Hypertonic and hypotonic dehydration

Dehydration occurs when the body loses too much fluid.
This can happen if you do not drink water or if you lose large amounts of fluid through diarrhea, vomiting, sweating or exercise.
If the lost fluid is not replaced by drinking, you can dry out.

Since about 75% of body weight consists of water, which is inside the cell, in the blood vessels and between the cells, the body needs a lot of fluid to survive.

Classification and types of dehydration

There are three types of dehydration:

1. Isotonic dehydration occurs when you lose water and mineral salts in the same proportion.
   There must be a balance between water and mineral salts in the cells.
   This type of dehydration usually occurs with diarrhea.

3. Hypertone or hypernatremic dehydration only affects infants and young children.
   Hypernatriemic refers to too high a salt content in the blood. So this type of dehydration occurs when a child loses more water than salt.
   For example, if a newborn suffers from watery diarrhea or excessive vomiting.
4. Hypotonic dehydration occurs when the individual loses mainly electrolytes, especially sodium.

What are the causes of dehydration?

Sometimes not enough fluids can be absorbed, for example due to upcoming and urgent commitments or because you live in an area where the necessary structures for sufficient drinking water are lacking (such as hiking or camping).

Other causes of dehydration include:

• Diarrhea – the most common cause of dehydration and related deaths. The large intestine absorbs water from the digested food. Diarrhea prevents this function and leads to water loss.
• Vomiting – causes the loss of fluids and drinking is difficult.
• Sweating – if the body temperature rises, the body releases a considerable amount of water in the form of sweat. Hot and humid climates, along with intense physical activity, can lead to further fluid loss through sweating.
• Diabetes – elevated blood sugar levels lead to increased urination and fluid loss.
• Frequent urination – usually caused by uncontrolled diabetes, but can also be caused by alcohol and diuretic medications, antihistamines, medications for elevated blood pressure, and antipsychotics.
• Burns – Water leaks through the damaged skin and the body loses fluid.
• Inability to drink fluids – the inability to drink enough is another potential cause of dehydration, for example in the following cases:
  • Lack of availability of water
  • Severe nausea with and without vomiting
  • Too little strength to drink

Diseases
Diseases that cause constant nausea or diarrhea can lead to dehydration.
This happens because vomiting and diarrhea lead to a large loss of water from the body.
Electrolytes are essential components for cell activity and are lost along with water.
Electrolytes are found in blood, urine and other body fluids.
Vomiting and diarrhea can alter these functions, causing serious problems such as stroke and coma.

Fever
With fever, the body loses fluid because it sweats profusely to lower body temperature.
Often fever causes profuse sweating. If not drunk to compensate for the lost fluid, dehydration can result.

Other causes
Older people are more likely to dehydrate for the following reasons:

• They do not drink water because they do not feel thirsty like younger people.
• The kidneys do not function well.
• They decide not to drink because they cannot control the bladder (incontinence).
• They take medications that increase urine production.
• They do not have enough money to feed themselves sufficiently.
• You have physical problems or a disease that causes this:

1. Difficulty drinking or holding a glass.
2. Pain when they rise from the chair.
3. Pain or discomfort when they go to the toilet.
4. Difficulty talking or communicating with someone about their symptoms.

Dehydration in infants and young children

Newborns and young children are more likely to experience dehydration for the following reasons:

• A high percentage of body tissue consists of water.
• Toddlers have a fast metabolism, so their body needs a lot of water.
• A toddler’s kidneys don’t store as much water as an adult’s kidneys.
• A toddler’s immune system is not yet fully developed. This increases the likelihood of diseases such as vomiting and diarrhoea.
• Toddlers often do not eat and drink when they do not feel well.
• Young children depend on their mother for food intake.

Who is at risk of dehydration?
Even if everyone can dry out, some people have a special risk for it. The most at risk are:

• People who live at higher altitudes.
• Athletes, especially those who practice endurance sports such as marathons, triathlons and cycling. Dehydration can decrease performance in sports.
• People with chronic diseases such as diabetes, kidney disease, adrenocortical disorders, alcohol abuse and cystic fibrosis.
• The elderly, infants and toddlers.

Symptoms of lack of water

It is important to recognize the symptoms of dehydration as soon as they occur.
Untreated dehydration can lead to shock.
Signs and symptoms of lack of water may include:

• Vertigo
• Headache
• Dark urine (may have a strong odor)
• Inability to urinate
• Weight loss
• Dry nose and mouth
• Weakness
• Musclespasms
• Tachycardia
• Cold hands and feet
• Decreased lacrimation and sweating
• Tremble

How to notice when a child is dehydrated
The symptoms that indicate whether a child is dehydrated or facing a lack of water are:

• No wet diaper for six or eight hours
• Urine that appears dark in the diaper and has a stronger odor than usual
• Lethargy (excessive fatigue)
• Mouth and lips dry and rough
• Lack of tears when crying

Signs of a serious lack of water in the child:

1. Sunken eye sockets
2. Cold hands and feet with spots on the skin
3. Pronounced drowsiness
4. Sunken fontanelles (the soft spots on the skull)

Complications of dehydration

Dehydration can lead to serious complications, including:

Heatstroke
If you do not drink enough fluids during intense physical activity and you sweat heavily, you can suffer heat stroke, which can range from mild cramps to life-threatening disorders.

Cerebral edema
Sometimes, when you absorb fluids after dehydration, the body tries to store too much water in the cells.
This can lead to excessive swelling of brain cells and their failure.

The consequences are especially serious when it affects the cells of the brain.

Epileptic crisis
The electrolytes potassium and sodium help conduct nerve signals from one cell to another.
If the electrolytes get out of balance, normal electrical messages can become confused, leading to involuntary muscle twitching and sometimes loss of consciousness.

Hypovolemic shock
This is one of the most serious complications of dehydration.
It occurs when the reduction in blood volume causes a drop in blood pressure and the amount of oxygen in the body.

Renal failure
Renal insufficiency is potentially fatal and occurs when the kidneys are no longer able to excrete excess fluids and blood residues.

Coma and death
In the absence of timely and appropriate treatment, severe dehydration can lead to death.

Diagnosis of dehydration

Examinations and tests
During the physical examination, it is necessary to pay attention to the following signs:

• Drop in blood pressure when getting up from lying down
• Hypotension
• Tension of the skin, the skin is no longer as elastic as before, after squeezing it does not return to its starting position (usually the skin immediately returns to its starting position)
• Tachycardia
• Shock

Examinations carried out:

1. Blood test (to check electrolytes, especially sodium, potassium and bicarbonate content)
2. Urea nitrogen in the blood increased
3. Large blood count, blood cell counts are elevated
4. Elevated creatinine levels
5. Specific gravity of urine

Therapy for dehydration and natural remedies

Rehydration solution
When you’re dehydrated, you lose sugar and salts along with the water. Drinking a rehydration solution restores the proper balance of body fluids.
The solution should contain a mixture of potassium and sodium salts, as well as glucose or starch.
There are various over-the-counter and prescription products for rehydration in the pharmacy, including solutions suitable for infants and children.

High-grade dehydration
If there is a suspicion that a person is severely dehydrated, the emergency doctor should be called immediately.
Hospitalization may be required for treatment.
Especially infants, toddlers and the elderly need immediate treatment if they are at risk of becoming dehydrated.
Fluids can be administered via a nasogastric tube to the stomach or by infusion into the vein (intravenously).
In this way, the nutrients reach their destination faster than when a solution is drunk.

The best way to treat dehydration is to rehydrate the body with plenty of fluids, such as water, low-fat milk, diluted syrup, or diluted fruit juices.
A sweet drink can help replace the lost sugar and a salt snack helps replace lost salt.

Infants and dehydrated children should not drink only water, because this further dilutes the (already low) mineral salt content in the body and exacerbates the problem.
Children need diluted syrup, fruit juice or special rehydrating solutions.
If there is a difficulty drinking due to vomiting and diarrhea, you can try small and more often given amounts.
To give small amounts of fluid to young children, the easiest way is to use a teaspoon or syringe.

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