POAC CLINICAL GUIDELINE

Acute Adult Dehydration

AIMS

Improvementinclinicalsigns
EXCLUDE: Achieveadequateurineoutput CAUTION:
Children(refer (Recordfluidbalance) OlderAdults
Paediatricpathway) Reductioninfluidlosses Preexistingheart
Diabetes Abletomanageoralrehydrationsolutionsafelyathome failure
RenalFailure Prolongeddurationof
Septicaemia symptoms
Signsofshock PersistentVomitingand/orDiarrhoea SignificantCo
HeartFailure Hyperemesisintractablevomitingin morbidity
Undiagnosed pregnancy<20weeks Featuresofevolving
abdominalpain illness
Intracranialcauses Recentoverseastravel

Assessdehydrationstatus

MILD(<5%) MODERATE(69%) SEVERE(>10%)

Mayhavenosymptoms Significantthirst Significantthirst
Mildthirst Oliguria Tachycardia
ConcentratedUrine Sunkeneyes Lowpulsevolume
Drymucousmembranes Coolextremities
Weakness Reducedskinturgor
Lightheaded Markedhypotension
Ketones0+ Posturalhypotension Confusion
(>20mmHg)

Ketones+++
TrialofOralFluids
+/antiemetic INVESTIGATIONS
34litresfluidover24Hrs Consider:
Glucose
Observationnotrequiredin MSU Admission
clinic. Weight
Electrolytes Recommended
POACFUNDINGDOESNOT FaecalSpecimen
APPLY P T t

TrialofOralFluids+antiemetic
Observeinclinicforupto60minutes
underPOAC
Aim34litresoralfluidover24hours

Ifinsufficientresponsetooralintake:
IntravenousFluidsANDAntiemetic
NormalSaline
1000mlstat(1820gangiocath)
Reviewhydrationstatus
LIMIT=2000mlperconsultation
Migraine WATCHFOR
GiveIVstemetil12.5mg Signsoffluidoverload
Inadequateresponse
IVfluidsnotindicated Reviewdailyandrepeatcycleprn Persistingfluidlosses
unlesspatientis Iffluidsrequired>2LIVperday/cycleAdmit Ketosis
dehydratedandisnot Monitorintake/losses Deteriorationof
abletotakeoralfluids Encourageoralfluids symptoms
Providepatientwithcontact/emergencynumbersand Signsofevolving
instructions illness

POACClinicalGuideline:AcuteAdultDehydration
July2015
POAC CLINICAL GUIDELINE
Acute Adult Dehydration

Aim
Toenablethepatienttocontinuetomanageadequateoralfluidrehydrationsafelyathome.

Dehydration
Thisguidelineisspecifictobodyfluidlossessecondarytohyperemesis,vomitingand/ordiarrhoea.Itaimsto
serve as a general guideline and support aid in the assessment and management of mild to moderate
dehydration.Severedehydrationistheresultoflargefluidlossesandmaybecomplicatedbyelectrolyteand
acidbasedisturbanceswhichrequiretreatmentandobservationoveraprolongedperiod.Severedehydration
isnotsuitableforcareunderPrimaryOptionsandadmissiontohospitalisrecommended.

Exclusions
Vomiting and/or diarrhoea are symptoms which may result from a wide range of diagnoses. A working
diagnosis is important in the management of subsequent dehydration. Patients with the following are
excludedandadmissionshouldbeconsidered:

Children<15years(refertopaediatricpathway
Diabetes
Renalfailure
Septicaemia
Shockresultingfrombloodloss
Heartfailure
Casesofabdominalpainwherethereisnotacleardiagnosis
Intracranialcauses

Cautionisalsorecommendedforcasesinvolvingolderadults,preexistingheartfailure,wheresymptomshave
beenprolongedorinvolvedoverseastravel,wherethereisadditionalsignificantcomorbidityorwherethe
socialsettingmayimpairmanagementathome.

Dehydration status
Assessment should include consideration of duration of symptoms combined with prospective total daily
losses.
Average70kgpersonnormaldailylossesrange25003000ml.
Averagevomitequalorgreaterthan200ml
Averagediarrhoeaequalorgreaterthan300ml

ForPOACfundingclinicalnotesmustgivedetailsupportingthediagnosisanddegreeofdehydration.

POACClinicalGuideline:AcuteAdultDehydration
July2015
POAC CLINICAL GUIDELINE
Acute Adult Dehydration

Investigations
Investigationsmaynotbenecessary.Clinicaljudgementisrecommendedfollowingtheassessmentofeachcase.
Ifrequired,simpletestswhichareeasytoperforminclude;
FaecalCulture
MSUinfection/ketones
Glucosefingerprick
Electrolytes Electrolyte disturbances and renal impairment may result from excessive fluid losses
andmaybeespeciallyimportantinolderpatients.
Pregnancytest

Fluid replacement
Forbothmildandmoderatedehydrationconsideratrialoforalrehydrationcombinedwithanantiemetic.
(Metoclopramide in pregnancy, and metoclopramide or prochlorperazine or ondansetron in Nonpregnant
cases) Specific oral fluid solution is at the Physicians discretion. Normal saline is the intravenous fluid of
choice,howeverPlasmalyteisanacceptablealternative.

Itisrecommendedthattheintravenousresuscitationfluidvolumeisrestrictedtoanupperlimitof2000ml
per consultation. Fluid volumes beyond this level are likely to require more investigation and clinical
monitoring.Shouldtheclinicianfeelfurtherfluidvolumesbeyondthislevelareneededthendiscussionwith
theappropriatespecialistorhospitaladmissionisrecommended.

In all cases of intravenous fluid replacement, details of fluid balance should be recorded. Observation and
reassessmentofhydrationstatusatregularintervalswillallowcalculationoffluidvolumerequirementsand
reducerisksoffluidoverload.

DISCLAIMER:
This management guideline has been prepared to provide general guidance with respect to a specific clinical
condition.Itshouldbeusedonlyasanaidforclinicaldecisionmakingandinconjunctionwithotherinformation
available.Thematerialhasbeenassembledbyagroupofprimarycarepractitionersandspecialistsinthefield.
Whereevidencebasedinformationisavailable,ithasbeenutilisedbythegroup.Intheabsenceofevidencebased
information,theguidelineconsistsofaconsensusviewofcurrent,generallyacceptedclinicalpractice.

Thisguidelineshouldnotreplaceprofessionalclinicaljudgmentinmanagingeachindividualpatient.

ENDORSEMENT:
ThisguidelinehasbeenendorsedbythePOACClinicalReferenceGroup,July2015

POACClinicalGuideline:AcuteAdultDehydration
July2015