Causes, management and complications of severe adult dehydration in the emergency room

Abdulrahman Mohammad Ghafouri, Shurouq Hamzah Arkoubi, Talal Maqboul Al-Amri, Afaf Matar Alshamari, Mohammed Ali Alqahtani, Zainalaabdeen Sayyar Alyami, Eiman Mohammad Alnemer, Ahmed Musallam Almujayrishi, Najdi Ibrahem Najdi, Nawwaf Jamaan Althobaiti, Hanan Yahia Lamfon, Rayyan Abdullah Alyahya, Sally Ahmed Agbawi


This literature review aims to highlight the possible causes, complications, and management of this event from previously published studies discussing dehydration in critically-ill patients admitted to the emergency room (ER). In general, the administration of fluids has been used in the ER for critically-ill patients for many purposes. These include the optimization and adjustment of body fluids and electrolytes, increase renal protection against contrast, enhance uric acid, globins, caloric intake, and as an adjuvant to ameliorate the potentiality of certain medications or to dilute them. Many etiologies have been accused to cause dehydration in critically-ill patients. These include the fasting strategy that patients are obliged to whenever undergoing a surgical operation. Kidney, heart, and liver injuries have also been associated with patients’ dehydration. Old age and the presence of other co-morbidities diabetes insipidus and uncontrolled diabetes can also aggravate the condition. Mental affection is the main complication that patients with severe dehydration might complain about. Other complications might include aggravation of heart failure, and skin diseases, and deterioration of the kidney functions and other cellular processes that require adequate nourishment for their daily normal functions. Mortality is also a serious common complication, especially within elderly patients. Although the management of dehydration can be easily achieved by fluid administration, fluid overload can aggravate the underlying complications and develop others. Therefore, the main challenge here would be to frequently monitor patients during fluid administration and resuscitation to prevent this side effect.


Dehydration, Emergency; Complication, Management

Full Text:



McIntyre JW. Evolution of 20th century attitudes to prophylaxis of pulmonary aspiration during anaesthesia. Can J Anaesth. 1998;45(10):1024-30.

Shime N, Ono A, Chihara E, Tanaka Y. Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals. J Anesth. 2005;19(3):187-92.

Søreide E, Eriksson LI, Hirlekar G, Eriksson H, Henneberg SW, Sandin R. Pre-operative fasting guidelines: an update. Acta Anaesthesiol Scand. 2005;49(8):1041-7.

Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, De Boisblanc B et al. Comparison of two fluid-management strategies in acute lung injury. N Eng j med. 2006;354(24):2564-75.

Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen H et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238(5):641-8.

Malbrain M, Marik P, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: A systematic review with suggestions for clinical practice. Anaesthesiol intensive therapy. 2014;46:361-80.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Muzzin A et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Eng j med. 2001;345(19):1368-77.

Gunal AI, Celiker H, Dogukan A, Ozalp G, Kirciman E, Simsekli E et al. Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes. J Am Soc Nephrol. 2004;15(7):1862-7.

Davidson MB, Thakkar S, Hix JK, Bhandarkar ND, Wong A, Schreiber MJ. Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am j med. 2004;116(8):546-54.

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M et al. Intensive insulin therapy in critically ill patients. N Eng J med. 2001;345(19):1359-67.

Nemec K, Kopelent-Frank H, Greif R. Standardization of infusion solutions to reduce the risk of incompatibility. Am j health-system pharmacy. 2008;65(17):1648-54.

Besen BAMP, Gobatto ALN, Melro LMG, Maciel AT, Park M. Fluid and electrolyte overload in critically ill patients: An overview. World J Crit Care Med. 2015;4(2):116-29.

Kositzke JA. A question of balance--dehydration in the elderly. J gerontological nursing. 1990;16(5):4-11.

Begum MN, Johnson CS. A review of the literature on dehydration in the institutionalized elderly. Eur e-J Clin Nutrit Metabol. 2010;5(1):e47-53.

Lavizzo-Mourey RJ. Dehydration in the elderly: a short review. J Natl Med Assoc. 1987;79(10):1033-8.

Sheehy CM, Perry PA, Cromwell SL. Dehydration: biological considerations, age-related changes, and risk factors in older adults. Biological research for nursing. 1999;1(1):30-7.

Phillips PA, Johnston CI, Gray L. Disturbed fluid and electrolyte homoeostasis following dehydration in elderly people. Age and ageing. 1993;22(1):S26-33.

Martin JH, Larsen PD. Dehydration in the elderly surgical patient. Aorn j. 1994;60(4):666-71.

Mukand JA, Cai C, Zielinski A, Danish M, Berman J. The effects of dehydration on rehabilitation outcomes of elderly orthopedic patients. Arch physical med rehabil. 2003;84(1):58-61.

Feinsod FM, Levenson SA, Rapp K, Rapp MP, Beechinor E, Liebmann L. Dehydration in frail, older residents in long-term care facilities. J Am Med Directors Asso. 2004;5(2):S35-41.

Mentes JC. A typology of oral hydration problems exhibited by frail nursing home residents. J gerontol nursing. 2006;32(1):13-19;quiz 20-11.

Mentes JC, Culp K. Reducing hydration-linked events in nursing home residents. Clinical nursing research. 2003;12(3):210-225; discussion 226-218.

Cacchione PZ, Culp K, Laing J, Tripp-Reimer T. Clinical profile of acute confusion in the long-term care setting. Clin nursing res. 2003;12(2):145-58.

Mentes J, Culp K, Maas M, Rantz M. Acute confusion indicators: risk factors and prevalence using MDS data. Res nursing health. 1999;22(2):95-105.

Culp K, Mentes J, Wakefield B. Hydration and acute confusion in long-term care residents. Western j nursing res. 2003;25(3):251-66.

Gaspar PM. What determines how much patients drink? Geriatric nursing (New York, NY). 1988;9(4):221-4.

Paulis S, Everink I, Halfens R, Lohrmann C, Schols JMGA. Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review. J Am Med Directors Asso. 2018;19.

Häussinger D, Lang F, Gerok W. Regulation of cell function by the cellular hydration state. Am j physiol. 1994;267(3 Pt 1):E343-55.

Kayser-Jones J, Schell ES, Porter C, Barbaccia JC, Shaw H. Factors contributing to dehydration in nursing homes: inadequate staffing and lack of professional supervision. J Am Geriatrics Soc. 1999;47(10):1187-94.

Leiter LA, Marliss EB. Survival during fasting may depend on fat as well as protein stores. Jama. 1982;248(18):2306-7.

Xiao H, Barber J, Campbell ES. Economic burden of dehydration among hospitalized elderly patients. Am j health-system pharmacy. 2004;61(23):2534-40.

Cole MG, McCusker J. Treatment of delirium in older medical inpatients: a challenge for geriatric specialists. J Am Geriatrics Soc. 2002;50(12):2101-3.

Thomas DR, Tariq SH, Makhdomm S, Haddad R, Moinuddin A. Physician misdiagnosis of dehydration in older adults. J Am Med Directors Asso. 2004;5(2):S30-4.

Kavouras SA. Assessing hydration status. Current opinion clin nutrition metabolic care. 2002;5(5):519-24.

George J, Rockwood K. Dehydration and delirium--not a simple relationship. J Gerontol A Biol Sci Med Sci. 2004;59(8):811-2.

Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? Jama. 2005;294(15):1944-56.

Butman SM, Ewy GA, Standen JR, Kern KB, Hahn E. Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension. J Am College Cardiol. 1993;22(4):968-74.

Marantz PR, Kaplan MC, Alderman MH. Clinical diagnosis of congestive heart failure in patients with acute dyspnea. Chest. 1990;97(4):776-81.

Collins SP, Lindsell CJ, Storrow AB, Abraham WT. Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure. Ann emergency med. 2006;47(1):13-8.

Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CHC, Lassen K. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin nutr. 2005;24(3):466-77.

Nygren J, Thorell A, Jacobsson H, Larsson S, Schnell PO, Hylén L et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration. Ann Surg. 1995;222(6):728-34.

Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am j physiol Endocrinol metabol. 2001;280(4):E576-83.

Taniguchi H, Sasaki T, Fujita H, Takamori M, Kawasaki R, Momiyama Y et al. Preoperative fluid and electrolyte management with oral rehydration therapy. J Anesth. 2009;23(2):222-9.

Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 2009;76(4):422-7.

Schrier RW, Wang W. Acute renal failure and sepsis. N Eng j med. 2004;351(2):159-69.

Murphy CV, Schramm GE, Doherty JA, Reichley RM, Gajic O, Afessa B et al. The importance of fluid management in acute lung injury secondary to septic shock. Chest. 2009;136(1):102-9.

Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):259-65.

Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172-8.