Dehydration

In physiology, dehydration is a deficit of total body water,[1] with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mild dehydration can also be caused by immersion diuresis, which may increase risk of decompression sickness in divers.

Most people can tolerate a three to four percent decrease in total body water without difficulty or adverse health effects. A five to eight percent decrease can cause fatigue and dizziness. Loss of over ten percent of total body water can cause physical and mental deterioration, accompanied by severe thirst. Death occurs at a loss of between fifteen and twenty-five percent of the body water.[2] Mild dehydration is characterized by thirst and general discomfort and is usually resolved with oral rehydration.

Dehydration can cause hypernatremia (high levels of sodium ions in the blood) and is distinct from hypovolemia (loss of blood volume, particularly blood plasma).

Dehydration
Cholera rehydration nurses
Nurses encourage a patient to drink an oral rehydration solution to reduce the combination of dehydration and hypovolemia he acquired from cholera. Cholera leads to GI loss of both excess free water (dehydration) and sodium (hence ECF volume depletion—hypovolemia).
SpecialtyCritical care medicine

Signs and symptoms

Ultrasound of the blood vessels of the neck that supports the diagnosis of severe dehydration[3]

The hallmarks of dehydration include thirst and neurological changes such as headaches, general discomfort, loss of appetite, decreased urine volume (unless polyuria is the cause of dehydration), confusion, unexplained tiredness, purple fingernails and seizures. The symptoms of dehydration become increasingly severe with greater total body water loss. A body water loss of 1-2%, considered mild dehydration, is shown to impair cognitive performance.[4] In people over age 50, the body's thirst sensation diminishes and continues diminishing with age. Many senior citizens suffer symptoms of dehydration. Dehydration contributes to morbidity in the elderly especially during conditions that promote insensible free water losses such as hot weather. A Cochrane review on this subject defined water-loss dehydration as "people with serum osmolality of 295 mOsm/kg or more" and found that the main symptoms in the elderly were expressing fatigue, missing drinks between meals and bioelectrical impedance analysis.[5]

Cause

Risk factors for dehydration include but are not limited to: exerting oneself in hot and humid weather, habitation at high altitudes, endurance athletics, elderly adults, infants, children and people living with chronic illnesses.[6]

In the elderly, blunted response to thirst and/or inadequate ability to access free water in the face of excess free water losses (especially hyperglycemia related) seem to be the main causes of dehydration.[7] Excess free water or hypotonic water can leave the body in two ways - sensible loss such as osmotic diuresis, sweating, vomiting and diarrhea, and insensible water loss, occurring mainly through the skin and respiratory tract. In humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the body. These occur primarily through either impaired thirst/water access or sodium excess.[8]

Diagnosis

Definition

Dehydration occurs when water intake is not enough to replace free water lost due to normal physiologic processes, including breathing, urination, and perspiration, or other causes, including diarrhea and vomiting. Dehydration can be life-threatening when severe and lead to seizures or respiratory arrest, and also carries the risk of osmotic cerebral edema if rehydration is overly rapid.[9]

The term dehydration has sometimes been used incorrectly as a proxy for the separate, related condition hypovolemia, which specifically refers to a decrease in volume of blood plasma.[1] The two are regulated through independent mechanisms in humans;[1] the distinction is important in guiding treatment.[10]

Prevention

For routine activities, thirst is normally an adequate guide to maintain proper hydration.[11] Minimum water intake will vary individually depending on weight, environment, diet and genetics.[12] With exercise, exposure to hot environments, or a decreased thirst response, additional water may be required. In athletes in competition drinking to thirst optimizes performance and safety, despite weight loss, and as of 2010, there was no scientific study showing that it is beneficial to stay ahead of thirst and maintain weight during exercise.[13]

In warm or humid weather or during heavy exertion, water loss can increase markedly, because humans have a large and widely variable capacity for the active secretion of sweat. Whole-body sweat losses in men can exceed 2 L/h during competitive sport, with rates of 3–4 L/h observed during short-duration, high-intensity exercise in the heat.[14] When such large amounts of water are being lost through perspiration, electrolytes, especially sodium, are also being lost.

In most athletes, exercising and sweating for 4–5 hours with a sweat sodium concentration of less than 50 mmol/L, the total sodium lost is less than 10% of total body stores (total stores are approximately 2,500 mmol, or 58 g for a 70-kg person).[15] These losses appear to be well tolerated by most people. The inclusion of some sodium in fluid replacement drinks has some theoretical benefits[15] and poses little or no risk, so long as these fluids are hypotonic (since the mainstay of dehydration prevention is the replacement of free water losses).

The consumption of overly sugary and/or salty foods can cause dehydration.[16]

Treatment

The treatment for minor dehydration that is often considered the most effective is drinking water and stopping fluid loss. Plain water restores only the volume of the blood plasma, inhibiting the thirst mechanism before solute levels can be replenished.[17] Solid foods can contribute to fluid loss from vomiting and diarrhea.[18] Urine concentration and frequency will customarily return to normal as dehydration resolves.[19]

In some cases, correction of a dehydrated state is accomplished by the replenishment of necessary water and electrolytes (through oral rehydration therapy or fluid replacement by intravenous therapy). As oral rehydration is less painful, less invasive, less expensive, and easier to provide, it is the treatment of choice for mild dehydration. Solutions used for intravenous rehydration must be isotonic or hypertonic. Pure water injected into the veins will cause the breakdown (lysis) of red blood cells (erythrocytes).

When fresh water is unavailable (e.g. at sea or in a desert), seawater and ethanol will worsen the condition. Urine contains a lower solute concentration than seawater, and numerous guides advise against its consumption in survival situations.[20] If somebody is dehydrated and is taken to a hospital, IVs are also used.[21][22][23][24]

For severe cases of dehydration where fainting, unconsciousness, or other severely inhibiting symptom is present (the patient is incapable of standing or thinking clearly), emergency attention is required. Fluids containing a proper balance of replacement electrolytes are given orally or intravenously with continuing assessment of electrolyte status; complete resolution is the norm in all but the most extreme cases.[25]

See also

References

  1. ^ a b c Mange K, Matsuura D, Cizman B, Soto H, Ziyadeh FN, Goldfarb S, Neilson EG (November 1997). "Language guiding therapy: the case of dehydration versus volume depletion". Annals of Internal Medicine. 127 (9): 848–53. doi:10.7326/0003-4819-127-9-199711010-00020. PMID 9382413.
  2. ^ Ashcroft F, Life Without Water in Life at the Extremes. Berkeley and Los Angeles, 2000, 134-138.
  3. ^ "UOTW #59 - Ultrasound of the Week". Ultrasound of the Week. September 23, 2015. Retrieved May 27, 2017.
  4. ^ Riebl SK, Davy BM (November 2013). "The Hydration Equation: Update on Water Balance and Cognitive Performance". ACSM's Health & Fitness Journal. 17 (6): 21–28. doi:10.1249/FIT.0b013e3182a9570f. PMC 4207053. PMID 25346594.
  5. ^ Hooper L, Abdelhamid A, Attreed NJ, Campbell WW, Channell AM, Chassagne P, et al. (April 2015). "Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people". The Cochrane Database of Systematic Reviews. 4 (4): CD009647. doi:10.1002/14651858.CD009647.pub2. PMID 25924806.
  6. ^ "Dehydration Risk factors - Mayo Clinic". www.mayoclinic.org. Retrieved December 14, 2015.
  7. ^ Borra SI, Beredo R, Kleinfeld M (March 1995). "Hypernatremia in the aging: causes, manifestations, and outcome". Journal of the National Medical Association. 87 (3): 220–4. PMC 2607819. PMID 7731073.
  8. ^ Lindner G, Funk GC (April 2013). "Hypernatremia in critically ill patients". Journal of Critical Care. 28 (2): 216.e11–20. doi:10.1016/j.jcrc.2012.05.001. PMID 22762930.
  9. ^ Dehydration at eMedicine
  10. ^ Bhave G, Neilson EG (August 2011). "Volume depletion versus dehydration: how understanding the difference can guide therapy". American Journal of Kidney Diseases. 58 (2): 302–9. doi:10.1053/j.ajkd.2011.02.395. PMC 4096820. PMID 21705120.
  11. ^ "Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate : Health and Medicine Division". www.nationalacademies.org. Retrieved February 7, 2018.
  12. ^ Godman H (September 2016). "How much water should you drink?". Harvard Health. Retrieved February 7, 2018.
  13. ^ Noakes TD (2010). "Is drinking to thirst optimum?". Annals of Nutrition & Metabolism. 57 Suppl 2 (s2): 9–17. doi:10.1159/000322697. PMID 21346332.
  14. ^ Taylor NA, Machado-Moreira CA (February 2013). "Regional variations in transepidermal water loss, eccrine sweat gland density, sweat secretion rates and electrolyte composition in resting and exercising humans". Extreme Physiology & Medicine. 2 (1): 4. doi:10.1186/2046-7648-2-4. PMC 3710196. PMID 23849497.
  15. ^ a b Coyle EF (January 2004). "Fluid and fuel intake during exercise". Journal of Sports Sciences. 22 (1): 39–55. CiteSeerX 10.1.1.321.6991. doi:10.1080/0264041031000140545. PMID 14971432.
  16. ^ Graw M. "The Effect of Salt & Sugar on Dehydrated Cells". Retrieved December 12, 2017.
  17. ^ Murray R, Stofan J (2001). "Ch. 8: Formulating carbohydrate-electrolyte drinks for optimal efficacy". In Maughan RJ, Murray R (eds.). Sports Drinks: Basic Science and Practical Aspects. CRC Press. pp. 197–224. ISBN 978-0-8493-7008-3.
  18. ^ "Healthwise Handbook," Healthwise, Inc. 1999
  19. ^ Wedro B. "Dehydration". MedicineNet. Retrieved June 10, 2014.
  20. ^ "Can Humans drink seawater?". National Ocean Service. National Ocean Service NOAA Department of Commerce.
  21. ^ SimpleSurvival Find Water
  22. ^ Tracker Trail - Mother Earth News - Issue #72
  23. ^ EQUIPPED TO SURVIVE (tm) - A Survival Primer
  24. ^ Five Basic Survival Skills in the Wilderness
  25. ^ Ellershaw JE, Sutcliffe JM, Saunders CM (April 1995). "Dehydration and the dying patient". Journal of Pain and Symptom Management. 10 (3): 192–7. doi:10.1016/0885-3924(94)00123-3. PMID 7629413.

Further reading

External links

External resources
Alkene

In organic chemistry, an alkene is an unsaturated hydrocarbon that contains at least one carbon–carbon double bond. The words alkene and olefin are often used interchangeably (see nomenclature section below). Acyclic alkenes, with only one double bond and no other functional groups, known as mono-enes, form a homologous series of hydrocarbons with the general formula CnH2n. Alkenes have two hydrogen atoms fewer than the corresponding alkane (with the same number of carbon atoms). The simplest alkene, ethylene (C2H4), with the International Union of Pure and Applied Chemistry (IUPAC) name ethene, is the organic compound produced on the largest scale industrially. Aromatic compounds are often drawn as cyclic alkenes, but their structure and properties are different and they are not considered to be alkenes.

Convergent boundary

Convergent boundaries are areas on Earth where two or more lithospheric plates collide. One plate eventually slides beneath the other causing a process known as subduction. The subduction zone can be defined by a plane where many earthquakes occur, called the Benioff Zone. These collisions happen on scales of millions to tens of millions of years and can lead to volcanism, earthquakes, orogenesis, destruction of lithosphere, and deformation. Convergent boundaries occur between oceanic-oceanic lithosphere, oceanic-continental lithosphere, and continental-continental lithosphere. The geologic features related to convergent boundaries vary depending on crust types.

Plate tectonics is driven by convection cells in the mantle. Convection cells are the result of heat generated by radioactive decay of elements in the mantle escaping to the surface and the return of cool materials from the surface to the mantle. These convection cells bring hot mantle material to the surface along spreading centers creating new crust. As this new crust is pushed away from the spreading center by formation of newer crust, it cools, thins, and becomes denser. Subduction initiates when this dense crust converges with less dense crust. The force of gravity helps drive the subducting slab into the mantle. Evidence supports that the force of gravity will increase plate velocity. As the relatively cool subducting slab sinks deeper into the mantle, it is heated causing dehydration of hydrous minerals. This releases water into the hotter asthenosphere, which leads to partial melting of asthenosphere and volcanism. Both dehydration and partial melting occurs along the 1000 °C isotherm, generally at depths of 65 – 130 km.

Some lithospheric plates consist of both continental and oceanic lithosphere. In some instances, initial convergence with another plate will destroy oceanic lithosphere, leading to convergence of two continental plates. Neither continental plate will subduct. It is likely that the plate may break along the boundary of continental and oceanic crust. Seismic tomography reveals pieces of lithosphere that have broken off during convergence.

Dehydration reaction

In chemistry, a dehydration reaction is a conversion that involves the loss of water from the reacting molecule or ion. Dehydration reactions are common processes, the reverse of a hydration reaction. Common dehydrating agents used in organic synthesis include sulfuric acid and alumina. Often dehydration reactions are affected with heating.

Deoxyribonucleotide

A deoxyribonucleotide is the monomer, or single unit, of DNA, or deoxyribonucleic acid. Each deoxyribonucleotide comprises three parts: a nitrogenous base, a deoxyribose sugar, and one phosphate group. The nitrogenous base is always bonded to the 1' carbon of the deoxyribose, which is distinguished from ribose by the presence of a proton on the 2' carbon rather than an -OH group. The phosphate groups bind to the 5' carbon of the sugar.

When deoxyribonucleotides polymerize to form DNA, the phosphate group from one nucleotide will bond to the 3' carbon on another nucleotide, forming a phosphodiester bond via dehydration synthesis. New nucleotides are always added to the 3' carbon of the last nucleotide, so synthesis always proceeds from 5' to 3'.

Desert warfare

In desert warfare, the elements can sometimes be more dangerous than the actual enemy. The desert terrain is the second most inhospitable to troops following a cold environment. The low humidity, extremes of heat/cold, and lack of obstacles and wild-life allows the increased use of electronic devices and unmanned aircraft for surveillance and attacks.

Desiccant

A desiccant is a hygroscopic substance that induces or sustains a state of dryness (desiccation) in its vicinity; it is the opposite of a humectant. Commonly encountered pre-packaged desiccants are solids that absorb water. Desiccants for specialized purposes may be in forms other than solid, and may work through other principles, such as chemical bonding of water molecules. They are commonly encountered in foods to retain crispness. Industrially, desiccants are widely used to control the level of water in gas streams.

Diabetes insipidus

Diabetes insipidus (DI) is a condition characterized by large amounts of dilute urine and increased thirst. The amount of urine produced can be nearly 20 liters per day. Reduction of fluid has little effect on the concentration of the urine. Complications may include dehydration or seizures.There are four types of DI, each with a different set of causes. Central DI (CDI) is due to a lack of the hormone vasopressin (antidiuretic hormone). This can be due to damage to the hypothalamus or pituitary gland or genetics. Nephrogenic diabetes insipidus (NDI) occurs when the kidneys do not respond properly to vasopressin. Dipsogenic DI is due to abnormal thirst mechanisms in the hypothalamus while gestational DI occurs only during pregnancy. Diagnosis is often based on urine tests, blood tests, and the fluid deprivation test. Diabetes mellitus is a separate condition with an unrelated mechanism, though both can result in the production of large amounts of urine.Treatment involves drinking sufficient fluids to prevent dehydration. Other treatments depend on the type. In central and gestational DI treatment is with desmopressin. Nephrogenic DI may be treated by addressing the underlying cause or the use of a thiazide, aspirin, or ibuprofen. The number of new cases of diabetes insipidus each year is 3 in 100,000. Central DI usually starts between the ages of 10 and 20 and occurs in males and females equally. Nephrogenic DI can begin at any age. The term "diabetes" is derived from the Greek word meaning siphon.

Diabetic coma

Diabetic coma is a reversible form of coma found in people with diabetes mellitus. It is a medical emergency.Three different types of diabetic coma are identified:

Severe low blood sugar in a diabetic person

Diabetic ketoacidosis (usually type 1) advanced enough to result in unconsciousness from a combination of a severely increased blood sugar level, dehydration and shock, and exhaustion

Hyperosmolar nonketotic coma (usually type 2) in which an extremely high blood sugar level and dehydration alone are sufficient to cause unconsciousness.In most medical contexts, the term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that they have diabetes. An example might be a physician working in an emergency department who receives an unconscious patient wearing a medical identification tag saying DIABETIC. Paramedics may be called to rescue an unconscious person by friends who identify them as diabetic. Brief descriptions of the three major conditions are followed by a discussion of the diagnostic process used to distinguish among them, as well as a few other conditions which must be considered.

An estimated 2 to 15 percent of people with diabetes will suffer from at least one episode of diabetic coma in their lifetimes as a result of severe hypoglycemia.

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases, people may not realize they previously had diabetes.DKA happens most often in those with type 1 diabetes but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke and certain medications such as steroids. DKA results from a shortage of insulin; in response, the body switches to burning fatty acids, which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH and ketoacids in either the blood or urine.The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually, potassium is also needed to prevent the development of low blood potassium. Throughout treatment, blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended.Rates of DKA vary around the world. In the United Kingdom, about 4% of people with type 1 diabetes develop DKA each year, while in Malaysia the condition affects about 25% of type-1 diabetics a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is around 1–4%.

Diarrhea

Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.The most common cause is an infection of the intestines due to either a virus, bacteria, or parasite—a condition also known as gastroenteritis. These infections are often acquired from food or water that has been contaminated by feces, or directly from another person who is infected. The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks). The short duration watery diarrhea may be due to an infection by cholera, although this is rare in the developed world. If blood is present it is also known as dysentery. A number of non-infectious causes can result in diarrhea. These include lactose intolerance, irritable bowel syndrome, non-celiac gluten sensitivity, celiac disease, inflammatory bowel disease, hyperthyroidism, bile acid diarrhea, and a number of medications. In most cases, stool cultures to confirm the exact cause are not required.Diarrhea can be prevented by improved sanitation, clean drinking water, and hand washing with soap. Breastfeeding for at least six months and vaccination against rotavirus is also recommended. Oral rehydration solution (ORS)—clean water with modest amounts of salts and sugar—is the treatment of choice. Zinc tablets are also recommended. These treatments have been estimated to have saved 50 million children in the past 25 years. When people have diarrhea it is recommended that they continue to eat healthy food and babies continue to be breastfed. If commercial ORS are not available, homemade solutions may be used. In those with severe dehydration, intravenous fluids may be required. Most cases; however, can be managed well with fluids by mouth. Antibiotics, while rarely used, may be recommended in a few cases such as those who have bloody diarrhea and a high fever, those with severe diarrhea following travelling, and those who grow specific bacteria or parasites in their stool. Loperamide may help decrease the number of bowel movements but is not recommended in those with severe disease.About 1.7 to 5 billion cases of diarrhea occur per year. It is most common in developing countries, where young children get diarrhea on average three times a year. Total deaths from diarrhea are estimated at 1.26 million in 2013—down from 2.58 million in 1990. In 2012, it was the second most common cause of deaths in children younger than five (0.76 million or 11%). Frequent episodes of diarrhea are also a common cause of malnutrition and the most common cause in those younger than five years of age. Other long term problems that can result include stunted growth and poor intellectual development.

Drinking

Drinking is the act of ingesting water or other liquids into the body through the mouth. Water is required for many physiological processes. Both excessive and inadequate water intake are associated with health problems.

Electrolyte imbalance

Electrolyte imbalance or water-electrolyte imbalance is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis within the body. They help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance and much more. Electrolyte imbalances can develop by the following mechanisms: excessive ingestion; diminished elimination of an electrolyte; diminished ingestion or excessive elimination of an electrolyte.

The most serious electrolyte disturbances involve abnormalities in the levels of sodium, potassium or calcium. Other electrolyte imbalances are less common, and often occur in conjunction with major electrolyte changes. Chronic laxative abuse or severe diarrhea or vomiting (gastroenteritis) can lead to electrolyte disturbances along with dehydration. People suffering from bulimia or anorexia nervosa are at especially high risk for an electrolyte imbalance.

Ether

Ethers are a class of organic compounds that contain an ether group—an oxygen atom connected to two alkyl or aryl groups. They have the general formula R–O–R′, where R and R′ represent the alkyl or aryl groups. Ethers can again be classified into two varieties: if the alkyl groups are the same on both sides of the oxygen atom, then it is a simple or symmetrical ether, whereas if they are different, the ethers are called mixed or unsymmetrical ethers. A typical example of the first group is the solvent and anesthetic diethyl ether, commonly referred to simply as "ether" (CH3–CH2–O–CH2–CH3). Ethers are common in organic chemistry and even more prevalent in biochemistry, as they are common linkages in carbohydrates and lignin.

Food drying

Food drying is a method of food preservation in which food is dried (dehydrated or desiccated). Drying inhibits the growth of bacteria, yeasts, and mold through the removal of water. Dehydration has been used widely for this purpose since ancient times; the earliest known practice is 12,000 B.C. by inhabitants of the modern Middle East and Asia regions. Water is traditionally removed through evaporation (air drying, sun drying, smoking or wind drying), although today electric food dehydrators or freeze-drying can be used to speed the drying process and ensure more consistent results.

Freeze-drying

Freeze drying, also known as lyophilisation or cryodesiccation, is a low temperature dehydration process which involves freezing the product, lowering pressure, then removing the ice by sublimation. This is in contrast to dehydration by most conventional methods that evaporate water using heat.Freeze drying results in a high quality product because of the low temperature used in processing. The original shape of the product is maintained and quality of the rehydrated product is excellent. Primary applications of freeze drying include biological (e.g. bacteria and yeasts), biomedical (e.g. surgical transplants), and food processing (e.g. coffee) and preservation.

Gastroenteritis

Gastroenteritis, also known as infectious diarrhea, is inflammation of the gastrointestinal tract—the stomach and small intestine. Symptoms may include diarrhea, vomiting and abdominal pain. Fever, lack of energy and dehydration may also occur. This typically lasts less than two weeks. It is not related to influenza, though it has been called the "stomach flu".Gastroenteritis is usually caused by viruses. However, bacteria, parasites, and fungus can also cause gastroenteritis. In children, rotavirus is the most common cause of severe disease. In adults, norovirus and Campylobacter are common causes. Eating improperly prepared food, drinking contaminated water or close contact with a person who is infected can spread the disease. Treatment is generally the same with or without a definitive diagnosis, so testing to confirm is usually not needed.Prevention includes hand washing with soap, drinking clean water, proper disposal of human waste and breastfeeding babies instead of using formula. The rotavirus vaccine is recommended as a prevention for children. Treatment involves getting enough fluids. For mild or moderate cases, this can typically be achieved by drinking oral rehydration solution (a combination of water, salts and sugar). In those who are breastfed, continued breastfeeding is recommended. For more severe cases, intravenous fluids may be needed. Fluids may also be given by a nasogastric tube. Zinc supplementation is recommended in children. Antibiotics are generally not needed. However, antibiotics are recommended for young children with a fever and bloody diarrhea.In 2015, there were two billion cases of gastroenteritis, resulting in 1.3 million deaths globally. Children and those in the developing world are affected the most. In 2011, there were about 1.7 billion cases, resulting in about 700,000 deaths of children under the age of five. In the developing world, children less than two years of age frequently get six or more infections a year. It is less common in adults, partly due to the development of immunity.

Hangover

A hangover is the experience of various unpleasant physiological and psychological effects following the consumption of alcohol, such as wine, beer and distilled spirits. Hangovers can last for several hours or for more than 24 hours. Typical symptoms of a hangover may include headache, drowsiness, concentration problems, dry mouth, dizziness, fatigue, gastrointestinal distress (e.g., vomiting), absence of hunger, depression, sweating, nausea, hyper-excitability and anxiety.While the causes of a hangover are still poorly understood, several factors are known to be involved including acetaldehyde accumulation, changes in the immune system and glucose metabolism, dehydration, metabolic acidosis, disturbed prostaglandin synthesis, increased cardiac output, vasodilation, sleep deprivation and malnutrition. Beverage-specific effects of additives or by-products such as congeners in alcoholic beverages also play an important role. The symptoms occur typically after the intoxicating effect of the alcohol begins to wear off, generally the morning after a night of heavy drinking.Though many possible remedies and folk cures have been suggested, there is no compelling evidence to suggest that any are effective for preventing or treating alcohol hangover. Avoiding alcohol or drinking in moderation are the most effective ways to avoid a hangover.

The socioeconomic consequences and health risks of alcohol hangover include workplace absenteeism, impaired job performance, reduced productivity and poor academic achievement. A hangover may also compromise potentially dangerous daily activities such as driving a car or operating heavy machinery.

Hypovolemia

Hypovolemia also known as volume depletion is a state of decreased blood volume or diminished body fluid; more specifically, decrease in volume of blood plasma. It is thus the intravascular component of volume contraction (or loss of blood volume due to things such as bleeding or dehydration), but, as it also is the most essential one, hypovolemia and volume contraction are sometimes used synonymously.

Hypovolemia is characterized by sodium depletion, and thus is distinct from (although often overlapping with) dehydration, excessive loss of body water.

Oral rehydration therapy

Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially that due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydration therapy can also be given by a nasogastric tube. Therapy should routinely include the use of zinc supplements. Use of oral rehydration therapy has been estimated to decrease the risk of death from diarrhea by up to 93%.Side effects may include vomiting, high blood sodium, or high blood potassium. If vomiting occurs, it is recommended that use be paused for 10 minutes and then gradually restarted. The recommended formulation includes sodium chloride, sodium citrate, potassium chloride, and glucose. Glucose may be replaced by sucrose and sodium citrate may be replaced by sodium bicarbonate, if not available. It works as glucose increases the uptake of sodium and thus water by the intestines. A number of other formulations are also available including versions that can be made at home. However, the use of homemade solutions has not been well studied.Oral rehydration therapy was developed in the 1940s, but did not come into common use until the 1970s. Oral rehydration solution is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. The wholesale cost in the developing world of a package to mix with a liter of water is 0.03 to US$0.20. Globally as of 2015 oral rehydration therapy is used by 41% of children with diarrhea. This use has played an important role in reducing the number of deaths in children under the age of five.

Volume status
Electrolyte
Acid–base

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