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AIMS
EXCLUDE:
Children(refer
Paediatricpathway)
Diabetes
RenalFailure
Septicaemia
Signsofshock
HeartFailure
Undiagnosed
abdominalpain
Intracranialcauses
Improvementinclinicalsigns
Achieveadequateurineoutput
(Recordfluidbalance)
Reductioninfluidlosses
Abletomanageoralrehydrationsolutionsafelyathome
CAUTION:
OlderAdults
Preexistingheart
failure
Prolongeddurationof
symptoms
SignificantCo
morbidity
Featuresofevolving
illness
Recentoverseastravel
PersistentVomitingand/orDiarrhoea
Hyperemesisintractablevomitingin
pregnancy<20weeks
Assessdehydrationstatus
MILD(<5%)
MODERATE(69%)
SEVERE(>10%)
Mayhavenosymptoms
Mildthirst
ConcentratedUrine
Significantthirst
Oliguria
Sunkeneyes
Drymucousmembranes
Weakness
Lightheaded
Posturalhypotension
(>20mmHg)
Significantthirst
Tachycardia
Lowpulsevolume
Coolextremities
Reducedskinturgor
Markedhypotension
Confusion
Ketones0+
Ketones+++
TrialofOralFluids
+/antiemetic
34litresfluidover24Hrs
Observationnotrequiredin
clinic.
POACFUNDINGDOESNOT
APPLY
INVESTIGATIONS
Consider:
Glucose
MSU
Weight
Electrolytes
FaecalSpecimen
P
T t
Admission
Recommended
TrialofOralFluids+antiemetic
Observeinclinicforupto60minutes
underPOAC
Aim34litresoralfluidover24hours
Ifinsufficientresponsetooralintake:
IntravenousFluidsANDAntiemetic
NormalSaline
1000mlstat(1820gangiocath)
Reviewhydrationstatus
LIMIT=2000mlperconsultation
Migraine
GiveIVstemetil12.5mg
IVfluidsnotindicated
unlesspatientis
dehydratedandisnot
abletotakeoralfluids
Reviewdailyandrepeatcycleprn
Iffluidsrequired>2LIVperday/cycleAdmit
Monitorintake/losses
Encourageoralfluids
Providepatientwithcontact/emergencynumbersand
instructions
WATCHFOR
Signsoffluidoverload
Inadequateresponse
Persistingfluidlosses
Ketosis
Deteriorationof
symptoms
Signsofevolving
illness
POACClinicalGuideline:AcuteAdultDehydration
July2015
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
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