Dehydration

The loss of water from the body to abnormal or harmful levels is known as dehydration. This disturbs the normal working of the body as water is necessary for every physiological function right from breathing to producing hormones. Although dehydration can occur due to multiple causes, diarrhoea is the most common cause, especially in children and in people living in developing countries.

(Read more: Diarrhoea in children)

Sometimes, it’s difficult to identify the cause of dehydration, but therapy to recover the lost fluids should be started as soon as possible. Rehydration therapy helps in avoiding further complications and also prevents organ damage. In summers too, dehydration is very common due to prolonged exposure to heat when outdoors. Hence, the best way to prevent dehydration is to take adequate amount of water and fluids and watch out for any signs of dehydration.

As water is necessary for the processes taking place in the body, dehydration can result in many signs and symptoms:

• Restlessness and Irritability
  One may feel uneasy and irritable for no reason. This symptom is one of the typical signs of dehydration. (Read more - Irritability symptoms and causes)
• Sunken eyes
  This is mostly seen in the case of children. The eyes look as if they are deep-set and sunken into the face.
• Extreme thirst
  This is the most common feature of dehydration that even you might notice. You may feel very thirsty. This problem is typical to the cases of dehydration and is a result of the body’s mechanism to balance the fluids. Feeling thirsty makes one drink water and this eventually replenishes the lost water content in the body. (Read more: Excess thirst)
• Decreased frequency of urination or dark-coloured urine
  Due to a decrease in water content in your body, your urine output may decrease, or you may notice dark yellow coloured urine as it is concentrated due to lack of water.
• Headache
  You may experience a headache due to a decrease in water level of the body. This symptom is more common after taking alcohol as it is one of the reasons for a dehydrated body.

Causes

Dehydration may occur due to:

• Heat stroke
  Exposure to the sun for a long duration, especially during the afternoon and not taking enough water or fluids can cause a heat stroke. This is very common in construction workers, traffic police, workers involved in laying roads, farmers and people who do not protect themselves from the sun while travelling from one place to another.
• Diarrhoea
  Diarrhoea or loose motions i.e., passage of unusually loose or watery stools at least three times in a 24-hour period occurs most often due to an infection of the digestive tract on consuming food or water contaminated by microorganisms like bacteria, viruses or parasites. As a result, a lot of fluid is lost from the body through stools.
• Excessive alcohol intake
  Drinking excessive alcohol can lead to a loss of water from the body as alcohol affects the antidiuretic hormone, which helps in the absorption of water from the kidneys. Hence, urination increases. Secondly, alcohol can also induce vomiting, which can cause loss of water and electrolytes. (Read more: Side effects of excessive alcohol on body)
• Insufficient water intake
  Usually, a daily intake of 3-4 litres of water is recommended, but sometimes this need is not fulfilled. The reason may be the lack of availability of water or a habit of drinking less water or simply a lack of thirst. (Read more: Benefits of drinking water in the morning)
• Heavy exercise
  Heavy exercises lead to water loss through sweating. If adequate hydration is not maintained during sweating, it can lead to dehydration.
• Vomiting
  Frequent vomiting due to any reason (acidity, food poisoning, gastric or peptic ulcers, a side effect of drugs like analgesics, antibiotics, anticancer drugs among others) can result in the loss of water and nutrients from the body.
• Severe burns
  In people with severe burns, where damage to the thick layer of the skin occurs, seepage of body fluid occurs from the wounds as the protective skin layer gets damaged, leading to dehydration.
• Miscellaneous
  There are some other conditions that can lead to dehydration like uncontrolled diabetes, where patients have a higher frequency of urination, and infections like typhoid, where patients suffer from both vomiting and diarrhoea.

Risk factors

Several factors have been found to increase the risk of dehydration. These are:

• Drinking less water
  People who have a habit of drinking less water are at a higher risk of developing dehydration. Normally 3-4 litres of water is required by our body every day.
• Workers working in extreme heat
  Workers involved in road making, construction of buildings, and coal mines, which are exposed to very high heat are at a risk of dehydration through excess sweating.
• Summer season
  Children playing outdoors and people not using protection against the sun in the summer can be at risk of getting dehydrated due to a heat stroke.
• Bottle fed babies
  They have higher chances of developing diarrhoea because of unclean bottles that are used for feeding.
• Flies
  They can bring germs to uncovered food thus causing contamination resulting in diarrhoea after its consumption.
• Drinking contaminated water
  Drinking water without boiling or filtering can allow an infection to directly enter the body thus upsetting the digestive system.
• Unclean food, milk, unclean hands & soiled utensils
  This can lead to the growth of infection, which enters the gut causing diarrhoea.
• Malnourishment
  Malnourished children tend to have a low immunity and are more prone to getting infections, which may result in diseases like diarrhoea, shigellosis, cholera among others. These diseases are associated with a significant loss of water content from the body. (Read more: Weak immunity causes)

Prevention of dehydration is very easy. This includes inculcating healthy habits and immunization:

• Maintaining hydration
  Maintaining an adequate water intake by drinking 3-4 litres of water a day and even higher in summer and during heavy exercises can prevent dehydration.
• Protection from the extreme summer heat
  Using scarves, sunglasses, long-sleeved cotton clothes, summer coat, summer socks, hand gloves and drinking fluids or water frequently in the summer season can protect the body from water loss.
• Avoid alcohol consumption
  It is one of the commonest causes of dehydration; avoiding alcohol can prevent dehydration.
• Using sanitary latrines
  Always use hygienic latrines for urination and dumping. Avoid taking a dump in open space which increases the chances of infection.
• Keeping food and water clean
  Always wash fruits and vegetables before eating. Also, cook them thoroughly to kill disease-causing microorganisms like bacteria, viruses, fungi, and spores. Drinking water should always be kept in clean containers and never stored for more than two days. Decontamination of water by filtration or bringing it to a rolling boil for at least one minute (3 minutes in high altitudes) can be done to make it suitable for drinking.
• Washing hands before eating & after using a toilet
  Maintaining hygiene by washing hands after using toilets and before handling food can help in decreasing the chances of food contamination, thus preventing diarrhoea. (Read more: Right way to wash your hands)
• Rota vaccine
  Rotavirus vaccine should be given to children less than five years of age. Rotavirus is the most common cause of death due to dehydration and diarrhoea in children of this age group.
• Promote exclusive breastfeeding
  In the case of babies, exclusive breastfeeding can help increase their immunity and decrease the chances of infection.

Diagnosis is made usually based on the clinical signs and symptoms of the person. Your doctor will take a detailed history including habits, personal, medical and professional history. Signs of dehydration like sunken eyes, irritability, dry skin and low blood pressure help in making the diagnosis. Sometimes laboratory tests may be required. These include:

• Stool examination
  In the case of diarrhoea, stool examination with a microscope can assist in identifying the infection-causing agent. A stool culture might be needed in some cases.
• Blood tests
  ​Blood tests may be advised in certain cases to detect::
  • Infection
    For some suspicious infections like typhoid, a blood test known as Widal’s test can be done for diagnosis.
  • Serum Electrolytes
    Estimation of serum electrolyte concentration can help in determining the sodium and potassium levels in your body. 
  • Complete blood count
    CBC test is done to check for an increase in white blood cell count, which is generally seen in infections. 
  • Random blood sugar
    If your doctor suspects diabetes, random blood sugar test may be needed.

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Dehydration can be treated by giving fluids, which is called rehydration therapy. This therapy aims to restore the water content in the body. Assessing the severity of dehydration and finding the cause early is important for recovery.

Home remedies for recovery from dehydration

• Sugar salt solution
  When ORS is not available, it can easily be made at home by adding 6 level teaspoons of sugar and half level teaspoon of iodized salt in one litre of boiled water that has been cooled. It acts in the same manner as ORS.
• Green banana diet
  Consuming green/unripe banana can be helpful in reducing the duration of loose motions, which can further help in preventing dehydration. They also help in weight gain in malnourished children.
• Coconut water
  It is very useful in cases of heatstroke, diarrhoea and vomiting to recover fluid and electrolyte loss.
• Cold sponging
  To lower the body temperature in people suffering from heatstroke, frequent cold-water sponging of the whole body is helpful.
• Rest
  In the case of dehydration due to heavy exercise, complete rest along with maintaining fluid and electrolyte balance of the body is the treatment of choice.

Medical treatment for dehydration

• ORS (Oral Rehydration solution)
  ORS is lifesaving when used timely and in adequate quantities. It is a balanced mixture of glucose and electrolytes like sodium, potassium, and chloride. The glucose of ORS is absorbed by the small intestine, and along with it, sodium is also taken up. As a result, the concentration of sodium in the cells increases leading to a passive absorption of water. Hence, it helps in maintaining the desired balance of water and electrolytes in the body. It aids in rapid recovery from dehydration. It is available in medical stores as a one-time use packet. You need to mix this packet in one litre of boiled and then cooled water and drink a few sips after small intervals within 24-hours and discard the solution that is left thereafter.
• Zinc supplementation
  Zinc supplementation is beneficial in cases of diarrhoea. Some clinical studies concluded that daily zinc supplementation can prevent the worsening of diarrhoea. Hence, early recovery can help in improving water and electrolyte balance and also avoid further loss of water from the body.
• Use of probiotics
  Probiotics are available in the form of a solution or powdered sachet containing healthy bacteria like Lactobacillus species, which help in maintaining the normal flora of the gut and eliminating pathogenic bacteria.
• I.V.  infusions
  In the case of extreme dehydration, your doctor will start an intravenous infusion of fluids like Ringer’s lactate solution. Hospital admissions are common in the case of infants and children as they are not able to drink sufficient water orally and show signs of dehydration early.
• Antipyretic drugs
  In cases of heatstroke, the body temperature increases, which is can be controlled by taking antipyretic drugs like paracetamol. (Read more - Fever causes and treatment)
• Antibiotics
  In cases where dehydration is caused by infections, an antibiotic course is the treatment of choice along with rehydration therapy.

Lifestyle modification

Lifestyle modification can help to avoid dehydration due to heat stroke, infections and insufficient water intake. Some small changes which can help prevent further dehydration are:

• Drinking plenty of water and fluids
  Drink at least 3-4 litres of water daily to recover the water lost due to sweating. Drinking coconut water and lemonade is also beneficial.
• Maintaining good hygiene
  The habit of washing hands every time you come home from outside, after using toilets, and before cooking or eating anything can help in preventing infections.
• Limiting alcohol consumption
  Drinking alcohol is an important cause of dehydration. So, avoiding alcohol intake till you recover from dehydration and slowly decreasing its amount along with drinking adequate water can help prevent dehydration from recurring. (Read more: How to quit alcohol)

Prognosis

The outcome of dehydration is good in adults where plenty of fluids are administered, either orally or by an intravenous route. In children, prognosis depends upon the amount of fluid loss and the time of administration of the treatment. Early treatment can rapidly correct dehydration and prevent complications.

Complications

Dehydration, if not treated in time, can lead to some serious complications. These include:

• Hypotension
  Hypotension refers to a reduction in blood pressure due to a decrease in the volume of blood. This can decrease the supply of oxygen to vital organs and lead to dizziness or unconsciousness (fainting).
• Impaired cognition
  Moderate to severe dehydration affects memory and understanding. You may feel disoriented or take some time to understand what is happening around you.
• Organ damage and dysfunction
  Dehydration can lead to low blood volume which can affect the supply of essential nutrients and oxygen to the organs. This can cause organ damage and malfunctioning.