Language Guiding Therapy: The Case of Dehydration versus Volume Depletion

  title={Language Guiding Therapy: The Case of Dehydration versus Volume Depletion},
  author={Kevin C. Mange and Dean Matsuura and Borut {\vC}i{\vz}man and Haydee Soto and Fuad Ziyadeh and Stanley Goldfarb and Eric Neilson},
  journal={Annals of Internal Medicine},
Patients presenting with orthostatic hypotension and normal plasma sodium concentrations are frequently admitted to the hospital with a diagnosis of dehydration. If they are fortunate, they receive fluids containing sodium chloride instead of free water to correct obvious extracellular fluid volume depletion. Confusing this diagnosis highlights the growing and pernicious habit of using the terms dehydration and volume depletion interchangeably at the bedside when the two describe clearly… 
Dehydration versus volume depletion.
To the Editor: In his recent Nephrology Forum, Dr. Friedman1 makes a number of interesting and cogent observations regarding enteral and parenteral fluid and electrolyte therapy in infants and
Hypovolemia and dehydration in the oncology patient.
The physiologic control of extracellular volume and electrolytes, diagnosis of sodium and water balance problems, and the management of these concerns are reviewed.
Evaluation and treatment of cancer-related fluid deficits: volume depletion and dehydration
In hemodynamically compromised individuals with orthostatic hypotension and oliguria, replacement with isotonic saline until hemodynamic stabilization is crucial and oral or parenteral fluid should be given along with treatment of the underlying cause.
Dehydration despite drinking: beyond the BUN/creatinine ratio.
Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries
The article uses the clinical case examples to illustrate the bed-side approach to the management of three different types of dehydration using a pre-mixed isotonic fluid solution (with 20 or 40 mmol/L of potassium chloride added depending on the absence or presence of hypokalemia, respectively).
Understanding clinical dehydration and its treatment.
Special Communication of a Case of Hypovolemic-Associated EAH: Lessons Learned During Recovery.
Biochemical evidence is provided suggesting that this patient's severe symptomatic EAH was associated with volume depletion from underreplaced sodium losses, suggesting a 'reverse' perspective of the underlying pathophysiology.
Acute electrolyte and acid-base disorders in patients with ileostomies: a case series.
The cases emphasize the need to be aware of the variety of acute electrolyte and acid-base disorders that can occur in patients with ileostomies and to intervene rapidly when they develop, as well as considerations for long-term management of fluid and electrolyte balance.
Long-term enteral nutrition support and the risk of dehydration.
  • R. Dickerson, Rex O. Brown
  • Medicine
    Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
  • 2005
A case-based discussion is provided regarding the evaluation, treatment, and prevention of dehydration in long-term tube-fed patients who are not allowed oral intake, has an altered mental status, is unable to communicate, is elderly or fluid-restricted, or has thirst impairment.


Anatomy of body water and electrolytes.
Body Water in Man. The Acquisition and Maintenance of the Body Fluids
  • F. Epstein
  • Medicine
    The Yale Journal of Biology and Medicine
  • 1957
The excellence of much of the discussion justifies its use as a reference book, particularly for biochemists and medical students who will find the absence of formally presented biochemical concepts less of a problem than the medical practitioner.
Mechanisms of salt and water retention in heart failure.
  • A. Merrill
  • Medicine
    The American journal of medicine
  • 1949
Observations on voluntary water intake were correlated with changes in blood osmotic pressure and the general distribution of the body fluids in the present study.
The Body Cell Mass and Its Supporting Environment; Body Composition in Health and Disease.
This volume, based on the multiple isotope dilution technique, is a much more complete treatise on body composition and begins with sections on methodology, interpretation, calculation, and statistical methods, which are carefully described but are not easy reading compared to the rest of the text.
The role of sodium in the production of edema.
The simplest example of the formation of edema without change of the volume of fluid in the body is the swelling of the feet of a subject who stands still or rests in a relaxed position against a board at an angle of 60°.
Physiology of the kidney and body fluids; an introductory text
This excellent book is one of a projected, and partially completed, series of monographs in physiology being brought out by Year Book Medical Publishers, designed to serve the needs of both the medical student in physiology and the practitioner requiring a relatively short, readable, upto-date treatment of the subject.
On the Absorption of Fluids from the Connective Tissue Spaces
It is inquired whether the blood vessels do absorb such isotonic fluids, and the manner in which this absorption takes place.
Nonosmolar factors affecting renal water excretion (second of two parts).
These investigators clearly showed that an increase in plasma osmotic pressure as small as 1 to 2 per cent by the intracarotid injection of hypertonic saline causes the release of an amount of vasopressin capable of dramatically decreasing renal water excretion.