Phase 1 treatment of severe dehydration focuses on emergency management. Severe dehydration is characterized by a state of hypovolemic shock requiring rapid treatment. Initial management includes placement of an intravenous or intraosseous line and rapid administration of an isotonic crystalloid (eg, lactated Ringer solution, 0.9% sodium chloride). Additional fluid boluses may be required depending on the severity of the dehydration. As intravascular volume is replenished, tachycardia, capillary refill, urine output, and mental status all should improve. Hemodynamic monitoring and inotropic support may be indicated.
Phase 2 focuses on deficit replacement, provision of maintenance fluids, and replacement of ongoing losses. Maintenance fluid requirements are equal to measured fluid losses (urine, stool) plus insensible fluid losses.
Rapid oral rehydration with the appropriate solution has been shown to be as effective as intravenous fluid therapy in restoring intravascular volume and correcting acidosis. Vomiting is generally not a contraindication to oral rehydration therapy. If evidence of bowel obstruction, ileus, or acute abdomen is noted, then intravenous rehydration is indicated. Dimenhydrinate, although used in Europe and Canada, has not been found to improve oral rehydration.
For more on the treatment of dehydration, read here.
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Cite this: Richard H. Sinert. Fast Five Quiz: Test Your Knowledge of Common Summer Injuries - Medscape - Jun 26, 2017.
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