Brief Answer:
Fluid requirement in severe dehydration

Detailed Answer:
Hi Ma'am, ,

Good day to you.

May I introduce myself : I am Dr.(Col) R Karanwal, M.D. (Internal Medicine) and take this opportunity to reply to your query.

As details provided by you are inadequate, I presume that you want to know how to find out whether the fluid and electrolytes' loss has been fully compensated.

1. Firstly, the basic principle is TO REPLENISH THE ESTIMATE AMOUNT OF FLUID LOSS due to any reason, but at the same time, ensuring that the body is not overloaded with fluids, particularly in patients of heart failure, heart disease, pre-existing kidneys' failure.

2. The clinical and biochemical parameters- which guide us if complete replenishment of the lost fluid has been done, are given below.

3. Certain conditions which mandate prompt intravenous fluids are :-

- Prolonged, severe dehydration
- Dangerously low blood pressure
- No passage of urine for more than 6 hours which may be due to kidneys shutdown.
- Patient is drowsy, confused and listless.
- If patient us unable to take/tolerate oral fluids, such as, recurrent vomiting, vomits out whatever fluid is taken orally, patient is unconscious, to name a few.

4. Further, if the kidneys are still functioning (that is, if the patient is passing urine), and there is no blood pressure fall to XXXXXXX levels, ORAL REHYDRATION AND SALT SUPPLEMENTS IS THE IDEAL APPROACH, provided the patient is able to accept and tolerate oral fluids.

3. The standard indicators, guiding clinically whether adequate fluids and salts have been infused (intravenously or orally) are :-

- Urine output is more than 60ml/hour

- Blood pressure returns to within normal range

- The pulse, when palpated, is found to be strong, bounding and the rate is around 70/min

- The tongue becomes moist

- The wrinkles on the abdominal skin disappear.

- The patient is fully alert mentally and breathing normally.

- Blood electrolytes (salts) levels is restored to normal range.

Hope I have addressed your query to your satisfaction. If you have any further questions, I will be more than happy to help you.

However, if you do not have any further clarifications, you can close the discussion and rate the answer.

Wish you a good health.

Fond regards and best wishes,

Dr. (Col) R Karanwal

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Brief Answer:
Intravenous fluid requirement

Detailed Answer:
Hi Ma'am,

Thanks for specifying your query. Firstly, I regret for not having understood your query in the first instance.

In order to learn how to estimate the amount of fluid requirement through intravenous route in a case of severe dehydration, a brief knowledge of the total fluid content in male/female is essential. It depends on the body weight.

The fluid content in an average adult male has about 60% of body weight, while a female's water content is around 55% of body weight. It comes to around 42kg in males and 40kg females.

Water loss of more than 5% (that is, more than 2 liters) of the total body fluid, causes SEVERE dehydration. In extreme cases, the loss can be as high as 4-6 liters. Incidentally, loss of more that 15% of total body fluids can be fatal.

Hence, anything between 2-6 liters (or even more) of intravenous fluids would be required in a severely dehydrated patient.

Lastly, as far as the total amount of fluid that can be given intravenously, there is no limit. It depends on the requirement. If requirement of intravenous fluids is large, it is transfused with frequent monitoring of blood electrolytes/solutes, apart from other parameters, as highlighted earlier. Monitoring of early signs of fluid overload is also done.

I have tried my best to give you the medical definition of severe dehydration and, the amount of intravenous fluids required in different degrees of severe dehydration. May I also add that the requirement of intravenous fluids in severe dehydration, also varies from condition to condition, such as diabetic ketoacidosis where there may be extremely severe dehydration.

You are welcome to revert back to me if you have further queries. However, if you have no further queries, kindly close the discussion and rate my answer.

Regards and Have a nice day,

Dr. Karanwal

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