Dehydration intravenous rehydration

Nephrogenic diabetes insipidus secondary to lithium led to severe dehydration in two patients who required intravenous rehydration followed by a thiazide diuretic to reduce urine volume (382). One patient had persistent polyuria (6.7 1/day) 57 months after stopping lithium (296). 

Milder forms of volume depletion may be managed in outpatient settings. For example, supplemental fluids can be added to the usual estimated daily requirements of 30 to 35 mL/kg in patients older than 12 years of age with dehydration. Commercially available carbohy-drate/electrolyte drinks generally are more palatable than water and may promote earlier recovery. When the dehydration involves substantial losses of salt as well aswater, additional sodium may need to be added to these drinks because they usually contain 50 mEq/L or less of sodium. This is less than the amounts of sodium (e.g., 90 to 120 mEq/L) generally recommended for rehydration." The additional sodium will increase osmolarity, but this does not appear to delay gastric emptying." Also, guidelines for oral rehydration of children with acute diarrhea are available, which, if used appropriately, may prevent future hospitalization." Intravenous rehydration of... 

ReidSR, BonadioWA. Outpatient rapid intravenous rehydration to correct dehydration and resolve vomiting in children with acute gastroenteritis. Ann Emerg Med 1996 28 318-323. 

Because of concerns about hypernatremia, physicians continue to hospitalize and intravenously correct fluid and electrolyte deficits in severe dehydration. Oral solutions are strongly recommended. In developing countries, the World Health Organization Oral Rehydration Solution (WHO-ORS) saves the lives of millions of children annually. 

If the osmolality of the intravenous fluid is inappropriate, this may cause hemolysis, with subsequent changes to plasma electrolytes. Dehydration may occur when food and water intakes are severely reduced, and plasma sodium, total protein, albumin, and osmolality values tend to increase. In dehydration states, such as those associated with gastrointestinal toxicity, and diarrhea causing additional fluid loss, it is not uncommon for oliguria to occur until rehydration has taken place. Plasma... 

Salmonella infections usually resolve in 5-7 days and often do not require treatment unless die patient becomes severely dehydrated or the infection spreads from the intestines. Persons with severe diarrhea may require rehydration, often with intravenous fluids. Antibiotics aie not usually necessary unless the infection spreads from the intestines, then it can be treated with ampicillin, gentamicin, irimethoprim/sulfamethoxazole, or ciprofloxacin. Unfortunately, some Salinoneila bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of feed animals. 

---