DEHYDRATION
INTRODUCTION
Dehydration means that the body does not have enough fluid to function properly.
Dehydration can be caused by fluid loss (through vomiting, diarrhea, excessive, urination, or
perspiration), inadequate intake of fluids, or a combination of both. Dehydration in healthy
adults can be seen under extreme conditions, such as physical exertion on a hot day with
inadequate fluid intake. Infants and children are more susceptible to dehydration than adults
due to lower body weights and an increased turnover of water and electrolytes. Symptoms of
dehydration include thirst, dry mouth, rapid heart rate, decreased urine output, lethargy, and
confusion. Dehydration is classified as mild, moderate or severe based on the amount of the
body’s fluid that is lost or not replenished. Despite most patients with dehydration being
effectively treated in outpatient settings, hospitalization is warranted at times.
Dehydration is more common in the elderly due to the changes that occur with age such as
decreased kidney function, decreased urine concentration, reduced thirst sensation, and
decreased release of vasopressin. Elderly patients often have co morbid conditions such as
diabetes and are on multiple medications that can predispose them to dehydration. Some
elderly patients are also cognitively impaired which can result in the limited ability to
communicate thirst to their caregivers. For example, individuals with advanced dementia may
be unable to tell someone when they are thirsty, or they may be unable to eat or drink
effectively without assistance.
Risk factors for dehydration include:
 Increased fluid loss due to illnesses such as diarrhea and vomiting;
 Limited fluid intake;
 Cognitive impairment due to dementia, depression, sedation and psychosis;
 Medications that decrease thirst or/and increase urine output;
 Fever;
 Blood loss; and
 Children under the age of 5 and the elderly.
Since dehydration can occur in many settings and is caused by many underlying factors, a
clinical practice guideline covering dehydration in general is not available. However, guidelines
do exist for specific populations who are at risk for dehydration. For example, the American
Medical Directors Association (AMDA) has published guidelines on dehydration and fluid
maintenance for patients in long-term care facilities. These guidelines are available at their web
site (www.amda.com) or at the web site of the National Guideline Clearinghouse at
(www.guideline.gov).
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STATISTICS
In Texas, dehydration resulted in 18,783 hospitalizations in 2012. The average hospital stay was
3.5 days and the average hospital charge was $25,033. In adults, the majority of admissions for
dehydration involved the elderly with individuals over the age of 65 accounting for 62% of the
hospitalizations.
PREVENTION
Some of the ways that dehydration can be prevented include:
 Proper hydration:
o When the weather is hot or when exercising;
o When taking dehydrating medications such as diuretics and laxatives ; and
o During illness since persons have an increased need for fluids when fever,
vomiting, or diarrhea is present;
 Monitoring at risk patients’ hydration based on their input/output, general status and
vital signs;
 Preventing conditions that cause loss of fluids such as gastroenteritis(stomach flu)
through proper hygiene which includes hand washing; and
 Treating underlying condition that result in dehydration.
TREATMENT
Many patients with mild to moderate dehydration can be adequately treated with oral
rehydration therapy (ORT). Drinking too much fluid at once can induce vomiting so drinking
small amounts of fluid often may be preferable. Severe dehydration requires immediate
medical attention. The treatment for severe dehydration includes IV or subcutaneous fluids.
Patients should also receive medications that treat the underlying cause of dehydration such as
antinausea and antidiarrheal medications.
REDUCING REHOSPITALIZATIONS
Early detection of dehydration may prevent unnecessary hospitalization. This can be achieved
through encouraging proper fluid consumption and in reporting warning signs of dehydration
such as change in mental status, rapid weight loss (3% or more of baseline body weight within
30 days), decrease in urine output, decrease in blood pressure, or increase in pulse rate.
RESOURCES
 Call 2-1-1 or visit www.211texas.org to find information about resources in your local
community.
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References:
1. Dehydration. 5-Minute Clinical Suite. Clin-eguide. St. Louis, MO: Wolters Kluwer Health
Inc; 2014. Available at: http://clineguide.ovid.com/clinicalresource . Accessed March
11, 2014.
2. Dehydration and fluid maintenance in the long-term care setting. Agency for Healthcare
Research and Quality. Available at: http://www.guideline.gov/content.aspx?id=15590.
Accessed April 14, 2014.
3. Dehydration. National Institutes of Health. Available at:
http://www.nlm.nih.gov/medlineplus/ency/article/000982.htm. Updated February 26,
2014. Accessed March 3, 2014.
4. Durso, S. Homeostasis. In: Durso, S, Bowker, L, Price, J, Smith, S, editors. Oxford
American Handbook of Geriatric Medicine. New York, (NY): Oxford University Press;
2010. p.413-432.
5. Mentes JC. Managing oral hydration. In: Capezuti, D, Zwicker, M, Fulmer, M, Fulmer, T,
editors. Evidence-based geriatric nursing protocols for best practice. 3rd ed. New
York(NY): Springer Publishing Company. p.369-390.
6. Sandberg-Cook, J. Aging and common geriatric syndromes. In: Trybulski, J, Bailey, PP,
editors. Primary Care: A Collaborative Practice. Philadelphia (PA): Elsevier Health
Sciences; 2012. p.71-79
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