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Symptoms of Dehydration

Author Heartspring Staff healthy fluid maintenance topics.

The degree of dehydration is graded according to signs and symptoms that reflect the amount of fluid lost:

In the early stages of dehydration, there are no signs or symptoms.

Early features are difficult to detect but include dryness of mouth and thirst.

As dehydration increases, signs and symptoms develop. These include: thirst, restless or irritable behavior, decreased skin turgor, dry mucous membranes, sunken eyes, sunken fontanelle (in infants), and absence of tears when crying vigorously.

Symptoms Early or Mild

Water Molecule

In severe dehydration, these effects become more pronounced and the patient may develop evidence of hypovolemic shock, including: diminished consciousness, lack of urine output, cool moist extremities, a rapid and feeble pulse (the radial pulse may be undetectable), low or undetectable blood pressure, and peripheral cyanosis. Death follows soon if rehydration is not started quickly.

Symptoms Moderate to Severe

Water drop

Dehydration and Fluid Maintenance

By the American Medical Directors Association (AMDA).

Is the patient dehydrated or does the patient have a fluid/electrolyte imbalance? Consider seriously the presence of a fluid/electrolyte imbalance whenever a patient experiences new symptoms or a decline of an existing condition that cannot be readily attributed to another cause. Fluid/electrolyte imbalances must be identified promptly because they can increase the risk of subsequent decline and may be life threatening.

Using a stepwise approach, carefully evaluate the patient for physiological and functional signs and symptoms of dehydration or another fluid/electrolyte imbalance (see "Signs and Symptoms That May be Associated with Dehydration" below). First, perform a careful, focused medical history. Information from the patient's history that may suggest a hydration problem includes

Signs and Symptoms That May Be Associated with Dehydration

Physiological Dehydration Signs and Symptoms

Functional Signs and Symptoms of Dehydration

The presence of multiple signs and symptoms may provide a more urgent or specific indication that the patient has a fluid or electrolyte imbalance. Recent rapid weight loss is often an important clue because it may reflect progressive depletion of fluid volume. (The loss of 1 L of fluid results in a weight loss of 1 kg, or 2.2 lb.)

If relevant symptoms or abnormalities are identified, involve a physician or other health care practitioner as soon as possible to identify the possible causes of those symptoms (which may include fluid/electrolyte imbalance, medical illness, infection, etc.).

If dehydration or another fluid/electrolyte imbalance is identified, define its severity to determine the urgency of further assessments and interventions (see "Characterizing the Severity of Fluid/Electrolyte Imbalance" below). Mild deficits are usually readily correctable or can continue without causing major decline. Moderate or severe deficits, however, require prompt interventions and at least partial correction.

Severity of Fluid Electrolyte Imbalance

Mild: Some deficits or abnormalities in laboratory values exist, but they do not seriously impair the patient's circulation, organ function, or level of functioning. Examples:

Moderate: Some deficits or lab abnormalities exist that impair or are likely to impair circulation or organ function but are not immediately life threatening. Example:

Severe: Deficits or abnormalities causing significant, life-threatening risks or problems with circulation, organ function, or activities of daily living. Examples:

If dehydration is suspected, go immediately to Step 3 to begin assessment.

Is the patient at risk for dehydration or fluid/electrolyte imbalance? If the patient is not currently dehydrated and has either no fluid/electrolyte imbalance or a mild fluid/electrolyte imbalance, it is important to identify the risk for development or progression of these conditions. Caregivers should pay close attention to clinical conditions and environmental factors that may increase risk for dehydration or fluid/electrolyte imbalance (see "Conditions and Factors That May Increase Risk for Dehydration or Fluid/Electrolyte Imbalance" below). At the same time, caregivers should be aware that normal aging, end-of-life processes, and other clinical conditions can produce many of the same findings. If a patient appears to be at risk, the caregiver should document this observation and address the conditions or factors that present the risk.

Conditions and Factors That May Increase Risk for Dehydration or Fluid/Electrolyte Imbalance

Clinical Conditions

Environmental Factors

Risk Reduction. A facility-wide hydration program can contribute significantly to decreasing the risk of dehydration. The certified nursing assistant (CNA) can be a major resource for this program. Regular rounds for fluid distribution, one-on-one help with consuming fluids, records of fluid intake and output if indicated, and reporting of warning signs that caregivers have been trained to recognize all play a part in a facility-wide effort to reduce the risk of hydration problems.

Hydration should be considered part of everyone's job. Every staff member should be trained to help manage hydration and to offer fluids as appropriate, and all staff should be involved in managing hydration. All caregiving staff should pay attention to such issues as why a patient may not be consuming fluids that are offered and ensuring that a patient's liquid preferences are identified.

Questions about these issues should be asked of patients or of their family members or other advocates when patients are unable to respond.

Is A Medical Work-up Appropriate? An appropriate work-up may help to identify or characterize a current dehydration or fluid/electrolyte imbalance or to define the risks for developing these problems. A physical examination and laboratory tests help to confirm the diagnosis and guide patient management.

Mayo Clinic.

Adequate fluid replacement helps maintain hydration and, promotes the health, safety, and optimal physical performance

Recommendations on the amount and composition of fluid that should be ingested in preparation for, during, and after exercise or athletic competition:

Med Science Sports Exercise 1996 Jan;28(1):i-vii.

are assistants of board reviewed doctors that are medical editors, authors, and reviewers, providing oversight for Heartspring.net. This article is currently undergoing doctor reveiw.

by Dr. Vasey.

research review by Dr. Wells.

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Updated: Sept 24 2018