Cracked Lips: Sign of Dehydration

Cracked Lips

Dehydration describes a state of negative fluid balance that may be caused by numerous disease entities.

Diarrheal illnesses are the most common etiologies.

Worldwide, dehydration secondary to diarrheal illness is the leading cause of infant and child mortality.

Dehydration

Sign and Symptom of Dehydration

Isotonic/Isonatremic dehydration: water & electrolytes lost in equal proportions

Hypertonic/Hypernatremic dehydration: water loss exceeds electrolyte loss

Hypotonic/Hyponatremic dehydration: electrolyte loss exceeds water loss

Types of Dehydration

Isotonic: inadequate fluid intake, fluids shifts between compartments, excessive loss of body fluids

Hypertonic: excessive perspiration, hyperventilation, fever, diarrhea, Drinking sea water in attempt to treat dehydration

Hypotonic: chronic illness such as renal failure, Cystic fibrosis with excessive salt loss in sweat , Gastrointestinal obstruction, fistula, ileus 

Dehydration Etiology

Level of Dehydration

Symptom/Sign Mild Dehydration Moderate Dehydration Severe Dehydration

level of consciousness

Alert Lethargic Obtunded

Capillary refill* 2 s 2-4 s >4 s, cool limbs

Mucous membranes Normal Dry Parched, cracked

Tears Normal Decreased Absent

Heart rate Slightly increased Increased Very increased

Respiratory rate/pattern*

Normal Increased Increased and hyperpnea

Blood pressure Normal Normal, but orthostasis

Decreased

Pulse Normal Thready Faint or impalpable

Skin turgor* Normal Slow Tenting

Fontanel Normal Depressed Sunken

Eyes Normal Sunken Very sunken

Urine output Decreased Oliguria Oliguria/anuria

* Best indicators of hydration status[6]

Pathogenesis of Dehydration

Loss of GI fluids (vomiting, diarrhea, NG suctioning, fistulas, intestinal drainage, chronic abuse of laxatives and/or enemas)

Renal loss from diuretics Water loss from sweating or heatBlood loss (hemorrhage)Fluid lost to Third Space (burns, trauma)

Pathophysiology of Dehydration

Dehydration can lead to heart shock, fainting even death

Higher blood viscosityHigher blood pressureBlood clotting

Takes water from the rest of body when thirsty

Toxins accumulateCannot be flushed out of bodyCan be damaged

ConstipationAcid RefluxIndigestion

Toxin Accumulate

Diet therapy Oral replacement therapy Oral Rehydration therapy

Drug therapy(varies with type of dehydration)

IV=isotonic(safest) 0.9% NaCl,Ringer’s Lactate (sln isotonic

with blood) Medicine to treat underlying problem

Treatment for Dehydration

Drink at least 8-12 cups of liquid each day Choose beverages that are caffeine free.Drink before you feel thirsty. By the time you feel thirsty, you are already dehydrated.

Prevention

http://www.nhs.uk/Conditions/Dehydration/Pages/Treatment.aspx

http://www.aboutkidshealth.ca/en/healthaz/conditionsanddiseases/symptoms/pages/dehydration.aspx

http://www.aurorahealthcare.org/fywb_pdfs/x14172.pdf

http://www.webmd.com/a-to-z-guides/dehydration-adults

http://emedicine.medscape.com/article/906999-overview

Reference

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