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Dehydration

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Dehydration is a physiological state defined by a lack of total body water. This deficiency disrupts metabolic processes, which are the chemical reactions that sustain life. Water is essential for maintaining homeostasis, the stable internal environment of the body. In humans, water content varies significantly based on age and body composition. Newborns typically have a water content of 70% to 75%. An average adult carries about 60% water, though this can drop to 40% or less in obese adults.

Fluid composition of the body 1.3
Fluid composition of the body 1.3

To understand dehydration, one must look at how water is distributed. Water is classified into two main groups: intracellular fluid and extracellular fluid. Intracellular fluid is the water contained within the cells, making up about 57% of total body water. This fluid has high concentrations of proteins, phosphate, magnesium, and potassium. Extracellular fluid stays outside the cells and accounts for 43% of total body water. This includes blood plasma and interstitial fluid. The most common ions in extracellular fluid are sodium, chloride, and bicarbonate.

Fluid composition of the body 1.3
Fluid composition of the body 1.3

Dehydration occurs when free water loss exceeds the amount of water a person consumes. Water is lost through both sensible and insensible processes. Sensible loss includes visible outputs like sweating, vomiting, and diarrhea. It also includes osmotic diuresis, where the kidneys excrete more water. Insensible loss occurs more quietly through the respiratory tract and the skin. Many factors increase these losses, such as high altitudes, endurance athletics, or hot and humid weather. In men, sweat loss during intense exercise can exceed 2 L/h, and even reach 3–4 L/h in extreme heat.

The body uses a complex mechanism to combat water loss. When water levels drop, the concentration of solutes in the blood increases. This increase is known as higher serum osmolarity. Specialized sensors in the hypothalamus called osmoreceptors detect this change. In response, the hypothalamus triggers the release of antidiuretic hormone (ADH). ADH acts on V2 receptors in the collecting tubule of the nephron within the kidneys. This increases the expression of aquaporin, which helps the kidneys absorb more water back into the body.

Fluid composition of the body 1.3
Fluid composition of the body 1.3

In more severe cases, the body employs further emergency measures. If blood pressure becomes dangerously low, the hypothalamus releases higher amounts of ADH. This hormone then acts on V1 receptors. This action causes contractions in the peripheral vascular smooth muscle. These contractions increase systemic vascular resistance, which helps raise blood pressure. It is important to distinguish dehydration from hypovolemia. Hypovolemia specifically refers to a decrease in the volume of blood plasma. While related, they are regulated through independent biological mechanisms.

The severity of dehydration is measured by the percentage of body water lost. A loss of 1% to 2% is considered mild and can impair cognitive performance. A decrease of 5% to 8% often causes dizziness and fatigue. If a person loses more than 10% of their body water, they may experience physical and mental deterioration along with severe thirst. Extremely high levels of loss, between 15% and 25%, can lead to death.

PHIL 1939 lores
PHIL 1939 lores

Symptoms can include headaches, nausea, confusion, seizures, and sunken eyes.

PHIL 1939 lores
PHIL 1939 lores

Medical professionals use various methods to diagnose and treat this condition. Doctors may use a skin turgor test by pinching the skin to see how quickly it returns to its normal position. They also look for dry mucous membranes or increased capillary refill time.

Laboratory tests, such as urinalysis, can reveal darker urine or higher sodium levels. Mild dehydration is usually treated with oral rehydration. Severe cases may require intravenous (IV) therapy to replace fluids directly in the veins. However, doctors must be careful; injecting pure water into the veins can cause red blood cells to undergo lysis, or bursting.

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