Dehydration (Exsiccosis): Causes, Symptoms & Treatment

Exsiccosis is the medical term for physical dehydration in humans. It is generally the result of a lack of fluids.

What is dehydration (exsiccosis)?

Desiccosis refers to dehydration of the human body due to a lack of fluid and the resulting reduction in body water. This is often confused with so-called dehydration, which, however, merely describes an acute lack of water that is a precursor to exsiccosis.

Causes

Infants and the elderly are particularly likely to be affected by desiccosis. The former because they have only a very small supply of fluid to fall back on in the event of a deficient supply. In the elderly, on the other hand, the sensation of thirst, which often decreases with age, as well as a severely restricted intake of fluids in the event of an acute onset of thirst, ensure exsiccosis. Under certain circumstances, dehydration can occur in dementia patients if there is neglect of their needs by their respective caregivers. However, young people and children who have already passed infancy can also suffer from desiccosis. In this context, diseases such as diabetes, diarrhea or physical infirmities such as disphagia (difficulty swallowing), kidney disease or burns often play an important role. If necessary, the use of diuretics, i.e. medications that lead to a dehydration of the body, can also contribute to the development of exsiccosis. In addition to all these causes, however, a prolonged imbalance of fluid intake and fluid output can also lead to exsiccosis.

Symptoms, complaints, and signs

Exsiccosis is characterized by a variety of different symptoms. However, an unmistakable sign of dehydration is the stagnation of freshly pulled skin folds. The skin and mucous membranes feel dry. Furthermore, the patient is noticeable for increased excitability with erratic, hasty and aimless movements alternating with abnormal sleepiness. The amount of urine excreted decreases sharply. In extreme cases, the body stops passing urine altogether. Urinary substances are retained. The severe fluid loss also causes a sharp drop in blood pressure, which can lead to circulatory shock. The lack of fluid also causes the viscosity of the blood to increase. This increases the risk of thrombosis. Furthermore, there is severe weight loss, constipation, seizures and kidney pain. Older patients in particular then suffer from extreme drowsiness, agitation, confusion, disorientation and reduction in general condition. In severe cases, unconsciousness may also occur. Without rapid treatment, desiccosis can lead to death. However, after successful treatment via infusions with an electrolyte solution, the patient’s condition returns to normal very quickly. Even patients who were conspicuous for their high aggressiveness are suddenly completely normal again. However, many affected patients can no longer remember their previous condition.

Diagnosis and course

Symptoms of desiccosis vary widely, ranging from a barely perceptible drying of the mucous membranes and mild concentration problems to severe headaches, dizziness, muscle cramps, a feeling of weakness, palpitations, or problems chewing and swallowing. The clearest sign of desiccosis, however, is when wrinkles on the back of the hand do not disappear and remain for a long period of time. If no countermeasures are taken, exsiccosis in most cases leads to oliguria, i.e. too little urine is excreted, resulting in disturbed metabolism and electrolyte balance. This can then develop into anuria, in which almost no urine is excreted, which can sometimes be life-threatening. In addition, the lack of urinary tract irrigation significantly increases the risk of developing urinary tract diseases such as infections. Desiccosis is detected either by an increased sodium or hematocrit content in the blood, an increased body temperature (the so-called “thirst fever“) or a low central venous pressure (CVP). Furthermore, collapsed neck veins also indicate exsiccosis.

Complications

Desiccation can lead to very different and serious complications. If a person is dehydrated, his or her skin also loses fluid. As a result, this is more susceptible to wounds and infections. Elderly people in particular are at risk of pressure sores. A decubitus ulcer is a pressure sore. In late stages, this can result in complete death of the affected skin areas. In addition, desiccosis inevitably leads to constipation. This is accompanied by other possible complications affecting the entire gastrointestinal tract. The lack of fluids causes dizziness, which increases the risk of falling. Furthermore, a so-called oliguria can occur. In oliguria, the excretion of urine is limited. Anuria can develop from this condition. This means that less than 100 milliliters of urine are excreted per day. As a result, urinary substances can no longer be excreted. Further complications such as disturbances of the electrolyte and water balance may result. As a result, kidney failure with far-reaching negative effects may occur. In addition, pulmonary edema and cardiac arrhythmias may occur. In later stages of dehydration, the rheology of the blood is severely altered. Rheology describes the composition of substances. As a result, heart attacks and strokes can occur. These lead to further complications such as speech disorders and paralysis. In the worst case, they can be fatal.

Treatment and therapy

In the treatment of exsiccosis, normalization of fluid balance is usually the first priority. However, because in many cases the patients being treated may be uncooperative, unconscious, and sometimes very irritable or even handsy because of the accompanying symptoms of dehydration, providing adequate fluids often proves to be very complicated. Therefore, it must be decided on a case-by-case basis which method of fluid administration is the most promising and feasible. Possible options are either oral feeding with the aid of a spoon or small cup, infusion, or artificial feeding via a stomach tube or percutaneous endoscopic gastrostomy, in which an artificial access to the stomach is created through the abdominal wall. Once fluid balance is restored to healthy levels, symptoms of desiccosis usually disappear within hours or a few days.

Outlook and prognosis

Dehydration always leads to death within a few days unless action is taken. Various symptoms follow within three days, including hallucinations, the onset of delirium or coma, and significant weakness. In addition, the kidneys are affected with persistent desiccation. Dehydration progresses more rapidly the hotter the affected person’s environment. Diarrhea also accelerates the process. The first consequences of dehydration also become apparent within a day because the skin contracts and the affected person complains of a dry mouth (which in some cases is also noticeable by smell). The loss of fluid also causes a loss of nutrients and minerals. This further damages the body’s function and structure. A temporary loss of fluid can still be remedied within the three days. It may be necessary to administer fluids with nutrients intravenously. In this case, it is almost impossible that the affected person will not recover. However, possible consequential damage – especially to the kidneys – cannot be ruled out and depends on the general condition of the affected person and the duration of the desiccosis.

Prevention

The best prophylaxis against desiccosis is the daily intake of plenty of fluids. Thus, experts recommend the intake of about 2 liters of fluid (excluding alcoholic beverages) daily. In addition, the consumption of pectin-containing foods such as apples, oranges or carrots can promote the binding of water in the body, which is then only excreted very slowly via the intestines and can thus counteract exsiccosis. Since elderly people in need of care and infants often suffer from exsiccosis, it is recommended that they are closely monitored by nursing staff or parents, as dehydration can have serious consequences. However, it can be easily avoided by drinking plenty of fluids and eating fruit regularly.There is no adequate aftercare after the body has survived dehydration, insofar as the affected person is otherwise completely healthy (both mentally and physically). Aftercare is, if at all, to be equated with prevention. This consists essentially of not allowing dehydration to occur in the first place, i.e. taking in enough fluids.

Aftercare

Follow-up care in the sense of reducing further risk for the occurrence of desiccosis exists only in bedridden and mentally impaired individuals. This is due to the fact that they represent the skin risk group. Dehydration can occur here because the person concerned has taken in too little fluid. This can be the case if there is no sense of thirst or if the physical abilities are not sufficient to supply oneself with fluids. In such cases, nursing measures or even the artificial supply of fluids (by drip or tube) are indicated. In physically healthy people with mental illnesses that severely impair memory, supervision of drinking behavior also helps. In both cases, it may also be useful to make prophylactic dietary changes as part of follow-up care. The targeted administration of dietary fiber (especially pectins) helps to concentrate water reserves in the body and causes a slow release of the available fluid. This means that even large amounts of drink can be kept in the body at one time for several hours, eliminating the need for ongoing supervision or even force-feeding of fluids.

Here’s what you can do yourself

If dehydration is suspected, the first thing to do is talk to your primary care physician. Whether it is dehydration can be identified by typical symptoms such as headaches, psoriasis, indigestion and back pain. Advanced dehydration is noticeable by the fact that skin folds on the hand only disappear after a few seconds. In addition to a visit to the doctor, the fluid balance must be restored as quickly as possible to prevent a life-threatening course. Depending on the severity of the dehydration, it is sometimes necessary to supply the fluid orally in small doses or even to initiate artificial nutrition or an infusion. In cases of mild fluid deficiency, it may be sufficient to take plenty of water as well as herbal or fruit tea. Consumption of salty broths can compensate for the concomitant nutrient deficiency. The electrolyte balance can be regulated by fortified drinks and a whole food diet. In addition to these dietary measures, the cause of dehydration must be determined. If the dehydration is due to an illness such as diarrhea or fever, bed rest and mild medication are recommended. If excessive caffeine or alcohol consumption is responsible for the dehydration, a change in diet may be appropriate.