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What to do if there are signs of dehydration?

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What to do if there are signs of dehydration?

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When to suspect

  • Recent increase in diuretics.
  • Progressive weight loss under diuretic therapy.
  • Additional pathology causing anorexia for more than 1 day, inability to eat or drink, vomiting, diarrhea, fever, etc.

Symptoms

  • Recent weight loss of more than 2 kilograms
  • Muscle cramps
  • Standing skin folds
  • Dry tongue and thirst
  • Hypotension
  • Orthostatism with > 20 mmHg drop in blood pressure in standing position
  • Decreased diuresis, concentrated urine
  • General weakness
  • Dullness

Biochemical

  • Progressive renal insufficiency.
  • Electrolyte disturbances: hypernatremia,…
  • Increasing urea and uric acid.

Therapy

  • Interrupt diuretics (diuretics, MRA, SGLT2 inhibitor) and in case of hypotension and/or renal insufficiency ACE inhibitor/ARB / ARNI. 
  • Encourage sufficient drinking with re-evaluation after 2-4 days. After recovery of blood pressure and renal function, always try to quickly restart the interrupted heart failure therapy at 25% or 50% of the previous daily dose, initially without diuretics and in a lower dose, with an uptitration back to the normal maintenance dose over days to a few weeks to the therapy like before the event.
  • Hospitalization for intravenous fluid therapy and further exams is certainly indicated in case of drowsiness, symptomatic hypotension, significant renal insufficiency, inability to eat and drink, etc.
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