Dehydration: Symptoms in Children and Adults
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Dehydration facts

The body needs water to function.
Dehydration occurs when water intake is less than water loss.
Symptoms range from mild to life-threatening.
The young and the elderly are especially susceptible to dehydration.

What is dehydration?

Water is a critical element of the body, and keeping the body adequately hydrated is a must to allow the body to function. Up to 75% of the body's weight is made up of water. Most of the water is found within the cells of the body (intracellular space). The rest is found in the extracellular space, which consists of the blood vessels (intravascular space) and the spaces between cells (interstitial space).

Dehydration occurs when the amount of water leaving the body is greater than the amount being taken in. The body is very dynamic and always changing. This is especially true with water in the body. We lose water routinely when we:

breathe and humidified air leaves the body (this can be seen on a cold day when you can see your breath in the air, which is just water that has been exhaled);
sweat to cool the body; and
eliminate waste by urinating or having a bowel movement.
In a normal day, a person has to drink a significant amount of water to replace this routine loss.

The formula for daily fluid requirements depends upon an individual's weight. Normally, fluid and weight are calculated using the metric system; however, below is the approximation in imperial (American) units.

Body weight Daily fluid requirements (approximate)
10 pounds 15 ounces
20 pounds 30 ounces
30 pounds 40 ounces
40 pounds 45 ounces
50 pounds 50 ounces
75 pounds 55 ounces
100 pounds 60 ounces
150 pounds 65 ounces
200 pounds 70 ounces

If you would like to calculate your body weight and daily fluid requirements using the metric system, please use this formula.

For the first 10kg (kilogram) of body weight the daily fluid intake required is 100cc (or mL) per kg.
For the next 10kg of body weight, the fluid required is an additional 50 cc/kg.
For every additional kg of body weight, an additional 10cc/kg is required
This is the basic body requirement. More fluid would be needed to replace excess sweating from exercise or fever, fluid loss from vomiting, and diarrhea or increased urine production.

What causes dehydration?

Dehydration occurs because there is too much water lost, not enough water taken in, or most commonly, a combination of the two.

Diarrhea: Diarrhea is the most common reason for a person to lose excess amounts of water. A significant amount of water can be lost with each bowel movement. Worldwide, more than four million children die each year because of dehydration from diarrhea.

Vomiting: Vomiting can also be a cause of fluid loss. Not only can an individual lose fluid in the vomitus, but it may be difficult to replace water by drinking because of that same nausea and vomiting.

Sweat: The body can lose significant amounts of water in the form of sweat when it tries to cool itself. Whether the body temperature is increased because of working or exercising in a hot environment or because a fever is present due to an infection; the body uses water in the form of sweat to cool itself. Depending upon weather conditions, a brisk walk may generate up to 16 ounces of sweat (a pound of water) an hour to allow body cooling, and that water needs to be replaced by the thirst mechanism signaling the person to drink fluids.

Diabetes: In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine and water then follows, which may cause significant dehydration. For this reason, frequent urination and excessive thirst are among the early symptoms of diabetes.

Burns: The skin acts as a protective barrier for the body and is also responsible for regulating fluid loss. Burn victims become dehydrated because the damaged skin cannot prevent fluid from seeping out of the body. Other inflammatory diseases of the skin such as toxic epidermal necrolysis, also may be associated with significant fluid loss.

Inability to drink fluids: The inability to drink adequately is the other potential cause of dehydration. Whether it is the lack of availability of water, intense nausea with or without vomiting, or the lack of strength to drink. This coupled with routine or extraordinary water losses can compound the degree of dehydration.

What are the signs and symptoms of dehydration?

The body's initial responses to dehydration are thirst to increase water intake, and decreased urine output to try to conserve water loss. The urine will become concentrated and more yellow in color.

As the level of water loss increases, more symptoms can become apparent.

The following are further signs and symptoms of dehydration.

Dry mouth
Eyes stop making tears
Sweating may stop
Muscle cramps
Nausea and vomiting
Heart palpitations
Lightheadedness (especially when standing)
Weakness
Decreased urine output

The body tries to maintain cardiac output (the amount of blood that is pumped by the heart to the body); and if the amount of fluid in the intravascular space is decreased, the body compensates for this decrease by increasing the heart rate and making blood vessels constrict to try to maintain blood pressure and blood flow to the vital organs of the body. The body shunts blood flow away from the skin to internal organs, for example, the brain, heart, lungs, kidneys, and intestines; causing the skin to feel cool and clammy. This coping mechanism begins to fail as the level of dehydration increases.

With severe dehydration, confusion and weakness will occur as the brain and other body organs receive less blood flow. Finally, coma, organ failure, and death eventually will occur if the dehydration remains untreated.

What about dehydration in children?

Millions of children die worldwide each year because of dehydration, often because of diarrhea. As well, the temperature regulation and sweat mechanism of infants are not well developed, and this increases their risk of heat-related illness.

It is important to remember that infants and children are dependent upon others to provide them with water and nutrition. Infants cannot tell their parents or care providers when they are thirsty. Enough fluid needs to be provided so that the dehydration can be prevented. This is especially true if increased water loss occurs because of fever, vomiting or diarrhea.

In children, symptoms of dehydration increase as the level of dehydration increases.

Level of dehydration Estimated fluid loss Signs and Symptoms in Children

Level of Dehydration Estimated Fluid Loss Signs and Symptoms
Minimal <3% of body weight None
Mild to moderate <10% of body weight Fussy, tired, irritable child. Dry mucous membranes (mouth, tongue), increased heart rate, increased breathing rate, decreased urine output, increased thirst
Severe 10% of body weight or more Listless, lethargic, unconscious. Too weak to cry. Sunken eyes, sunken fontanelle (soft spot of skull). Increased heart rate, weak pulses, and rapid shallow breathing. Cool, mottled skin. No urine output (dry diapers). Too weak to suckle or drink fluids. Loss of muscle tone with the child appearing "floppy."

Infants and children respond well to fluid replacement, and often oral rehydration therapy (ORT) can treat dehydration. Small, frequent sips of fluid replacement solutions such as Pedialyte or Gatorade may be enough to prevent the need for intravenous fluids. In ORT, replacement begins with 5cc or one teaspoon of fluid every 5-10 minutes. If this is tolerated without vomiting, the amount of fluid is doubled, again providing small amounts every few minutes. However, if the child is too ill to drink or cannot tolerate even small sips of fluid, medical care should be accessed immediately.

Intravenous fluids can rehydrate the infant or child while the underlying illness is evaluated and treated. Occasionally, there is difficulty in placing an intravenous line and an intraosseous (inside the bone) needle can be placed, usually in the tibia (shin bone) that allows fluid resuscitation.

In children who are markedly dehydrated, blood tests may be used to monitor electrolytes, kidney function, and acid-base balance in the body.

It is important to find the reason for the illness because dehydration is the result of a disease process, not the cause of it.