Adult Dehydration
Aim
To enable the patient to continue to manage adequate oral fluid rehydration safely at home.
This guideline is specific to body fluid losses, secondary to hyperemesis, vomiting and / or diarrhoea. It aims to serve as a general guideline and support aid in the assessment and management of mild to moderate dehydration. Severe dehydration is the result of large fluid losses and may be complicated by electrolyte and acid base disturbances which require treatment and observation over a prolonged period. Severe dehydration is not suitable for care under Primary Options and admission to hospital is recommended.
Exclusions
Vomiting and/or diarrhoea are symptoms which may result from a wide range of diagnoses. A working is diagnosis is important in the management of subsequent dehydration.
Exclusions
• Children < 15yrs
• Diabetes
• Renal failure
• Septicaemia
• Shock resulting from blood loss
• Heart failure
• Cases of abdominal pain where there is not a clear diagnosis
• Intracranial causes
- Caution is also recommended for cases involving older adults, pre-existing heart failure, where symptoms have been prolonged or involved overseas travel, where there is additional significant co-morbidity or where the social setting may impair management at home.
Dehydration Status
Assessment should include consideration of duration of symptoms combined with prospective total daily losses.
- Average 70kg person normal daily losses range 2500-3000ml.
- Average vomit equal or greater than 200ml
- Average diarrhoea equal or greater than 300ml
Investigations
Investigations may not be necessary. Clinical judgement is recommended following the assessment of each case. If requried, simple tests which are easy to perform include;
- Faecal Culture
- MSU – infection / ketones
- Glucose – finger prick
- Electrolyte disturbances and renal impairment may result from excessive fluid losses and may be especially important in older patients.
- Ultrasound scan may be useful in some cases of hyperemesis - intractable vomiting may also be associated with multiple pregnancy or hydatidiform mole.
Fluid Replacement
For both mild and moderate dehydration consider a trial of oral rehydration combined with an anti-emetic (Metaclopramide in pregnancy and metaclopramide or prochlorperazine in Non-pregnant cases). Specific oral fluid solution is at the Physicians discretion. Normal saline is the intravenous fluid of choice, however Plasmalyte is an acceptable alternative.
It is recommended that the intravenous resuscitation fluid volume is restricted to an upper limit of 2000ml per consultation. Fluid volumes beyond this level are likely to require more investigation and clinical monitoring. Should the clinician feel further fluid volumes beyond this level are needed then discussion with the appropriate specialist or hospital admission is recommended.
| Fluid volume limit |
| 2000 ML |
In all cases of intravenous fluid replacement, details of fluid balance should be recorded. Observation and reassessment of hydration status at regular intervals will allow calculation of fluid volume requirements and reduce risks of fluid overload.
DISCLAIMER
This management guideline has been prepared to provide general guidance with respect to a specific clinical condition. It should be used only as an aid for clinical decision making and in conjunction with other information available. The material has been assembled by a group of primary care practitioners and specialists in the field. Where evidence based information is available, it has been utilised by the group. In the absence of evidence based information, the guideline consists of a consensus view of current, generally accepted clinical practice.