Hypotonic dehydration: Description, Causes and Risk Factors:This name is given to those clinical situations in which fluid and electrolyte losses exceed current spending. Hypotonic dehydration occurs when the lost fluid contains more sodium than the blood (loss of hypertonic fluid). Relatively more sodium than water is lost. Because the serum sodium is low, intravascular water shifts to the extravascular space, exaggerating intravascular volume depletion for a given amount of total body water loss.There are many causes of hypotonic dehydration, patients with surgical are a common cause of the loss of extracellular fluid, it only added the lack of water or salt added, so the relative lack of sodium in the body than water.Common causes:
Continuity loss of gastrointestinal fluid, such as diarrhea, vomiting, gastrointestinal fistula, intestinal obstruction and so on, digestive juice with substantial loss of sodium.
Large wound exudate, such as burns, extensive post-operative fluid loss.
Excessive output water and sodium from kidney. Long-term use of diuretics, inhibition of renal tubular sodium reabsorption.
Extracellular sodium concentration decreased after the status was hypotonic, first of all reduce the body's secretion of antidiuretic hormone in order to discharge water, to increase the secretion of aldosterone in order to maintain sodium. At the same time, interstitial fluid into the blood circulation, in part, compensation for blood volume to maintain blood circulation. If lost or continue to lose too much salt, salt, water continues to discharge from the urine, the decline in extracellular osmotic pressure, water from the extracellular to the cells, the blood volume and interstitial fluid were significantly reduced, there would be a low volume of shock. At this time renal blood flow and filtration rate, urine or reduce urine.Acute hypotonic dehydration may be seen in older infants and children with the severe diarrhea associated with bacterial G.I. infection (i.e., shigella, salmonella) in which the stool volumes may be large and contain a fairly high concentration of salt.This type of dehydration may occur when patients have received as their only intake very low salt containing fluids such as water, rice water, or tea over a period of time and is also seen in malnourished and chronically ill patients. Hypotonic dehydration is also seen in adrenal insufficiency.Not only is fluid lost to the outside of the body but there is also a shift of fluid from the ECF (extracellular fluid) to the ICF (intracellular fluid). Due to the predominant loss of extracellular fluid in hypotonic dehydration, vascular collapse is seen more often and earlier than in the other types of dehydration.Symptoms:Hypotonic dehydration symptoms is different according to degree on lack of sodium, common symptoms are dizziness, blurred vision, weak and thin pulse rate, severe cases, unconsciousness, muscle cramps and pain, decreased tendon reflexes, coma and so on. Lack of sodium in accordance with the degree of clinical hypotonic water will be divided into three degrees:Slight lack of sodium: The patient has a sense of fatigue, dizziness, hand, foot numbness, no thirst. At serum sodium 135mmol/L below to reduce the urine sodium.
Medium lacking sodium: In addition to the above symptoms, the often nausea, vomiting, rapid pulse of small, unstable blood pressure, blurred vision, less urine. At serum sodium 130mmol/L following.
Severe lack of sodium: Patient unconsciousness, weakening or disappearance of tendon reflex, there stupor, and even coma. Shock often happen. At serum sodium 120mmol/L following.
Diagnosis:Diagnosis of hypotonic dehydration is according to a history of loss of body fluids and symptoms.Determination of urinary Na+, are often significantly reduced.
Determination of serum Na+ at 135mmoL/L or less, indicating that there is hyponatremia, and to determine the extent of lack of sodium.
Lower plasma osmolality.
Red blood cell count, hemoglobin volume, hematocrit, blood non-protein nitrogen and urea were increased, and the specific gravity under 1.010.
Treatment:Most cases of dehydration in children and adults are isotonic. However, there are patients who have hypotonic dehydration, but it must be emphasized that it is of extreme importance that one determines the etiology of the hypotonic dehydration during the course of the patient's hospitalization.If the patient has hypotonic dehydration, one can use the formula outlined below to calculate the amount of sodium that would be necessary to increase the serum sodium to the desired level. This sodium deficit is in addition to the other deficits outlined above.Na deficit = (Na desired - Na current) x (0.6) x (Body weight in Kg).The rate at which the serum sodium should be corrected had been under some debate. However, it is now generally agreed that the serum sodium should be corrected slowly to prevent central pontine myelinolysis. Thus, the serum sodium should not increase by more than 15 mEq/L in a 24-hour period. If a patient has hypotonic dehydration, the serum sodium needs to be measured frequently.NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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