Adult Dehydration

What is Adult Dehydration?

Despite popular belief, there’s no solid evidence to suggest that 75% of Americans are chronically dehydrated. However, dehydration is a common issue among older adults, affecting about 17% to 28% of them. This issue often leads to hospital admission and can cause various health problems. It can also complicate other existing medical conditions.

Interestingly, dehydration can be overestimated at times, leading to misdiagnosis and unnecessary fluid treatment. This situation can divert attention from the actual cause of the patient’s illness. Thankfully, dehydration is a condition that can be easily managed and prevented. By understanding its causes and how it’s diagnosed, we can provide better care for patients.

What Causes Adult Dehydration?

Our bodies naturally lose water through the skin, lungs, digestive system, and kidneys. If we lose too much water without also losing sodium, this can cause dehydration. Basically, dehydration happens when the amount of water leaving our bodies is greater than the amount of water going in.

There are different types of dehydration. If both water and sodium leave the body together, it’s called isotonic dehydration. This can be caused by things like vomiting, diarrhea, sweating, burns, kidney disease, high blood sugar, and underproduction of a hormone called aldosterone.

Something called hypertonic dehydration happens when the body loses more water than sodium. In these cases, blood sodium levels and osmolality (a measure of the concentration of particles in your blood) are usually high. This type of dehydration is most often caused by fever, increased breath rates, or a condition called diabetes insipidus.

Finally, hypotonic dehydration can be caused by some medications, like diuretics, which make the body lose more sodium than water. This type of dehydration usually results in low sodium and osmolality levels.

Understanding why the body is losing too much water can help identify the causes of dehydration. This can be due to not drinking enough water due to changes in mental state, inability to move, problems with the sense of thirst, or falling into a coma from drug overdose. It can also result from excessive water loss from the skin due to heat, exercise, burns, or severe skin diseases. Some conditions or medications can cause excessive water loss from the kidneys or digestive system. Other potential causes of dehydration include pancreatitis, new onset accumulation of fluid in the abdomen (ascites), inflammation of the inner lining of the abdomen (peritonitis), severe infection (sepsis), overactive thyroid gland (hyperthyroidism), asthma, chronic obstructive pulmonary disease, and certain drugs.

Risk Factors and Frequency for Adult Dehydration

While there’s no recent data on how common dehydration is in the general population, we do know some about its commonness in adults. It’s rare for healthy adults with access to water to get dehydrated. However, any adult can become dehydrated if hit by an illness that causes it, like high blood sugar. Dehydration can both cause illness and be caused by illness, so the information we have might not cover every case of dehydration.

However, we do know that older adults are more likely to get dehydrated.
Older people are 20% to 30% more at risk of dehydration due to factors such as restricted movement, impaired sense of thirst, and conditions like diabetes, kidney disease, and a tendency to fall.

Signs and Symptoms of Adult Dehydration

People who are hypovolemic, or experiencing decreased levels of body fluid, can show many different symptoms. Common signs of dehydration may include feeling tired, being thirsty, having dry skin and lips, passing dark urine or urinating less than normal, headaches, muscle cramps, feeling lightheaded or dizzy, fainting, changes in blood pressure when standing up, and even a fast heartbeat. Dehydration can be caused by various factors, like exercise, hot weather, medications, illness, limited access to water, fever, or losing fluid.

Key indicators such as low blood pressure, fast heart rate, fever, and fast breathing may show up in a person’s vital signs. However, it’s important to know that blood pressure doesn’t usually drop until a person is significantly dehydrated. Also, certain medications, like beta-blockers, can prevent a fast heart rate. In severe cases of dehydration, a person may seem very tired or even confused. On physical examination, doctors may see dry mucus membranes, skin that stays “tented” when pinched, slow capillary refill, or cracked lips.

A detailed study in 2015 investigated signs of dehydration in older adults, looking at a number of physical and historical factors. These included areas of dryness on the body, a slow capillary refill time, poor skin elasticity, sunken eyes, a drop in blood pressure upon standing, dizziness, a feeling of thirst, urine colour, weakness, blue lips, mental confusion, tiredness, and reduced appetite. Out of all these, only feeling tired and missing drinks between meal times were found to predict dehydration.

Keep in mind that each person can show different signs of dehydration, and it’s important to seek medical advice if you suspect that you or someone else may be dehydrated.

Testing for Adult Dehydration

There is not a single, definitive test for dehydration. However, various methods like analyzing serum and plasma osmolality can help diagnose this condition. If the result is equal to or more than 295 mOsm/kg, it could indicate dehydration. Weight loss of 3% or more over a week might also suggest dehydration.

In a 2015 Cochrane review considering dehydration diagnosis, many tests including bioelectrical impedance analysis and the osmolality of various fluids like urine, saliva and tears were found to be ineffective for diagnosing dehydration in elderly patients.

The ratio of blood urea nitrogen to creatinine should normally be more than 10:1 in cases of dehydration. But, factors like high urea production, low creatinine due to muscle loss, and urea reabsorption due to upper gastrointestinal bleeding can mimic this ratio. Urine tests can provide other potential indicators of dehydration – low urine sodium concentration, fractional excretion of sodium less than 1%, and urine osmolality greater than 450 mOsm/kg can all suggest a body’s response to low blood flow. These signs, however, may also be visible in conditions like heart failure, cirrhosis, nephrotic syndrome, and other kidney diseases.

Ultrasound can be used to evaluate a patient’s hydration by measuring the collapsibility of the inferior vena cava (IVC), a large vein that carries deoxygenated blood to the heart, with each breath. If the IVC’s diameter changes by more than 50% with breathing, it suggests dehydration. But, conditions like cirrhosis, chronic heart disorders, and the use of a ventilator can impact the accuracy of IVC ultrasound. Despite its limitations, IVC ultrasound could still be part of a larger clinical evaluation for dehydration.

Treatment Options for Adult Dehydration

When treating dehydration, the goal is to quickly replace lost fluids and find out what’s causing fluid loss. For patients who are low on fluids, they should be given fluid infusions designed to suit their specific situation. Those with a severe case of dehydration might get larger fluid infusions. However, in elderly patients, as well as those with heart failure and kidney failure, a more cautious approach is required. These patients should be given small fluid infusions to start with, followed by checks to see how they are doing and additional fluid as needed.

A patient’s dehydration level and response to fluids can be assessed by checking blood pressure and heart rate, lactate levels in the blood, hematocrit (used to check for blood loss), and urine output.

In most cases of dehydration, you want to use a type of fluid called isotonic crystalloid. While a protein solution called albumin might be used in certain situations, it doesn’t really change the outcome.

When it comes to selecting the best type of crystalloid fluid treatment, it should be tailored to the patient’s situation. Options include normal saline, lactated Ringer’s solution (a mix of several fluids), and a balanced crystalloid solution. However, these different types of fluid can have side effects when given in large amounts. For instance, normal saline could lead to an excess of chloride in the blood resulting in acidosis, while buffered crystalloids might cause low sodium levels in the blood. Lactated Ringer’s solution has potassium in it, so it’s not suitable for patients with kidney failure or excess potassium. No one type of fluid treatment is best for all patients.

Using a fast fluid treatment can cause sodium levels in the blood to rise quickly in patients who are dehydrated and have very low blood sodium. This could lead to a condition known as central pontine myelinolysis. Doctors need to balance the risks of staying dehydrated against the dangers of central pontine myelinolysis. It’s important to regularly check a patient’s fluid levels and blood sodium levels as they’re being treated.

Whilst providing these treatments, doctors should also be actively looking for and treating the underlying cause of dehydration.

Dehydration in adults primarily stems from two main causes – either loss of body water or loss of blood. Determining the cause is crucial as it decides the treatment approach: blood loss is replenished with blood, while loss of water requires fluid replacement. Understanding the specific reason behind the dehydration is necessary for choosing the appropriate treatment method.

What to expect with Adult Dehydration

Generally, most people recover completely when the cause of their dehydration is addressed, and their fluid levels are brought back to normal. However, it’s crucial to note that if dehydration isn’t treated in older adults, it could lead to serious life-threatening consequences.

Possible Complications When Diagnosed with Adult Dehydration

Dehydration can become more problematic due to not drinking enough fluids or drinking too much fluid. If the body is not sufficiently hydrated, the organs may not function well, leading to various complications. The kidneys may also struggle to hold onto the amount of fluid they need to operate properly. Symptoms of dehydration can include changes in consciousness, kidney failure, damage to the liver, excessively high levels of lactic acid, low blood pressure, and in extreme cases, even death.

Dehydration can also lead to various issues with fluid and electrolyte balance in the body. This can result in conditions like high blood urea levels, low sodium levels, high sodium levels, low potassium levels, high potassium levels, high acid levels, and a high level of alkalinity.

If someone with dehydration drinks too much fluid too quickly, it can cause swelling in the hands, feet, and lungs. In severe cases of low sodium, if the volume of fluid in the body is corrected too quickly, the sodium levels can rise too rapidly and potentially damage the nerves in the brain.

Common Dehydration Complications:

Changes in consciousness
Kidney failure
Liver damage
Excessively high levels of lactic acid
Low blood pressure
Potential death
High blood urea levels
Low sodium levels
High sodium levels
Low potassium levels
High potassium levels
High acid levels
High alkalinity levels
Swelling in hands and feet
Lung swelling
Potential damage to brain nerves

Preventing Adult Dehydration

While the Centers for Disease Control and Prevention (CDC) doesn’t explicitly state how much water we should drink each day, they suggest adults aim for drinking 2-3 liters daily. This helps replace any fluids we lose during physical activities. So, for instance, a marathon runner would need to drink more water than someone who is less active. However, it’s important to note that in older adults, drinking too much water can lead to a condition called hyponatremia, which means having low sodium levels in the blood. Therefore, it’s safer for them to have balanced hydration solutions to maintain a healthy water-sodium balance.

Frequently asked questions

Adult dehydration is a common issue among older adults, affecting about 17% to 28% of them. It can lead to hospital admission and various health problems, and can complicate other existing medical conditions. However, it can be easily managed and prevented with proper understanding of its causes and diagnosis.

It's rare for healthy adults with access to water to get dehydrated.

Signs and symptoms of adult dehydration can include: - Feeling tired - Being thirsty - Having dry skin and lips - Passing dark urine or urinating less than normal - Headaches - Muscle cramps - Feeling lightheaded or dizzy - Fainting - Changes in blood pressure when standing up - A fast heartbeat In severe cases of dehydration, a person may also experience: - Feeling very tired or confused On physical examination, doctors may observe: - Dry mucus membranes - Skin that stays "tented" when pinched - Slow capillary refill - Cracked lips A detailed study in 2015 found that signs of dehydration in older adults can include: - Areas of dryness on the body - Slow capillary refill time - Poor skin elasticity - Sunken eyes - A drop in blood pressure upon standing - Dizziness - Feeling of thirst - Urine color - Weakness - Blue lips - Mental confusion - Tiredness - Reduced appetite However, out of all these factors, only feeling tired and missing drinks between meal times were found to predict dehydration. It is important to note that each person may show different signs of dehydration, and it is recommended to seek medical advice if dehydration is suspected.

Adult dehydration can be caused by various factors such as restricted movement, impaired sense of thirst, conditions like diabetes and kidney disease, and a tendency to fall. Other potential causes include not drinking enough water, excessive water loss from the skin, kidneys, or digestive system, certain medications, illnesses, limited access to water, fever, and losing fluid.

Conditions that a doctor needs to rule out when diagnosing Adult Dehydration include heart failure, cirrhosis, nephrotic syndrome, other kidney diseases, high urea production, low creatinine due to muscle loss, urea reabsorption due to upper gastrointestinal bleeding, cirrhosis, chronic heart disorders, and the use of a ventilator.

The types of tests that a doctor would order to properly diagnose adult dehydration include: - Analyzing serum and plasma osmolality: If the result is equal to or more than 295 mOsm/kg, it could indicate dehydration. - Weight loss measurement: A weight loss of 3% or more over a week might suggest dehydration. - Blood urea nitrogen to creatinine ratio: The ratio should normally be more than 10:1 in cases of dehydration. - Urine tests: These can provide potential indicators of dehydration, such as low urine sodium concentration, fractional excretion of sodium less than 1%, and urine osmolality greater than 450 mOsm/kg. - Ultrasound: Measuring the collapsibility of the inferior vena cava (IVC) with each breath can suggest dehydration. - Checking blood pressure and heart rate, lactate levels in the blood, hematocrit, and urine output can assess dehydration level and response to fluids.

Adult dehydration is treated by quickly replacing lost fluids and identifying the cause of fluid loss. The treatment involves giving fluid infusions tailored to the patient's specific situation. In severe cases, larger fluid infusions may be necessary, but a more cautious approach is required for elderly patients, as well as those with heart failure and kidney failure. These patients should be given small fluid infusions initially, followed by monitoring and additional fluid as needed. The patient's dehydration level and response to fluids can be assessed through various measures such as blood pressure, heart rate, lactate levels, hematocrit, and urine output. The type of fluid treatment used should be tailored to the patient's situation, with options including isotonic crystalloid fluids like normal saline, lactated Ringer's solution, and balanced crystalloid solution. However, different types of fluid can have side effects when given in large amounts, so careful consideration is needed. Additionally, doctors need to balance the risks of dehydration against the dangers of central pontine myelinolysis, a condition that can occur if sodium levels in the blood rise too quickly during fast fluid treatment. Regular monitoring of fluid levels and blood sodium levels is important during treatment, and doctors should also actively search for and treat the underlying cause of dehydration.

The side effects when treating adult dehydration can include: - Excess of chloride in the blood resulting in acidosis when using normal saline - Low sodium levels in the blood when using buffered crystalloids - Potassium levels in the blood increasing when using lactated Ringer's solution, which is not suitable for patients with kidney failure or excess potassium - Sodium levels in the blood rising quickly in patients with very low blood sodium, which could lead to central pontine myelinolysis if treated too quickly

Most people recover completely when the cause of their dehydration is addressed and their fluid levels are brought back to normal. However, if dehydration isn't treated in older adults, it could lead to serious life-threatening consequences.

You should see a healthcare professional or a doctor for adult dehydration.