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Dehydration is a deficiency of body water caused by inadequate intake of water or, more commonly, loss of water and sodium by the kidneys, gastrointestinal tract or skin. Water depletion may affect extracellular or intracellular volume, or both. Dehydration results from abnormal water intake (hypothalamic malfunction) or renal water wasting (diabetes insipidus). Hypernatraemia (Na > 145 mmol/l) is common. When both water and sodium are depleted, tachycardia, hypotension, and weight loss are common. Clinical findings vary based on the severity of the dehydration. In mild dehydration, the patient is alert, has capillary refill of 2 seconds or less and normal mucous membranes, tears, respirations, blood pressure, pulse and skin turgor. The eyes and fontanelles appear normal. Heart rate is slightly increased and urine output is decreased. In moderate dehydration, patients are lethargic, have capillary refill between 2 and 4 seconds, dry mucous membranes, decreased tears, increased respirations and heart rate, normal blood pressure (although orthostasis is present), thready pulse and skin turgor is slow to recover. Fontanelles can be depressed, eyes are sunken and oliguria is present. In severe dehydration, the patient is obtunded, has capillary refill over 4 seconds, cool extremities, parched or cracked mucous membranes, absent tears, increased respiratory rate, hyperpnea, tachycardia, decreased blood pressure, faint or impalpable pulse, and increased skin turgor with tenting. Fontanelles are sunken, eyes are very sunken and oliguria/anuria is present.
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