Wednesday, July 30, 2014

Dehydration - Adult

Lately, dehydration can been becoming a leading call, when I'm at work. I am pulling about two dehydration calls a shift. Since this is the case, let's talk about how one gets dehydrated, how it effects our body, why it causes hypertensive, and how it is treat.

Dehydration is caused by a loss of water in our system. If one does not drink enough water, or someone is suffering from diarrhea, vomiting, excessive sweating, fever, excessive urination, too much alcohol consumption, diabetes, DKA, and some other ways, than our body is not able to compensate. The longer one goes without replacing that lost water, the more dehydrated they will get.

Dehydration can effect our body in different stages. Most commonly, dehydration can cause an increase in thirst, dry mouth, weakness, dizziness, confusion, syncopals, inability to sweat, decrease urine output and hypertension. In addition, dehydration will effect our urine output and color. Dehydration will reduce the urine output and turn the urine deep yellow. Dehydration can also lead to a fever, headaches, and chest or abdominal pains. With our geriatric population, don't forget you can always use the turgor test.* This test is used to help determine the dehydration status of your patient.

Now, let's talk about the hypertension effect. Dehydration causes hypertension. The reason for this, is because our body is losing the water, which is causing our blood to become "thick." Due to the "thickness" of the blood, our heart will have to pump harder and harder to get the blood throughout our cardiovascular system. The harder the heart has to work, the high the blood pressure. Also, this can cause an increase in heart rate, because the heart has to pump faster to help compensate. But, not in all patient's, will the tachycardia be noted.

Their is a simple way for us, prehospital providers, to try to treat patient's suffering from dehydration. Normal Saline. Simple as that. IV access, with a large bore IV catheter, should to inserted into the most central site (like the antecubital area), and hanging a bad of Normal Saline. Run the bag wide open, and reassess the patient. Make sure to check lung sounds often, to ensure that you are not putting to much fluid into their body, that it is causing the fluid to enter into the lungs. For me, I like to do it in 250mL increments.** Recheck vitals every five minutes. As always, depending on the patient condition, transport priority may vary.***

*The reason this tool is best used in the geriatric patient, is because their body is less able to compensate for fluid loss, so the loner they are dehydrated, the longer the skin turgor will last. 
**Personally, I like to reassess my patient every five minutes, or after each 250mL fluid bolus has been admitted. I also like to check lung sounds every few minutes to make sure that I am not pushing fluids into the patient's lungs. 
***ALWAYS, ALWAYS reference your local protocol. 

Here is also a good reference site for why patient's are hypertensive when they are dehydrated:

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