Emergency Hydration: Hospital Techniques To Know

Dehydration is a condition in which the body loses more fluids than it takes in, causing it to be unable to function normally. It can occur due to various reasons such as vomiting, fever, diarrhea, insufficient water intake, or certain medications. In cases of severe dehydration, hospitalization may be required for treatment with intravenous (IV) fluids. IV rehydration therapy is a critical treatment option, especially for hospitalized patients, as it delivers fluids directly into the bloodstream, bypassing the waiting time associated with oral rehydration. In addition to IV therapy, nurses in hospitals play a vital role in keeping patients hydrated by monitoring fluid intake and output, offering flavored drinks or fresh fruits with high water content, and encouraging patients to drink at regular intervals.

Intravenous (IV) rehydration therapy

IV rehydration therapy is often used to treat moderate to severe dehydration, especially in children, who are more susceptible to dangerous dehydration when ill or exercising vigorously without adequate fluid intake. It is also used in adults, albeit less frequently, in cases of fever, diarrhoea, drug intoxication, hypercalcemia, cancer, and postural tachycardia syndrome.

IV rehydration therapy is critical in hospitalised patients, especially in cases of acute renal failure, hyponatremia, acute pancreatitis, and sepsis, where it forms the most important and life-saving part of the treatment. It is also used to maintain hydration in cancer patients or terminally ill patients who cannot consume adequate fluids orally.

The procedure for IV rehydration involves inserting an IV line into a vein in the arm. The IV line consists of a tube with a needle on one end, which is connected to a bag of fluids hung above the patient's head. The patient's doctor or nurse regulates the fluid flow, ensuring the patient receives the correct amount. They also monitor the IV line to ensure it is secure and not leaking. The treatment time and fluid amount depend on the severity of dehydration.

While IV rehydration therapy is generally safe, there are some associated risks, such as a mild sting during insertion, a small risk of infection, vein collapse, and dislodgement of the IV, which can lead to infiltration. However, these risks are typically outweighed by the benefits, especially in severe dehydration, which can be life-threatening if untreated.

Oral rehydration solutions

The ingredients in an ORS are formulated to match what the body needs to recover from diarrhoea. It contains clean water, electrolytes (also called salts), and carbohydrates, usually in the form of sugar. The water used should be boiled or disinfected, or from a sealed bottle. It is important to carefully follow the instructions for preparing the oral rehydration solution and dosage. The World Health Organization recommends that infants continue to receive breast milk or their usual formula in addition to ORS, while children and adults should continue to eat solid food in addition to ORS.

It is important to avoid alcohol, caffeine, and sugary drinks when using ORS, as these can worsen dehydration and diarrhoea. It is also recommended to seek medical attention if the diarrhoea is bloody, is accompanied by a high fever, jaundice, or persistent vomiting, or if dehydration or diarrhoea does not improve despite the use of ORS. Oral rehydration salts can be purchased from pharmacies in most countries, although it is advised to buy them before leaving Canada.

Monitoring fluid intake

Nurses play a vital role in monitoring fluid intake and output in hospital settings. They encourage patients to drink fluids regularly, especially water, and may add natural flavours or sweeteners to make it more palatable. Nurses also measure urine output to assess kidney function and prevent potential health risks due to dehydration. They document the patient's fluid intake and output, including the time and method of administration, in an intake-output chart or fluid-balance chart. This information is shared with other healthcare providers to ensure optimal patient outcomes.

To assess fluid status, healthcare professionals consider physical signs such as weight, blood pressure, capillary refill, jugular venous pressure, and urine output, as well as laboratory values. Weight fluctuations can indicate fluid balance, with weight gain suggesting fluid excess and weight loss indicating fluid deficits. Heart rate is also monitored, as tachycardia may indicate hypovolemia.

In addition to oral intake, fluid intake may also include parenteral nutrition, intravenous therapy, enteral nutrition, or total parenteral nutrition. Output is typically measured in milliliters and includes urine output and other forms of fluid output, such as stool or vomit in certain cases. Monitoring fluid intake and output helps determine the progress of a disease and the effects of treatment, ensuring proper fluid and nutrient intake and adequate urine output and defecation.

Electrolyte imbalance

An electrolyte imbalance occurs when the levels of certain minerals in the blood are either too high or too low. Electrolytes, such as potassium, sodium, magnesium, and calcium, carry an electric charge when dissolved in bodily fluids, including blood, urine, and tissues. These electrolytes play a crucial role in regulating fluids and maintaining essential bodily functions. For instance, calcium helps build and maintain strong bones and teeth, while magnesium is essential for proper muscle, nerve, and heart function.

Several factors can contribute to an electrolyte imbalance. Dehydration, caused by inadequate fluid intake, excessive sweating, vomiting, diarrhoea, or fever, can lead to an imbalance. Conversely, overhydration or water intoxication can also disrupt electrolyte levels. Certain health conditions, such as cardiovascular disease, heart failure, high blood pressure, kidney disease, liver disease, and eating disorders, can affect the body's ability to maintain proper electrolyte balance. Additionally, specific medications, including antibiotics, may influence electrolyte levels.

The symptoms of an electrolyte imbalance can vary depending on its severity and the type of electrolytes involved. Weakness, muscle spasms, increased thirst, dry mouth, dizziness, and headaches are some common symptoms. In more severe cases, individuals may experience low blood pressure, rapid heartbeat, confusion, or lethargy.

Treating an electrolyte imbalance depends on its underlying cause and severity. For mild dehydration or imbalances, oral rehydration solutions or electrolyte-rich drinks can help restore balance. These drinks typically contain water and salts in specific proportions to replenish fluids and electrolytes. However, for more severe imbalances or those caused by underlying health conditions, medical intervention may be necessary. In such cases, individuals may require intravenous (IV) rehydration therapy, where fluids are administered directly into the bloodstream to correct the imbalance and restore hydration.

It is important to note that infants, young children, and older adults are more susceptible to electrolyte imbalances and should seek medical advice if any symptoms of dehydration or electrolyte imbalance are present.

Natural remedies

While dehydration is usually easy to treat at home, severe cases may require hospitalisation. Natural ways to rehydrate in a hospital setting include:

Fresh fruit and vegetables

Fresh fruits and vegetables with high water content, such as grapes, watermelon, oranges, lettuce, cucumbers, and celery, can be offered to patients to encourage hydration.

Water with natural flavouring

Water is the best way to stay hydrated, but it can get boring to drink. Nurses can add natural flavouring to water, such as fresh lemons, limes, oranges, pineapples, or cherries, to encourage patients to drink more.

Natural sweeteners

Small amounts of natural plant sweeteners can be added to water to make it more palatable for patients.

Fresh foods

Hospital meal plans often offer fresh, unprocessed foods, which have a higher moisture content than processed foods.

Encouraging regular drinking

Nurses support patients by encouraging them to drink small amounts regularly. This helps patients get into a routine and slowly increase their fluid intake.

Monitoring fluid intake

Nurses monitor the amount of fluid a patient is taking in, as well as their urine output, to assess kidney function and prevent dehydration.

Frequently asked questions