WHO Hydration Plans

The hydration plans of the WHO (World Health Organization) are defined according to this entity as a set of behaviors and measures to follow whose purpose is to restore and maintain the hydroelectric balance of an individual. They are also called rehydration plans.

These plans are well described and differentiated. They take into account in particular the state of hydration of the patient through signology or characteristic symptomatology. There are many diseases, syndromes, conditions and clinical entities capable of altering the hemodynamics of the human body due to their physiopathological characteristics.

At this point is when the importance of hydration plans is denoted, as they prevent early dehydration or treat it immediately, thus avoiding the evolution to states in which the life of the individual is compromised.

Physiology of body fluids

Liquids are the fundamental component of the human body, representing 70% of the total body weight of an individual under normal conditions. However, body fluids are separated within the human anatomy in compartments.

The compartments receive their name in relation to whether they are inside the cells or outside them. The two most voluminous compartments are the intracellular compartment and the extracellular compartment.

The intracellular compartment possesses two thirds of the total body water; On the other hand, the extracellular compartment has the remaining third.

To his see; The extracellular compartment is divided into two subcompartments called intravascular (25% extracellular fluid) and interstitial (75% extracellular fluid).

Oral rehydration salts

Oral rehydration salts (ORS) are a group of salts and / or substances used in the rehydration plans according to the WHO for the treatment of dehydration.

WHO describes ORS as the fastest, safest and cheapest way to prevent and treat electrolyte imbalances. Its most frequent presentation is in the form of envelopes, inside which are the salts in powder form. These are diluted in a certain amount of water.

Many different laboratories around the world make SRO for sale, but regardless of the origin or the commercial home, oral rehydration salts must be composed of the following elements:

- 20g of anhydrous glucose.

- 3.5 g of sodium chloride.

- 2.5 g of sodium bicarbonate.

- 1.5 g of potassium chloride.

In case of not having SRO available to apply the rehydration plans that include them, WHO suggests using this recipe: dilution in a liter of water of 6 tablespoons of sugar and one tablespoon of salt. Some doctors in underdeveloped countries have incorporated the juice of a lemon or ¼ of a small spoonful of bicarbonate.

However, this last recipe is very controversial and its use has been relegated to cases of extreme need, since it is rather imprecise and in certain occasions can generate serious complications, such as hyperosmolar coma in pediatric patients.

Crystalloids and colloids

The name crystalloids is attributed to liquids that in medicine are used to restore or supply the water and electrolyte needs of the human body.

The most commonly used are 0.9% saline solutions (isotonic), 3% saline solution (hypertonic) and 0.45% saline solution (hypotonic), lactate ringer solution and dextrose solution.

On the other hand, colloid solutions in medicine are those whose oncotic pressure is similar to the plasma oncotic pressure.

For this reason they are used to retain water in the intravascular space; that's why they are called plasma expanders. The most used at present is albumin.

Dehydration

Dehydration is defined as an electrolyte imbalance whose multifactorial genesis is attributable to two main factors: decreased intake and increased fluid loss. In the context of fluid loss, two mechanisms are described:

Sensitive losses

Liquid that is excreted through urine, stool or sweat. They are quantifiable.

Insensitive losses

Liquid that is lost through breathing (lungs) or evaporation (skin). It has the characteristic that it is not measurable.

Signs and symptoms

Depending on the severity of the dehydration, it will be expressed with a specific symptomatology. From there comes the following classification:

Mild dehydration

In this type of dehydration the percentage loss of body fluids is

Moderate dehydration

In this type of dehydration, the percentage loss of liquids is> 6% up to 30%, there is a decrease in the turgor and elasticity of the skin, sunken eyes, dry mucous membranes, irritability, nausea, vomiting and much thirst.

Severe dehydration

Percent loss of body fluids> 30%, patient soporous, lethargic, sunken eyes, dry mucous membranes, tachycardia, hypotension, sign of positive fold and anuria. General hemodynamic commitment.

Hydration plans according to WHO

The World Health Organization classifies rehydration plans depending on the severity of the state of dehydration. These plans are applied to individuals with a potentially dehydrating disease or syndrome, such as acute diarrhea.

Plan A

Patient that tolerates the oral route. If it is less than 2 years, apply 50 to 100 cc of oral rehydration salts for each liquid evacuation that occurs.

If you are older than 2 years, you should consume 100 to 200 cc of ORS for each liquid evacuation.

Plan A applies to individuals who do not have any symptoms or to patients with mild dehydration.

Plan B

Oral rehydration salts should be administered under 50 to 100 cc per kg of weight in a time of 4 to 6 hours, and then reevaluated.

Plan B is applied to individuals who have symptoms of moderate dehydration that tolerate the oral route.

Plan C

It is applied to individuals who have symptoms of severe dehydration or to individuals with moderate dehydration who do not tolerate the oral route.

Moderate dehydration that does not tolerate the oral route

25 cc per kg of weight should be administered via intravenous solution of physiological solution in the first hour, and repeat the same amount in the second and third hours. Then you must reevaluate.

Severe dehydration

50 cc per kg of weight should be administered intravenously of physiological solution in the first hour, 25 cc of solution per kg of weight in the second hour and repeat this last during the third hour. Then, reevaluate.

References

1. Treatment of diarrhea. Retrieved from: who.int
2. Body fluids and kidneys. Retrieved from: dyndns.org
3. WHO articles Oral rehydration salts to reduce mortality from cholera. Retrieved from: who.int
4. Dehydration Health science journal of Cienfuegos. Retrieved from: sld.cu
5. Hydration and dehydration. Retrieved from: meditip.lat