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DEHYDRATION - A MEDICAL CRISIS!
by Carol Edson RN
Water is crucial to life. It is the medium of all our body fluids and chemical processes, the 'coolant' that controls our body temperature, and a natural lubricant. Our 'inner see' of chemicals and fluids must be maintained for our bodies to continue to function well.
Dehydration is a condition with numerous causes and serious implications. It refers to the net loss of water from the body. Children are more susceptible to dehydration than adults. This is because children's bodies are normally composed of a higher percentage of water - around 75% of their TOTAL weight!
Under usual conditions of health, intake and loss of water are in balance. Water intake comes from food and liquids eaten. Water is also produced by metabollic processes as well. Water is lost through stool, urine, sweat, saliva and breathing.
As you can imagine, if there is a shift in one side of this equation, there will need to be a change on the other side to maintain the balance. If water losses increase, intake must also increase. If intake falls, the body will try to conserve water through the kidneys by concentrating the urine. For children with clefts, any of these mechanisms can be at work to contribute to dehydration. It is important to recognize the symptoms of dehydration and seek treatment PROMPTLY. Serious dehydration is life-threatening (Ed's note: WS chose to cover this subject due to the increased risk of dehydration among children and babies who may be difficult to feed, who experience chronic reflux, and/or who have had recent surgical procedures that make feeding difficult. We feel that it is essential that every parent know the signs and symptoms of dehydration. JG)
Symptoms of Dehydration are: thick secretions; dry mouth; loss of skin elasticity; sunken eyes' depressed fontanel in infants; loss of weight; and dark, concentrated urine or no urine. Fever, rapid pulse and thirst are also common. Children may be irritable, or lethargic, seeming to sleep all the time.
The causes of dehydration include increased water loss and decreased water intake.
Increased losses may be caused by vomiting and diarrhea. For children undergoing surgical procedures, post operative vomiting can contribute to dehydration. IV fluids are used to sustain the body's healthy water balance when oral intake is limited. Generally the IV is left in until the child appears well hydrated, urinates on her or his own, and can take adequate oral fluids and keep them down. Be aware that a standard 500cc bag of IV fluid contains only 80 calories and is not a longterm substitute for food. It doesn't prevent hunger!
Decreased intake may be occur under the following circumstances: Postoperatively, or with illnesses such as sore throats, a child's intake may fall below what the body needs. Giving small amounts of liquid by mouth frequently is usually recommended. The baseline fluid intake is 125cc (about 1/2 cup) per kilo (2.2 lbs) of body weight per day. (A 22 lb child should drink about 5 cups of liquid per day.) More is needed to actively treat dehydration. Depending on the situation, the doctor may ask you to use juice, broth, or an electrolyte replacement fluid such as Pedialyte. The normal chemical balance of the body is thrown off during dehydration and restoring that balance must be addressed at the same time. Pedialyte contains the minerals and salts lost during vomiting and diarrhea, as well as water. If the child loses weight, or continues to appear dehydrated, she or he may need to be given IV fluids.
Fever can be a symptom of dehydration, as mentioned, or it can CAUSE it. The metabolic requirements of the body are greatly increased during a high fever. The risk of net water loss from sweating increases. It is frustrating but true that a child may have several mechanisms contributing to dehydration, and that reversing it may be multi-faceted.
It is also important to note that over-hydration is possible and must be watched for. This usually arises in the hospital setting; too much IV fluid is given compared to the the child's ability to excrete water. (An example would be a child with kidney problems.) I mention this to be sure that you understand that "more is not always better"; great care is used in correcting the fluid balance of infants and children. Please consult your health care provider if you suspect that your child is developing dehydration or any fluid balance problem. The underlying causes of the dehydration will need to be treated as well.
(A final note from the editor: Dehydration can be a medical crisis. It can happen quickly - almost without notice, and the results of severe dehydration can be devastating. If you suspect that your child is becoming dehydrated at any time, do NOT wait to see how it will progress. Call your pediatrician or medical professional immediately and report that you suspect dehydration. The times in our children's lives that dehydration is MOST likely to be a problem are very early, as you struggle to learn how to feed your cleft-affected newborn, and post-surgically, when oral structures are sore and anesthesia can cause vomiting. While those are the most risky times, dehydration can occur at any time. When it does occur, it is a condition that can never be ignored.)
A parent from the email list, Cleft-Talk also wrote this:
I recently found a great new type of electrolyte replacement that you can use instead of the nasty tasting Pedialyte, it is sold just beside the bottles of Pedialyte, but you freeze it instead, and it tastes SO much better. It is comparable to Pedialyte, but tastes time and again better, it also tastes better than Pedialyte thawed, but tastes best when frozen or slushy. I don't think that the Dr will let you give the baby something hard, but as a slushy it is good in a cup. Don't forget to take the wrapper off though, even for older kids, when using it for fever, vomiting an diarrhea, the edges are very sharp! I am not talking about the regular freezer pops either, these are sold beside the Pedialyte as an electrolyte replacement therapy, you can ask your pharmacist, there are several different brands out there. We had to go find them for my son when he had the stomach flu, the Pedialyte was too nasty tasting for him, and he refused to take it, then we found these and they worked great. But don't use any electrolyte replacement therapy except under a doctor's supervision, they can be a problem if not used properly, particularly in very young babies. Ask your doctor about your concerns. The pulse of a child is very fast too, so just because your child has a very rapid pulse, does not mean that the baby is dehydrated. But when watching for dehydration remember that not all of the signs/symptoms listed will appear, children all compensate differently, so don't wait to check off the whole list before calling your Dr. if you suspect dehydration.
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