NOTES ON SOME REMEDIES XXXI.?DEHYDRATION AND ITS TREATMENT
By R. N. CHAUDHURI, m.b., m.r.c.p., t.d.d. Professor of Tropical Medicine, School of Tropical
Medicine, Part III.
Calcutta
Treatment of dehydration
From what has been said before, it will be obvious that the administration of the wrong kind of fluid will make a dehydrated patient worse. Water, for instance, to a patient deficient mainly in ?salt, will further lower the salt content of the extra-cellular fluid, in consequence of which the kidneys will excrete as much of the water as possible to bring the osmotic pressure back to normal. This diuresis will also remove Thus the ingestion of some of the electrolytes. water alone will aggravate the state of dehydration. Isotonic saline, on the other hand, will make a patient worse if he is deficient mainly in water, for it will tend to increase the extra-cellular hypertonicity, thereby causing further withdrawal of water from the cells and intensifying the thirst. This also adds to the work of kidneys which try to excrete the unnecessary amount of sodium chloride, but this they can do only by using additional fluid, if available. To quote McCance and Young ' (1944), Let us suppose that a patient is unable to take anything by mouth and that, in consequence, he is given during 24 hours, 1,500 mlof normal saline intravenously?that is, 1,500 ml-
Sept., 1949]
TREATMENT OF DEHYDRATION: CHAUDHURI
water and (approximately) 15 gm. of salt, to make We will require 1,000 ml. of this water good the unavoidable losses from his lungs and skin, and so his kidneys will have the impossible task of excreting; 15 gm. of salt in 500 ml. of b water \ Treatment is directed to the restoration of body fluids and to the maintenance of normal fluid balance. A point that must be emphasized is that dehydration is an emergency
Amount
397
of fluid
_
^
5ere
demanding urgent attention, being a rapidly "Progressive state which may lead to irreversible
even though the been relieved. In general terms, water and 5 per cent glucose are appropriate for water deficiency, water being given by mouth or rectum and glucose be Patients not acutely ill may able to take the whole required amount by m?uth. Normal saline and % normal saline indicated in salt or mixed water and salt eficiency according to the urgency of symptoms and hypertonic saline is reserved for cholera cases. Jf there is any doubt as to the nature the normal saline or lesser
changes resulting in death, dehydration has apparently
Payenterallv.
By R. N. CHAUDHURI, m.b., m.r.c.p., t.d.d. Professor of Tropical Medicine, School of Tropical
Medicine, Part III.
Calcutta
Treatment of dehydration
From what has been said before, it will be obvious that the administration of the wrong kind of fluid will make a dehydrated patient worse. Water, for instance, to a patient deficient mainly in ?salt, will further lower the salt content of the extra-cellular fluid, in consequence of which the kidneys will excrete as much of the water as possible to bring the osmotic pressure back to normal. This diuresis will also remove Thus the ingestion of some of the electrolytes. water alone will aggravate the state of dehydration. Isotonic saline, on the other hand, will make a patient worse if he is deficient mainly in water, for it will tend to increase the extra-cellular hypertonicity, thereby causing further withdrawal of water from the cells and intensifying the thirst. This also adds to the work of kidneys which try to excrete the unnecessary amount of sodium chloride, but this they can do only by using additional fluid, if available. To quote McCance and Young ' (1944), Let us suppose that a patient is unable to take anything by mouth and that, in consequence, he is given during 24 hours, 1,500 mlof normal saline intravenously?that is, 1,500 ml-
Sept., 1949]
TREATMENT OF DEHYDRATION: CHAUDHURI
water and (approximately) 15 gm. of salt, to make We will require 1,000 ml. of this water good the unavoidable losses from his lungs and skin, and so his kidneys will have the impossible task of excreting; 15 gm. of salt in 500 ml. of b water \ Treatment is directed to the restoration of body fluids and to the maintenance of normal fluid balance. A point that must be emphasized is that dehydration is an emergency
Amount
397
of fluid
_
^
5ere
demanding urgent attention, being a rapidly "Progressive state which may lead to irreversible
even though the been relieved. In general terms, water and 5 per cent glucose are appropriate for water deficiency, water being given by mouth or rectum and glucose be Patients not acutely ill may able to take the whole required amount by m?uth. Normal saline and % normal saline indicated in salt or mixed water and salt eficiency according to the urgency of symptoms and hypertonic saline is reserved for cholera cases. Jf there is any doubt as to the nature the normal saline or lesser
changes resulting in death, dehydration has apparently
Payenterallv.
