent to
one liter of fluid lost. If the prior weight is not known, multiply the weight in kilograms by the
dehydration percent.
For a 10 kg patient who is 10% dehydrated, 0.1 represents 10%
 (10 kg) x (.10) = 1 kilogram
Maintenance fluids can be calculated as follows:
For a patient weighing less than 10 kg, they should receive 100 mL/kg/day.
If the patient weighs less than 20 kg, fluids will include the 1000 mL/day plus 50 mL/kg/day for
each kilogram between 10 kg and 20 kg.
For patients weighing more than 20 kg, give 1500 mL/day, plus 20 mL/kg/day for each kilogram
over 20 kg. Divide the total by 24 to determine the hourly rate.
In hyponatremic dehydration, half of the deficit can be replaced over eight hours with the
remaining half the following sixteen hours. Severe hyponatremia (< 130 mEq/L) or
hypernatremic dehydration (> 150 mEq/L) is corrected over 24 to 48 hours. Symptomatic
hyponatremia (seizures, lethargy) can be acutely managed with hypertonic saline (3% sodium
chloride). The deficit may be calculated to restore the sodium to 130 mEq/L and administered
over 48 hours, as follows:
Sodium deficit = (sodium desired - sodium actual) x volume of distribution x weight (kg))
Example: Sodium = 123, weight = 10 kg, assumed volume of distribution of 0.6; Sodium deficit
= (130-123) X 0.6 X 10 kg = 42 mEq sodium. Hypertonic saline (3%) which contains 0.5
mEq/mL may be used for rapid partial correction of symptomatic hyponatremia. A bolus dose of
4 mL/kg raises the serum sodium by 3 mEq/L to 4 mEq/L.
Rapid correction of hypernatremia may result in cerebral edema, as a result of intracellular
swelling occurs. Osmotic demyelination syndrome, also known as central pontine myelinolytic,
can occur as a result of rapid correction of hyponatremia. Symptoms include a headache,
confusion, altered consciousness, gait disturbance, and may lead to respiratory arrest.
Go to:

Enhancing Healthcare Team Outcomes

Diarrheal diseases and resulting severe dehydration are the leading cause of infant mortality
worldwide especially in children < 5years of age.[11]. This burden is even higher among
children in developing countries. To improve the outcome and decrease the morbidity and
mortality from the diarrhea diseases especially Rotaviral disease which is the leading cause of
death in children we need cooperation between various different agencies and countries.
World health organization while working with member countries and other agencies promotes
national policies and investments to have access to safe drinking water, to improve sanitation, to
research in diarrhea prevention like vaccination, to implement preventive measures like source
water treatments, safe storage and to help train the health care workers who could go into
communities to bring the change at local level.
Overview, mayoclinic
(https://www.mayoclinic.org/diseases-
conditions/dehydration/symptoms-causes/syc-20354086)
17 Februari 2019

Dehydration occurs when you use or lose more fluid than you take in, and your body
doesn't have enough water and other fluids to carry out its normal functions. If you don't
replace lost fluids, you will get dehydrated.

Anyone may become dehydrated, but the condition is especially dangerous for young
children and older adults.

The most common cause of dehydration in young children is severe diarrhea and
vomiting. Older adults naturally have a lower volume of water in their bodies, and may
have conditions or take medications that increase the risk of dehydration.

This means that even minor illnesses, such as infections affecting the lungs or bladder,
can result in dehydration in older adults.

Dehydration also can occur in any age group if you don't drink enough water during hot
weather — especially if you are exercising vigorously.

You can usually reverse mild to moderate dehydration by drinking more fluids, but
severe dehydration needs immediate medical treatment.

Symptoms

Thirst isn't always a reliable early indicator of the body's need for water. Many people,
particularly older adults, don't feel thirsty until they're already dehydrated. That's why it's
important to increase water intake during hot weather or when you're ill.

The signs and symptoms of dehydration also may differ by age.

Infant or young child

 Dry mouth and tongue

 No tears when crying

 No wet diapers for three hours

 Sunken eyes, cheeks

 Sunken soft spot on top of skull

 Listlessness or irritability
Adult

 Extreme thirst

 Less frequent urination

 Dark-colored urine

 Fatigue

 Dizziness

 Confusion
When to see a doctor

Call your family doctor if you or a loved one:

 Has had diarrhea for 24 hours or more

 Is irritable or disoriented and much sleepier or less active than usual

 Can't keep down fluids

 Has bloody or black stool

Request an Appointment at Mayo Clinic
Causes
Sometimes dehydration occurs for simple reasons: You don't drink enough because
you're sick or busy, or because you lack access to safe drinking water when you're
traveling, hiking or camping.

Other dehydration causes include:

 Diarrhea, vomiting. Severe, acute diarrhea — that is, diarrhea that comes on suddenly
and violently — can cause a tremendous loss of water and electrolytes in a short amount
of time. If you have vomiting along with diarrhea, you lose even more fluids and minerals.

 Fever. In general, the higher your fever, the more dehydrated you may become. The
problem worsens if you have a fever in addition to diarrhea and vomiting.

 Excessive sweating. You lose water when you sweat. If you do vigorous activity and
don't replace fluids as you go along, you can become dehydrated. Hot, humid weather
increases the amount you sweat and the amount of fluid you lose.

 Increased urination. This may be due to undiagnosed or uncontrolled diabetes. Certain

medications, such as diuretics and some blood pressure medications, also can lead to
dehydration, generally because they cause you to urinate more.

Risk factors

Anyone can become dehydrated, but certain people are at greater risk:

 Infants and children. The most likely group to experience severe diarrhea and vomiting,
infants and children are especially vulnerable to dehydration. Having a higher surface area
to volume area, they also lose a higher proportion of their fluids from a high fever or burns.
Young children often can't tell you that they're thirsty, nor can they get a drink for
themselves.

 Older adults. As you age, your body's fluid reserve becomes smaller, your ability to
conserve water is reduced and your thirst sense becomes less acute. These problems are
compounded by chronic illnesses such as diabetes and dementia, and by the use of
certain medications. Older adults also may have mobility problems that limit their ability to
obtain water for themselves.

 People with chronic illnesses. Having uncontrolled or untreated diabetes puts you at
high risk of dehydration. Kidney disease also increases your risk, as do medications that
 increase urination. Even having a cold or sore throat makes you more susceptible to
dehydration because you're less likely to feel like eating or drinking when you're sick.

 People who work or exercise outside. When it's hot and humid, your risk of dehydration
and heat illness increases. That's because when the air is humid, sweat can't evaporate
and cool you as quickly as it normally does, and this can lead to an increased body
temperature and the need for more fluids.

Complications

Dehydration can lead to serious complications, including:

 Heat injury. If you don't drink enough fluids when you're exercising vigorously and
perspiring heavily, you may end up with a heat injury, ranging in severity from mild heat
cramps to heat exhaustion or potentially life-threatening heatstroke.

 Urinary and kidney problems. Prolonged or repeated bouts of dehydration can cause
urinary tract infections, kidney stones and even kidney failure.

 Seizures. Electrolytes — such as potassium and sodium — help carry electrical signals
from cell to cell. If your electrolytes are out of balance, the normal electrical messages can
become mixed up, which can lead to involuntary muscle contractions and sometimes to a
loss of consciousness.

 Low blood volume shock (hypovolemic shock). This is one of the most serious, and
sometimes life-threatening, complications of dehydration. It occurs when low blood volume
causes a drop in blood pressure and a drop in the amount of oxygen in your body.

Prevention

To prevent dehydration, drink plenty of fluids and eat foods high in water such as fruits
and vegetables. Letting thirst be your guide is an adequate daily guideline for most
healthy people.

People may need to take in more fluids if they are experiencing conditions such as:

 Vomiting or diarrhea. If your child is vomiting or has diarrhea, start giving extra water or
an oral rehydration solution at the first signs of illness. Don't wait until dehydration occurs.
  Strenuous exercise. In general, it's best to start hydrating the day before strenuous
exercise. Producing lots of clear, dilute urine is a good indication that you're well-hydrated.
During the activity, replenish fluids at regular intervals and continue drinking water or other
fluids after you're finished.

 Hot or cold weather. You need to drink additional water in hot or humid weather to help
lower your body temperature and to replace what you lose through sweating. You may
also need extra water in cold weather to combat moisture loss from dry air, particularly at
higher altitudes

 Illness. Older adults most commonly become dehydrated during minor illnesses — such
as influenza, bronchitis or bladder infections. Make sure to drink extra fluids when you're
not feeling well.

Diagnosis

Your doctor can often diagnose dehydration on the basis of physical signs and
symptoms. If you're dehydrated, you're also likely to have low blood pressure, especially
when moving from a lying to a standing position, a faster than normal heart rate and
reduced blood flow to your extremities.

To help confirm the diagnosis and pinpoint the degree of dehydration, you may have
other tests, such as:

 Blood tests. Blood samples may be used to check for a number of factors, such as the
levels of your electrolytes — especially sodium and potassium — and how well your
kidneys are working.

 Urinalysis. Tests done on your urine can help show whether you're dehydrated and to
what degree. They also can check for signs of a bladder infection.

Treatment

The only effective treatment for dehydration is to replace lost fluids and lost electrolytes.
The best approach to dehydration treatment depends on age, the severity of
dehydration and its cause.
For infants and children who have become dehydrated from diarrhea, vomiting or fever,
use an over-the-counter oral rehydration solution. These solutions contain water and
salts in specific proportions to replenish both fluids and electrolytes.

Start with about a teaspoon (5 milliliters) every one to five minutes and increase as
tolerated. It may be easier to use a syringe for very young children. Older children can
be given diluted sports drinks. Use 1 part sports drink to 1 part water.

Most adults with mild to moderate dehydration from diarrhea, vomiting or fever can
improve their condition by drinking more water or other liquids. Diarrhea may be
worsened by full-strength fruit juice and soft drinks.

If you work or exercise outdoors during hot or humid weather, cool water is your best
bet. Sports drinks containing electrolytes and a carbohydrate solution also may be
helpful.

Children and adults who are severely dehydrated should be treated by emergency
personnel arriving in an ambulance or in a hospital emergency room. Salts and fluids
delivered through a vein (intravenously) are absorbed quickly and speed recovery.

Request an Appointment at Mayo Clinic

Preparing for your appointment

You're likely to start by seeing your or your child's doctor. However, in some cases
when you call to set up an appointment, the doctor may recommend urgent medical
care. If you, your child or an adult who you care for is showing signs of severe
dehydration, such as lethargy or reduced responsiveness, seek immediate care at a
hospital.

If you have time to prepare for your appointment, here's some information to help you
get ready, and what to expect from the doctor.
What you can do

 Write down any symptoms you or the person you're caring for is
experiencing, including any that may seem unrelated to the reason for which you
scheduled the appointment. If you or the person you're caring for has been vomiting or has
had diarrhea, the doctor will want to know when it began and how frequently it's been
occurring.

 Write down key personal information, including any recent trips taken or foods recently
eaten that might have caused illness. In addition, your doctor will want to know if you or
the person you're caring for has recently been exposed to anyone with diarrhea.

 Make a list of key medical information, including other conditions you or the person
you're caring for is being treated for and the names of the medications being taken.
Include on your list prescription and over-the-counter drugs, as well as any vitamins and
supplements.

 Write down questions to ask your doctor.

For dehydration, some basic questions to ask the doctor include:

 What's causing these symptoms?

 What kinds of tests are needed?

 What treatment do you recommend?

 How soon after treatment will there be improvement?

 Are there any activity or dietary restrictions?

 Is there anything I can do to prevent a recurrence of dehydration?

 I have other health conditions. Do I need to change the treatments I've been using for
them?

 What steps can I take to prevent dehydration from happening again?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

 When did the symptoms begin? What were you doing?

 Are you able to keep down any food or drink?

 How recently have you urinated? Are you experiencing any pain or urgency with urination?

 Do you also have other signs or symptoms, such as abdominal cramping, fever, headache
or muscle aches? How severe are these signs and symptoms?

 Has there been blood in your stools?

 Have you recently eaten any food that you suspect was spoiled?

 Has anyone gotten sick after eating the same food that you did?

 Have you recently been exposed to someone who you know was experiencing diarrhea?

 Have you been coughing or had a runny nose?

 What medications are you currently taking?

 Have you recently traveled to another country?

 Do you know what your or your child's weight was before symptoms started?
https://www.webmd.com/first-aid/dehydration-in-children-treatment diakses 17 februari 2019
WebMD Medical Reference Reviewed by Dan Brennan, MD on October 22, 2017

 Has extremely dry mouth or no tears

 Is lethargic
 Is older and does not urinate in 12 or more hours
 Isn't alert or able to think clearly
 Passes out
 Is too weak or dizzy to stand

1. Call a Doctor
In young children, mild to moderate dehydration can happen very easily, particularly if the child
has diarrhea or is vomiting. Contact your child's pediatrician if your child:

 Is not drinking enough or eating enough

 Looks tired
 Has dark yellow urine or decreased urination
 Has dry mouth and eyes
 Is cranky or irritable
 Vomits more than once
 Is under 1 year old

2. Replace Fluids
For dehydration in an infant up to 1 year old:
CONTINUE READING BELOW

YOU MIGHT LIKE

VIDEO

Effects of Dehydration
Dehydration is more than just being thirsty. Other signs are dry mouth, fatigue, headaches, and
dizziness.

 If you breast-feed, nurse more often.

 If you bottle feed, give your baby the usual amount of fluid, unless the baby is vomiting. If your
baby is vomiting, give smaller amounts more frequently. For example, instead of 6 ounces every
4 hours, give 3 ounces every 2 hours. If she vomits more than once, call your doctor.
 If your baby eats solid food, cereal, strained bananas, and mashed potatoes, also provide fluids.
  Give an oral rehydration solution such as Pedialyte, if possible. It replaces salt, sugar, potassium,
and other nutrients. Ask your doctor what type and quantity to use.

For mild dehydration in a child age 1 to 11:

 Give extra fluids in frequent, small sips, especially if the child is vomiting.
 Choose clear soup, clear soda, or Pedialyte, if possible.
 Give popsicles, ice chips, and cereal mixed with milk for added water or fluid.
 Continue a regular diet.

3. Follow Up
 For mild dehydration, have your child rest for 24 hours and keep drinking fluids, even if
symptoms get better. Fluid replacement may take up to a day and a half. Continue on your
child's regular diet as well.
 For severe dehydration, the child may need IV fluids in the hospital. If you feel that your child is
not improving or is getting worse, see your doctor right away.

Dehydration
Definition

Dehydration occurs when your body does not have as much water and fluids as it needs.

Dehydration can be mild, moderate, or severe, based on how much of your body's fluid is lost or not replaced. Severe
dehydration is a life-threatening emergency.

Alternative Names

Vomiting - dehydration; Diarrhea - dehydration; Diabetes - dehydration; Stomach flu - dehydration; Gastroenteritis -
dehydration; Excessive sweating - dehydration

Causes

You can become dehydrated if you lose too much fluid, do not drink enough water or fluids, or both.

Your body may lose a lot of fluid from:

 Sweating too much, for example, from exercising in hot weather

 Fever
 Vomiting or diarrhea
 Urinating too much (uncontrolled diabetes or some medications, like diuretics, can cause you to urinate a
lot)

You might not drink enough fluids because:

 You do not feel like eating or drinking because you are sick
 You are nauseated
  You have a sore throat or mouth sores

Older adults and people with certain diseases, such as diabetes, are also at higher risk for dehydration.

Symptoms

Signs of mild to moderate dehydration:

 Thirst
 Dry or sticky mouth
 Not urinating much
 Darker yellow urine
 Dry, cool skin
 Headache
 Muscle cramps

Signs of severe dehydration:

 Not urinating, or very dark yellow or amber-colored urine

 Dry, shriveled skin
 Irritability or confusion
 Dizziness or lightheadedness
 Rapid heartbeat
 Rapid breathing
 Sunken eyes
 Listlessness
 Shock (not enough blood flow through the body)
 Unconsciousness or delirium

Exams and Tests

Your health care provider will look for these signs of dehydration:

 Low blood pressure.

 Blood pressure that drops when you stand up after lying down.
 White finger tips that do not return to a pink color after your provider presses the fingertip.
 Skin that is not as elastic as normal. When the provider pinches it into a fold, it may slowly sag back into
place. Normally, skin springs back right away.
 Rapid heart rate.

Your provider may do lab tests such as:

 Blood tests to check kidney function

 Urine tests to see what may be causing dehydration
 Other tests to see what may be causing dehydration (blood sugar test for diabetes)
Treatment

To treat dehydration:

 Try sipping water or sucking on ice cubes.

 Try drinking water or sports drinks that contain electrolytes.
 Do not take salt tablets. They can cause serious complications.
 Ask your provider what you should eat if you have diarrhea.

For more severe dehydration or heat emergency, you may need to stay in a hospital and receive fluid through a vein
(IV). The provider will also treat the cause of the dehydration.

Dehydration caused by a stomach virus should get better on its own after a few days.

Outlook (Prognosis)

If you notice signs of dehydration and treat it quickly, you should recover completely.

Possible Complications

Untreated severe dehydration may cause:

 Death
 Permanent brain damage
 Seizures

When to Contact a Medical Professional

You should call 911 if:

 The person loses consciousness at any time.

 There is any other change in the person's alertness (for example, confusion or seizures).
 The person has a fever over 102°F (38.8°C).
 You notice symptoms of heatstroke (such as rapid pulse or rapid breathing).
 The person's condition does not improve or gets worse despite treatment.

Prevention

To prevent dehydration:

 Drink plenty of fluids every day, even when you are well. Drink more when the weather is hot or you are
exercising.
 If anyone in your family is ill, pay attention to how much they are able to drink. Pay close attention to children
and older adults.
 Anyone with a fever, vomiting, or diarrhea should drink plenty of fluids. DO NOT wait for signs of
dehydration.
  If you think you or someone in your family may become dehydrated, call your provider. Do this before the
person becomes dehydrated.

References

Kenefick RW, Cheuvront SN, Leon LR, O'brien KK. Dehydration and rehydration. In: Auerbach PS, Cushing TA,
Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 89.

Padlipsky P, McCormick T. Infectious diarrheal disease and dehydration. In: Walls RM, Hockberger RS, Gausche-Hill
M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice.9th ed. Philadelphia, PA: Elsevier; 2018:chap
172.

Review Date: 9/5/2017

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also
reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.