Volume depletion versus dehydration: how understanding the difference can guide therapy - PubMed (original) (raw)

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Volume depletion versus dehydration: how understanding the difference can guide therapy

Gautam Bhave et al. Am J Kidney Dis. 2011 Aug.

Abstract

Although often used interchangeably, dehydration and volume depletion are not synonyms. Dehydration refers to loss of total-body water, producing hypertonicity, which now is the preferred term in lieu of dehydration, whereas volume depletion refers to a deficit in extracellular fluid volume. In particular, hypertonicity implies intracellular volume contraction, whereas volume depletion implies blood volume contraction. Using a case of hyperglycemic hypertonic nonketosis as an example, we examine the changing composition of body fluid spaces to explore the distinction between dehydration and hypertonicity from volume depletion.

Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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Figures

Figure 1

Figure 1. Schematic Representation of Body Water Compartments

Figure 2

Figure 2. Body Fluid Derangements and Fluid Therapy Strategy in HHNK with Volume Depletion & Hypertonicity

Circulating volume depletion is the overriding initial therapeutic goal followed by interstitial fluid depletion which account for 1/4th and 3/4th of the ECFV deficit respectively. Correction of tonicity with free water or hypotonic solutions is conducted slowly ensuring serum Na+G falls at a rate < 10 mEq/day.

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