Last time, we talked about dehydration, what causes it, and signs and symptoms to watch for. Now I want to cover treatment of dehydration. Now, this can get a little confusing so stay with me.
The first and most important thing to do in treating ECFVD is replace the lost fluid. If the dehydration is mild and the client is able and wants to drink, the best option is oral rehydration. Oral glucose replacements, such as Pedialyte, are good options in order to restore the lost electrolytes. Water is always a very good option as well. It is never a good idea to drink soda when dehydrated because it can worsen the condition. Fruit juice, sports drinks, and broth should be avoided as well.
If the dehydration is severe or life-threatening, intravascular (IV) fluids are used to treat it. The type of fluid used is determined by the type of dehydration. Isotonic dehydration is replaced by isotonic fluid. Hypertonic dehydration is replaced by hypotonic fluid. Hypotonic dehydration is replaced by hypertonic fluid. Let’s go over these in a little more detail.
Now, as you remember, isotonic dehydration is when the fluid and electrolyte losses are equal. Because of this there is no need to worry about the balance of the fluid and electrolytes. Isotonic fluid will only expand the intravascular space. It will keep this balance intact. Types of isotonic solutions are Lactated Ringer’s (LR) and Normal Saline (NS, 0.9% Sodium Chloride).
Hypertonic dehydration is when water loss is greater than electrolyte loss. Because of this, the intracellular compartments are deprived of water. In order to replace that water, we infuse a hypotonic solution. This solution contains more water than solute. This will cause the fluid to move from the intravascular space into the intracellular space due to osmosis and oncotic pressure. The fluid moves from the space with the least solutes to the space with the most solutes. This evens out the fluid level in both compartments. The way I remember what hypotonic solutions do is this. Hypotonic solutions cause the cells to fill with water, making them look more like an “O”. So hypOtonic makes the cell look like an “O”. Types of hypotonic solutions are 0.45% NS, 0.33% NS, and D5W.
Hypotonic dehydration is when electrolyte loss is greater than water loss. This causes the cells to contain too much water. To treat this, we infuse a hypertonic solution. This solution has more solute than water. This causes the water to move out of the intracellular space and into the intravascular space, once again evening out the fluid level in both compartments. Types of hypertonic solutions are D5/LR, D5 0.9% NS, D5 0.45% NS, and D5 0.25% NS.
The important thing to remember with these solutions is that water follows solute. The water will move to the compartment with the most electrolytes.
It is also important to correct the underlying problem when treating dehydration. If the cause if vomiting or diarrhea, antiemetic and antidiarrheal drugs are given. Antipyretics are given to patients that have a fever. Make sure you are looking at the whole picture and treating the patient accordingly.
This was a lot of information to go over, so I am going to give you a break and not assign any questions today!
White, B. (2009). Clients with fluid imbalances. In Black, J. M., & Hawks, J. H. (Eds). Medical-surgical nursing. Clinical management for positive outcomes, (Vol 1., 8th Ed), (pp. 127-150). St. Louis, MO: Elsevier Inc.
McCarthy, M. & Olsen, K. (2011). Clients with fluid imbalances [PowerPoint Slides].