Signs and Symptoms of Dehydration
Dehydration caused by diarrhea is the biggest single killer of children in the modern world and diarrhea itself is one of the major causes of nutritional loss and poor growth.
The Treatment of Diarrhoea: A manual for physicians and other senior health workers. World Health Organization (WHO). 50 pages pdf
Dehydration from chpt 13 of Where There Is No Doctor
Dehydration results when the body loses more liquid than it takes in. This can happen with severe diarrhea, especially when there is vomiting too. It can also happen in very serious illness, when a person is too sick to take much food or liquid.
People of any age can become dehydrated, but dehydration develops more quickly and is most dangerous in small children.
It is important that everyone-especially mothers-know the signs of dehydration and how to prevent and treat it. Signs of dehydration:
- thirst is often a first, early sign of dehydration
- little or no urine; the urine is dark yellow
- sudden weight loss
- dry mouth
- sunken, tearless eyes
- loss of elasticity or stretchiness of the skin
When a person has watery diarrhea, or diarrhea and vomiting, do not wait for signs of dehydration.
To prevent or treat dehydration: When a person has watery diarrhea, act quickly: Give lots of liquids to drink: Rehydration Drink is best. Or give a thin cereal porridge or gruel, teas, soups, or even plain water. Keep giving food. As soon as the sick child (or adult) will accept food, give frequent feedings of foods he likes and accepts. To babies, keep giving breast milk often-and before other drinks.
Give the dehydrated person sips of this drink every 5 minutes, day and night, until he begins to urinate normally. A large person needs 3 or more liters a day. A small child usually needs at least 1 liter a day, or 1 glass for each watery stool. Keep giving the Drink often in small sips, even if the person vomits. Not all of the drink will be vomited.
When the person is vomiting or feels too sick to eat, he should drink: watery mush or broth of rice, maize powder, or potato, rice water (with some mashed rice), chicken, meat, egg, or bean broth, Kool-Aid or similar sweetened drinks, REHYDRATION DRINK, Breast milk.
As soon as the person is able to eat, in addition to giving the drinks listed at the left, he should eat a balanced selection of the following foods or similar ones: ripe or cooked bananas, crackers, rice, oatmeal, or other well-cooked grain, fresh maize (well cooked and mashed), potatoes, applesauce (cooked), Papaya.
For most cases of diarrhea no medicines are needed. But in certain cases, using the right medicine can be important. However, many of the medicines commonly used for diarrhea do little or no good.
10 Things you should know about Rehydrating a child.
1- Wash your hands with soap and water before preparing solution.
2- Prepare a solution, in a clean pot, by mixing - one teaspoon salt and 8 teaspoons sugar or - 1 packet of Oral Rehydration Salts (ORS) - with one litre of clean drinking or boiled water (after cooled) Stir the mixture till all the contents dissolve.
3- Wash your hands and the baby’s hands with soap and water before feeding solution.
4- Give the sick child as much of the solution as it needs, in small amounts frequently.
5- Give child alternately other fluids - such as breast milk and juices.
6- Continue to give solids if child is four months or older.
7- If the child still needs ORS after 24 hours, make a fresh solution.
8- ORS does not stop diarrhoea. It prevents the body from drying up. The diarrhoea will stop by itself.
9- If child vomits, wait ten minutes and give it ORS again. Usually vomiting will stop.
10- If diarrhoea increases and /or vomiting persists, take child over to a health clinic.
Footnote: People often refer to home-prepared oral dehydration solutions as “home-brew.” This should be discouraged because the word brew implies: either fermenting which in fact is an obstacle to some home-prepared solutions especially those made with rice-powder or it implies boiling (as in tea) which, especially with sugar and salt or using packets of ORS, should not be done because it decomposes the sugar, or caramelises.
Measure carefully, too much sugar or salt can make diarrhea worse, that can be life threatening Global manufacturers of pre-packaged Oral Rehydration Salts are listed here http://rehydrate.org/resources/suppliers.htm and http://www.supply.unicef.dk/Catalogue/bulletin9.htm
Print the document below! It is 9 pages, too long to cut and paste
New formulation of Oral Rehydration Salts (ORS) with reduced osmolarity February 2004 Frequently Asked Technical Questions Here is the list of questions it addresses.
- What should we advise mothers to give at home to a child with diarrhoea, but who has no signs of dehydration?
- Should I continue to breastfeed my child with diarrhoea?
- Should we advise mothers to continue to feed a child who has diarrhoea?
What foods to give, how much and how often?
- When should I take my child with diarrhoea to a health centre?
- What should I do in case of vomiting?
- What should I do in case of electrolyte disturbances in a child with diarrhoea?
- What should I do if intravenous therapy is not available for a severely dehydrated child?
- When should I suspect cholera in a child with diarrhoea?
- How can I assess for dehydration in a severely malnourished child?
- What should I do in case of fever in a child with diarrhoea?
- What should I do in case of convulsions in a child with diarrhoea?
- Should we give vitamin A to a child with diarrhoea?
- Should we give zinc supplementation to a child with diarrhoea?
- Can I give anti-diarrhoeal drugs to a child with diarrhoea?
These agents, though commonly used, have no practical benefit and are never indicated for the treatment of acute diarrhoea in children. Some of them are dangerous.
- What antimicrobials can be used with ORS in the clinical management of diarrhoea ?
- How can we protect our water?
- How important is handwashing?
What should we advise mothers to give at home to a child with diarrhoea, but who has no signs of dehydration? Give the child more fluids, or increased frequency of breastfeeding, than usual, to prevent dehydration What fluids to give Many countries have designated recommended home fluids. Wherever possible, these should include at least one fluid that normally contains salt (see below). Plain clean water should also be given. Other fluids should be recommended that are frequently given to children in the area, that mothers consider acceptable for children with diarrhea, and that mothers would be likely to give in increased amounts when advised to do so. Suitable fluids Most fluids that a child normally takes can be used. It is helpful to divide suitable fluids into two groups: Fluids that normally contain salt, such as:
- ORS solution
- Salted drinks (e.g. salted rice water or a salted yoghurt drink)
- Vegetable or chicken soup with salt
Teaching mothers to add salt (about 3g/l) to an unsalted drink or soup during diarrhoea is also possible, but requires a sustained educational effort. Fluids that do not contain salt, such as:
- plain water
- water in which a cereal has been cooked (e.g. unsalted rice water)
- unsalted soup
- yoghurt drinks without salt
- green coconut water
- weak tea (unsweetened)
- unsweetened fresh fruit juice.
Unsuitable fluidsA few fluids are potentially dangerous and should be avoided during diarrhoea. Especially risky are those drinks sweetened with sugar, which can cause osmotic diarrhoea and hypernatraemia. Some examples are:
- soft drinks
- sweetened fruit drinks
- sweetened tea.
Other fluids to avoid are those with stimulant, diuretic or purgative effects, for example:
- some medicinal teas or infusions.
How much fluid to give The general rule is: give as much fluid as the child wants until diarrhoea stops. As a guide, after each loose stool, give:
- children under 2 years of age: 50–100 ml (a quarter to half a large cup) of fluid; or one to two
- children aged 2 up to 10 years: 100–200 ml (a half to one large cup);
- older children and adults: as much fluid as they want.