Types of dehydration in Diarrhoea| ICDS Supervisor Exam|ICDS Supervisor Kerala PSC
In this post Types of dehydration in Diarrhoea is explained. Diarrhoea, one of the Infections spread by food and water is explained. The Types of Diarrhoea and the pathogens of Diarrhoea are explained in detail. Other Infections spread by water are Typhoid, Paratyphoid fever, Poliomyelitis, Hepatitis A and Hepatitis E. Those will be explained in next post. Immunization and Vaccines are important topics for ICDS Supervisor Exam.
Types of dehydration in Diarrhoea
Diarrhoea stools contain large amounts of sodium chloride, potassium, and bicarbonate.
All the acute effects of watery diarrhoea result from the loss of water and electrolytes from the body in liquid stool.
Additional amounts of water and electrolytes are lost when there is vomiting and water loss is further increased by fever.
These losses cause dehydration (due to the loss of water and sodium chloride), metabolic acidosis (due to the loss of bicarbonate), and potassium depletion.
Among these, dehydration is the most dangerous because it can cause decreased blood volume (hypovolaemia), cardiovascular collapse, and death if not treated promptly.
Types of dehydration
1. Isotonic dehydration
This is the type of dehydration most frequently caused by diarrhoea.
It occurs when the net losses of water and sodium are in the same proportion as normally found in the extracellular fluid (ECF).
Principal features include:
• a balanced deficit of water and sodium;
• serum sodium concentration is normal (130–150 mmol/l);
• Serum osmolality is normal, that is, (275–295 mOsmol/l); and
• hypovolaemia occurs as a result of a substantial loss of extracellular fluid.
Manifestations
• Thirst, followed by:
• decreased skin turgor, tachycardia, dry mucous membranes, sunken eyes, lack of tears, a sunken anterior fontanelle in infants, and oliguria.
• Physical signs appear when the fluid deficit approaches 5% of body weight and worsens as the deficit increases.
• As the fluid deficit approaches 10% of body weight, dehydration becomes severe and anuria, hypotension, a feeble and very rapid pulse, cool and moist extremities, diminished consciousness,
and signs of shock appear.
• A fluid deficit that exceeds 10% of body weight leads rapidly to death from circulatory collapse.
2. Hypertonic (hypernatraemic) dehydration
Some children with diarrhoea, especially young infants, develop hypernatraemic dehydration.
This reflects a net loss of water in excess of sodium when compared with the proportion normally found in ECF and blood. It usually results from:
• the ingestion and inefficient absorption, during diarrhoea, of fluids that are hypertonic (owing to their content of sodium, sugar, or other osmotically active solutes, such as the lactose in whole cow’s milk); and
• an insufficient intake of water or other low-solute drinks.
The hypertonic fluids create an osmotic gradient that causes a flow of water from the extracellular fluid (ECF) into the intestine, leading to a decrease in the ECF volume and an increase in sodium
concentration within the ECF.
Principal features include:
• a deficit of water and sodium, but the deficit of water is greater;
• serum sodium concentration is elevated (>150 mmol/l); and
• serum osmolality is elevated (>295 mOsmol/l).’
Manifestations
• Thirst is severe and out of proportion to the apparent degree of dehydration.
• The child is very irritable.
• Seizures may occur, especially when the serum sodium concentration exceeds 165 mmol/l.
3. Hypotomic dehydration
Children with diarrhoea who drink large amounts of water or other hypotonic fluids containing very low concentrations of salt and other solutes, or who receive intravenous infusions of 50% glucose in water, may develop hyponatremia.
This occurs because water is absorbed from the gut while the loss of salt (NaCl) continues, causing the net loss of sodium to exceed the net loss of water.
Principal features include:
• a deficit of water and sodium, but the deficit of sodium is greater;
• serum sodium concentration is low (<130 mmol/l); and
• serum osmolality is low (<275 mOsmol/l).
Manifestations
• The child is lethargic; infrequently, there are seizures.
4. Base-deficit acidosis (metabolic acidosis) During diarrhoea, a large amount of bicarbonate may be lost in the stool.
If the kidneys continue to function normally they replace most of the lost bicarbonate and a serious base deficit does not develop.
However, this compensating mechanism fails when the renal function deteriorates, as happens when there is poor renal blood flow due to hypovolaemia.
When this occurs, base deficit and acidosis develop rapidly. Acidosis can also result from excessive production of lactic acid when patients have a hypovolaemic shock.
Principal features include:
• serum bicarbonate concentration is reduced - it may be less than 10 mmol/l; and
• arterial pH is reduced – it may be less than 7.10..7.10 Manifestations
• Breathing becomes deep and rapid causing a compensating respiratory alkalosis and raising arterial pH
• Increased vomiting
Potassium depletion
Patients with diarrhea often develop potassium depletion owing to large faecal losses of this ion.
These losses are greatest in infants and can be especially dangerous in malnourished children, who are frequently potassium-deficient before diarrhoea starts.
When potassium and bicarbonate are lost together, hypokalaemia does not usually develop.
This is because the metabolic acidosis that results from the loss of bicarbonate causes potassium to move from an intracellular fluid (ICF) to ECF in exchange for hydrogen ions, thus keeping the serum potassium level in a normal or even elevated range.
However, when metabolic acidosis is corrected by giving bicarbonate, this shift is rapidly reversed, and serious hypokalaemia can develop.
This can be prevented by replacing potassium whilst simultaneously correcting the base deficit.
Manifestations
• General muscular weakness
• Cardiac arrhythmias
• Paralytic ileus, especially when drugs are taken
that also affect peristalsis (such as opiates)
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