Pediatric Nursing Management for Dehydration

Definition of Dehydration :

1. Dehydration is a condition where a person who did not undergo fasting experiencing or at risk of dehydration vascular, interstitial or intra-vascular (Lynda Jual Carpenito, 2000 : 139).
2. Dehydration is a lack of body fluids due to the amount of fluid that comes out more than the amount of fluid intake (Sri Ayu Ambarwati, 2003).
3. Dehydration is a disturbance in fluid balance, along with the output exceeds intake, so the amount of water in the body is reduced (Drs. Syaifuddin, 1992: 3).

Based on the above notions, it can be concluded that dehydration is the lack of extra cellular fluid which resulted in the migration of fluids or lost from the body.


3 Types Classification of Dehydration :

a. Isotonic dehydration
Isotonic dehydration is an equal loss of water and sodium. Isotonic means that the number of particles contained on one side of a permeable membrane is the same as on the other side, thus there is no fluid shift in either direction. The amount of intracellular and extracellular water remains in balance. This can be caused by a complete fast, vomiting, and diarrhea.

b. Hypotonic dehydration
Hypotonic dehydration is the loss of water and sodium at the same time but lack of water than sodium, serum sodium lower than the normal range of extracellular fluid was hypotonic body status to reduce the secretion of antidiuretic hormone, so that the water in the renal tubular reabsorption decrease in urine output to increase from an increase in extracellular osmotic pressure.

c. Hypertonic dehydration
Hypertonic dehydration is the loss of water and sodium at the same time, but the lack of sodium than water, it is higher than the normal range of serum sodium, extracellular fluid status was hypertonic. When lack of water than sodium, the increase in extracellular osmotic pressure, increased secretion of antidiuretic hormone, renal tubular reabsorption of water increased, reduced urine output.


Etiology of Dehydration

Various types cause dehydration (According to Donna D. Ignatavicus, 1991: 253).

1. Dehydration

• bleeding
• vomitus
• diarrhea
• hypersalivation
• fistula
• Ileustomy (cuts colon)
• diaporesis (excessive sweating)
• burn
• fasting
• therapy hypotonic
• suction gastrointestinal (stomach wash)

2. Hypotonic dehydration

• DM disease
• excess fluid rehydration
• severe malnutrition and chronic

3. Hypertonic dehydration

• hyperventilation
• water diarrhea
• diabetes insipidus (ADH hormones decreased)
• excessive fluid rehydration
• dysphagia
• Impaired sense of thirst
• disorders of consciousness
• systemic infection: increased body temperature.

Clinical Manifestations of Dehydration

The following symptoms or signs of dehydration by level (Nelson, 2000):

1. Mild dehydration (loss of fluids 2-5%, of its original weight)

• thirsty, restless
• pulse: 90 -110 x / min, normal breath
• normal skin turgor
• urine output (1300 ml / day)
• good awareness
• heart rate increased

2. Moderate dehydration (fluid loss of 5%, of its original weight)

• increased thirst
• rapid and weak pulse
• dry skin turgor, dry mucous membranes
• reduced urine output
• increased body temperature

3. Severe dehydration (loss of fluids 8%, of its original weight)

• loss of consciousness
• weak, lethargic
• tachycardia
• sunken eyes
• no urine output
• hypotension
• pulse rapid and smooth
• cold extremities

Management of Dehydration

Management in patients with dehydration (Doenges & Sylvia Anderson):

1. Antiemetic drugs (To overcome vomiting)

2. Antidiarrheal drugs
Spending excessive feces may be given anti-diarrhea medications.

3. Provision of drinking water
Provision of drinking water containing sodium sufficient to address the imbalance that occurs.

4. Intravenous fluid administration
In the severe dehydration, intravenous fluid administration is needed. Isotonic saline solution (0.9%) were intravenous fluids chosen for cases with near-normal sodium levels, as it will increase the plasma volume. Soon after reaching normotensive patients, half of normal saline solution (0.45%) is given to provide water to the cells and helps the disposal of metabolic waste products.

5. IV fluid bolus administration
Initial IV bolus administration of fluid in a fluid load test, to determine whether to increase the flow of urine, which showed normal renal function.