Dehydration Health Dictionary

Bacterial infection caused by Vibrio cholerae. The patient suffers profuse watery DIARRHOEA, and resultant dehydration and electrolyte imbalance. Formerly known as the Asiatic cholera, the disease has occurred in epidemics and pandemics for many centuries. When it entered Europe in 1853, Dr John Snow, a London anaesthetist, carried out seminal epidemiological work in Soho, London, which established that the source of infection was contaminated drinking water derived from the Broad Street pump. Several smaller epidemics involved Europe in the latter years of the 19th century, but none has arisen in Britain or the United States for many years. In 1971, the El Tor biotype of V. cholerae emerged, replacing much of the classical infection in Asia and, to a much lesser extent, Europe; parts of Africa were seriously affected. Recently a non-01 strain has arisen and is causing much disease in Asia. Cholera remains a major health problem (this is technically the seventh pandemic) in many countries of Asia, Africa and South America. It is one of three quarantinable infections.

Incubation period varies from a few hours to ?ve days. Watery diarrhoea may be torrential and the resultant dehydration and electrolyte imbalance, complicated by cardiac failure, commonly causes death. The victim’s skin elasticity is lost, the eyes are sunken, and the radial pulse may be barely perceptible. Urine production may be completely suppressed. Diagnosis is by detection of V. cholerae in a faecal sample. Treatment consists of rapid rehydration. Whereas the intravenous route may be required in a severe case, in the vast majority of patients oral rehydration (using an appropriate solution containing sodium chloride, glucose, sodium bicarbonate, and potassium) gives satisfactory results. Proprietary rehydration ?uids do not always contain adequate sodium for rehydration in a severe case. ANTIBIOTICS, for example, tetracycline and doxycycline, reduce the period during which V. cholerae is excreted (in children and pregnant women, furazolidone is safer); in an epidemic, rapid resistance to these, and other antibiotics, has been clearly demonstrated. Prevention consists of improving public health infrastructure – in particular, the quality of drinking water. When supplies of the latter are satisfactory, the infection fails to thrive. Though there have recently been large epidemics of cholera in much of South America and parts of central Africa and the Indian subcontinent, the risk of tourists and travellers contracting the disease is low if they take simple precautions. These include eating safe food (avoid raw or undercooked seafood, and wash vegetables in clean water) and drinking clean water. There is no cholera vaccine at present available in the UK as it provides little protection and cannot control spread of the disease. Those travelling to countries where it exists should pay scrupulous attention to food and water cleanliness and to personal hygiene.... cholera

Diarrhoea or looseness of the bowels is increased frequency, ?uidity or volume of bowel movements compared to usual. Most people have occasional attacks of acute diarrhoea, usually caused by contaminated food or water or excessive alcohol consumption. Such attacks normally clear up within a day or two, whether or not they are treated. Chronic diarrhoea, on the other hand, may be the result of a serious intestinal disorder or of more general disease.

The commonest cause of acute diarrhoea is food poisoning, the organisms involved usually being STAPHYLOCOCCUS, CLOSTRIDIUM bacteria, salmonella, E. coli O157 (see ESCHERICHIA), CAMPYLOBACTER, cryptosporidium, and Norwalk virus. A person may also acquire infective diarrhoea as a result of droplet infections from adenoviruses or echoviruses. Interference with the bacterial ?ora of the intestine may cause acute diarrhoea: this often happens to someone who travels to another country and acquires unfamiliar intestinal bacteria. Other infections include bacillary dysentery, typhoid fever and paratyphoid fevers (see ENTERIC FEVER). Drug toxicity, food allergy, food intolerance and anxiety may also cause acute diarrhoea, and habitual constipation may result in attacks of diarrhoea.

Treatment of diarrhoea in adults depends on the cause. The water and salts (see ELECTROLYTES) lost during a severe attack must be replaced to prevent dehydration. Ready-prepared mixtures of salts can be bought from a pharmacist. Antidiarrhoeal drugs such as codeine phosphate or loperamide should be used in infectious diarrhoea only if the symptoms are disabling. Antibacterial drugs may be used under medical direction. Persistent diarrhoea – longer than a week – or blood-stained diarrhoea must be investigated under medical supervision.

Diarrhoea in infants can be such a serious condition that it requires separate consideration. One of its features is that it is usually accompanied by vomiting; the result can be rapid dehydration as infants have relatively high ?uid requirements. Mostly it is causd by acute gastroenteritis caused by various viruses, most commonly ROTAVIRUSES, but also by many bacteria. In the developed world most children recover rapidly, but diarrhoea is the single greatest cause of infant mortality worldwide. The younger the infant, the higher the mortality rate.

Diarrhoea is much more rare in breast-fed babies, and when it does occur it is usually less severe. The environment of the infant is also important: the condition is highly infectious and, if a case occurs in a maternity home or a children’s hospital, it tends to spread quickly. This is why doctors prefer to treat such children at home but if hospital admission is essential, isolation and infection-control procedures are necessary.

Treatment An infant with diarrhoea should not be fed milk (unless breast-fed, when this should continue) but should be given an electrolyte mixture, available from pharmacists or on prescription, to replace lost water and salts. If the diarrhoea improves within 24 hours, milk can gradually be reintroduced. If diarrhoea continues beyond 36–48 hours, a doctor should be consulted. Any signs of dehydration require urgent medical attention; such signs include drowsiness, lack of response, loose skin, persistent crying, glazed eyes and a dry mouth and tongue.... diarrhoea

A clinical state arising from invasive colo-rectal disease; it is accompanied by abdominal colic, diarrhoea, and passage of blood/mucus in the stool. Although the two major forms are caused by Shigella spp. (bacillary dysentery) and Entamoeba histolytica (amoebic dysentery), other organisms including entero-haemorrhagic Escherichia coli (serotypes 0157:H7 and 026:H11) and Campylobacter spp. are also relevant. Other causes of dysentery include Balantidium coli and that caused by schistosomiasis (bilharzia) – Schistosoma mansoni and S. japonicum infection.

Shigellosis This form is usually caused by Shigella dysenteriae-1 (Shiga’s bacillus), Shigella ?exneri, Shigella boydii, and Shigella sonnei; the latter is the most benign and occurs in temperate climates also. It is transmitted by food and water contamination, by direct contact, and by ?ies; the organisms thrive in the presence of overcrowding and insanitary conditions. The incubation is between one and seven days, and the severity of the illness depends on the strain responsible. Duration of illness varies from a few days to two weeks and can be particularly severe in young, old, and malnourished individuals. Complications include perforation and haemorrhage from the colo-rectum, the haemolytic uraemic syndrome (which includes renal failure), and REITER’S SYNDROME. Diagnosis is dependent on demonstration of Shigella in (a) faecal sample(s) – before or usually after culture.

If dehydration is present, this should be treated accordingly, usually with an oral rehydration technique. Shigella is eradicated by antibiotics such as trimethoprimsulphamethoxazole, trimethoprim, ampicillin, and amoxycillin. Recently, a widespread resistance to many antibiotics has developed, especially in Asia and southern America, where the agent of choice is now a quinolone compound, for example, cipro?oxacin; nalidixic acid is also e?ective. Prevention depends on improved hygiene and sanitation, careful protection of food from ?ies, ?y destruction, and garbage disposal. A Shigella carrier must not be allowed to handle food.

Entamoeba histolytica infection Most cases occur in the tropics and subtropics. Dysentery may be accompanied by weight loss, anaemia, and occasionally DYSPNOEA. E. histolytica contaminates food (e.g. uncooked vegetables) or drinking water. After ingestion of the cyst-stage, and following the action of digestive enzymes, the motile trophozoite emerges in the colon causing local invasive disease (amoebic colitis). On entering the portal system, these organisms may gain access to the liver, causing invasive hepatic disease (amoebic liver ‘abscess’). Other sites of ‘abscess’ formation include the lungs (usually right) and brain. In the colo-rectum an amoeboma may be di?cult to di?erentiate from a carcinoma. Clinical symptoms usually occur within a week, but can be delayed for months, or even years; onset may be acute – as for Shigella spp. infection. Perforation, colo-rectal haemorrhage, and appendicitis are unusual complications. Diagnosis is by demonstration of E. histolytica trophozoites in a fresh faecal sample; other amoebae affecting humans do not invade tissues. Research techniques can be used to di?erentiate between pathogenic (E. dysenteriae) and non-pathogenic strains (E. dispar). Alternatively, several serological tests are of value in diagnosis, but only in the presence of invasive disease.

Treatment consists of one of the 5nitroimidazole compounds – metronidazole, tinidazole, and ornidazole; alcohol avoidance is important during their administration. A ?ve- to ten-day course should be followed by diloxanide furoate for ten days. Other compounds – emetine, chloroquine, iodoquinol, and paromomycin – are now rarely used. Invasive disease involving the liver or other organ(s) usually responds favourably to a similar regimen; aspiration of a liver ‘abscess’ is now rarely indicated, as controlled trials have indicated a similar resolution rate whether this technique is used or not, provided a 5-nitroimidazole compound is administered.... dysentery

A disease causing failure of adrenal gland function, in particular deficiency of adrenal cortical hormones, mainly cortisol and aldosterone. Commonest causes are tuberculosis and auto- immune disease.

Symptoms: (acute) abdominal pain, muscle weakness, vomiting, low blood pressure due to dehydration, tiredness, mental confusion, loss of weight and appetite. Vomiting, dizzy spells. Increased dark pigmentation around genitals, nipples, palms and inside mouth. Persistent low blood pressure with occasional low blood sugar. Crisis is treated by increased salt intake. Research project revealed a craving for liquorice sweets in twenty five per cent of patients.

Herbs with an affinity for the adrenal glands: Parsley, Sarsaparilla, Wild Yam, Borage, Liquorice, Ginseng, Chaparral. Where steroid therapy is unavoidable, supplementation with Liquorice and Ginseng is believed to sustain function of the glands. Ginseng is supportive when glands are exhausted by prolonged stress. BHP (1983) recommends: Liquorice, Dandelion leaf.

Alternatives. Teas. Gotu Kola, Parsley, Liquorice root, Borage, Ginseng, Balm.

Tea formula. Combine equal parts: Balm and Gotu Kola. Preparation of teas and tea mixture: 1 heaped teaspoon to each cup boiling water: infuse 5-10 minutes; 1 cup 2 to 3 times daily.

Tablets/capsules. Ginseng, Seaweed and Sarsaparilla, Wild Yam, Liquorice. Dosage as on bottle. Formula. Combine: Gotu Kola 3; Sarsaparilla 2; Ginseng 1; Liquorice quarter. Doses. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 30-60 drops. Tinctures: 1-2 teaspoons 2 to 3 times daily.

Formula. Alternative. Tinctures 1:5. Echinacea 20ml; Yellow Dock 10ml; Barberry 10ml; Sarsaparilla 10ml; Liquorice (liquid extract) 5ml. Dose: 1-2 teaspoons thrice daily.

Supplementation. Cod liver oil. Extra salt. B-Vitamins. Folic acid. ... addison’s disease

Areas on the head on which bone has not yet formed. The chief of these is the anterior fontanelle, situated on the top of the head between the frontal and two parietal bones. In shape it is four-sided, about 25 mm (1 inch) square at the time of birth, gradually diminishing until it is completely covered by bone, which should happen by the age of 18 months. The pulsations of the brain can be readily felt through it. Delay in its closure is particularly found in cases of RICKETS, as well as in other states of defective development. The fontanelle bulges in raised intracranial pressure from HYDROCEPHALUS and MENINGITIS, and depressed in DEHYDRATION.... fontanelle

A rare condition (less than 0·2 per cent) of pregnancy, in which there is severe vomiting. If untreated it can result in severe dehydration, ketoacidosis (an excess of KETONE acids) and liver damage. More common in multiple pregnancy, it may recur in subsequent pregnancies.... hyperemesis gravidarum

Persistent vomiting.

Of gastric flu: See, INFLUENZA.

Of intestinal obstruction: Wild Yam. Black Horehound.

Of pregnancy: (Hyperemesis Gravidarum). A serious form of morning sickness causing dehydration with rapid loss of fluids; should receive hospital treatment.

Treatment: herbal sedatives and antinauseant remedies. See: MORNING SICKNESS. ... hyperemesis

In?ammation of the STOMACH and intestines (see INTESTINE), usually resulting from an acute bacterial or viral infection. The main symptoms are diarrhoea and vomiting, often accompanied by fever and – especially in infants – DEHYDRATION. Although generally a mild disease in western countries, it is the number-one killer of infants in the developing world, with more than 1·5 million children dying annually from the disease in India – a situation exacerbated by early weaning and malnutrition. Complications may include CONVULSIONS, kidney failure, and, in severe cases, brain damage.

Treatment This involves the urgent correction of dehydration, using intravenous saline and dextrose feeds initially, with continuing replacement as required. Antibiotics are not indicated unless systemic spread of bacterial infection is likely. (See also FOOD POISONING.)... gastroenteritis

Presence of abnormally low levels of potassium in the blood. May occur, with dehydration, in the elderly or in diabetics. A common cause is the prolonged use of the thiazides and loop diuretic drugs that leech potassium from the body. In severe degree may cause muscle weakness or paralysis. May also be caused by excessive fluid loss due to chronic diarrhoea.

Symptoms: Always tired. Lethargy. Irregular heart-beats from heart-muscle irritability. Possible cardiac arrest. Breathlessness.

Alternatives. Teas. Plantain, Chamomile, Mullein, Coltsfoot. Mistletoe. Nettles, Gotu Kola, or Yarrow. Decoction. Irish Moss, Agar-Agar, Kelp, Dandelion root.

Powders. Formula. Dandelion, Hawthorn, Liquorice. Equal parts. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Hawthorn, Dandelion, Liquorice. Dose: 1-2 teaspoons, thrice daily. Diet. Bananas: (fruit with highest potassium). Dates, Raisins. Oily fish. Figs. Prunes, Carrot leaves, Cider vinegar (impressive record), Black Molasses. ... hypokalaemia

The cause of Addison’s disease (also called chronic adrenal insu?ciency and hypocortisolism) is a de?ciency of the adrenocortical hormones CORTISOL, ALDOSTERONE and androgens (see ANDROGEN) due to destruction of the adrenal cortex (see ADRENAL GLANDS). It occurs in about 1 in 25,000 of the population. In the past, destruction of the adrenal cortex was due to TUBERCULOSIS (TB), but nowadays fewer than 20 per cent of patients have TB while 70 per cent suffer from autoimmune damage. Rare causes of Addison’s disease include metastases (see METASTASIS) from CARCINOMA, usually of the bronchus; granulomata (see GRANULOMA); and HAEMOCHROMATOSIS. It can also occur as a result of surgery for cancer of the PITUITARY GLAND destroying the cells which produce ACTH (ADRENOCORTICOTROPHIC HORMONE)

– the hormone which provokes the adrenal cortex into action.

Symptoms The clinical symptoms appear slowly and depend upon the severity of the underlying disease process. The patient usually complains of appetite and weight loss, nausea, weakness and fatigue. The skin becomes pigmented due to the increased production of ACTH. Faintness, especially on standing, is due to postural HYPOTENSION secondary to aldosterone de?ciency. Women lose their axillary hair and both sexes are liable to develop mental symptoms such as DEPRESSION. Acute episodes – Addisonian crises – may occur, brought on by infection, injury or other stressful events; they are caused by a fall in aldosterone levels, leading to abnormal loss of sodium and water via the kidneys, dehydration, low blood pressure and confusion. Patients may develop increased tanning of the skin from extra pigmentation, with black or blue discoloration of the skin, lips, mouth, rectum and vagina occurring. ANOREXIA, nausea and vomiting are common and the sufferer may feel cold.

Diagnosis This depends on demonstrating impaired serum levels of cortisol and inability of these levels to rise after an injection of ACTH.

Treatment consists in replacement of the de?cient hormones. HYDROCORTISONE tablets are commonly used; some patients also require the salt-retaining hormone, ?udrocortisone. Treatment enables them to lead a completely normal life and to enjoy a normal life expectancy. Before surgery, or if the patient is pregnant and unable to take tablets, injectable hydrocortisone may be needed. Rarely, treated patients may have a crisis, perhaps because they have not been taking their medication or have been vomiting it. Emergency resuscitation is needed with ?uids, salt and sugar. Because of this, all patients should carry a card detailing their condition and necessary management. Treatment of any complicating infections such as tuberculosis is essential. Sometimes DIABETES MELLITUS coexists with Addison’s disease and must be treated.

Secondary adrenal insu?ciency may occur in panhypopituitarism (see PITUITARY GLAND), in patients treated with CORTICOSTEROIDS or after such patients have stopped treatment.... addison’s disease

An inherited condition, the adrenogenital syndrome – also known as congenital adrenal hyperplasia – is an uncommon disorder affecting about 1 baby in 7,500. The condition is present from birth and causes various ENZYME defects as well as blocking the production of HYDROCORTISONE and ALDOSTERONE by the ADRENAL GLANDS. In girls the syndrome often produces VIRILISATION of the genital tract, often with gross enlargement of the clitoris and fusion of the labia so that the genitalia may be mistaken for a malformed penis. The metabolism of salt and water may be disturbed, causing dehydration, low blood pressure and weight loss; this can produce collapse at a few days or weeks of age. Enlargement of the adrenal glands occurs and the affected individual may also develop excessive pigmentation in the skin.

When virilisation is noted at birth, great care must be taken to determine genetic sex by karyotyping: parents should be reassured as to the baby’s sex (never ‘in between’). Blood levels of adrenal hormones are measured to obtain a precise diagnosis. Traditionally, doctors have advised parents to ‘choose’ their child’s gender on the basis of discussing the likely condition of the genitalia after puberty. Thus, where the phallus is likely to be inadequate as a male organ, it may be preferred to rear the child as female. Surgery is usually advised in the ?rst two years to deal with clitoromegaly but parent/ patient pressure groups, especially in the US, have declared it wrong to consider surgery until the children are competent to make their own decision.

Other treatment requires replacement of the missing hormones which, if started early, may lead to normal sexual development. There is still controversy surrounding the ethics of gender reassignment.

See www.baps.org.uk... adrenogenital syndrome

A solution commonly used as a means of ?uid replacement in dehydrated patients (see also DEHYDRATION). Each litre contains 3·1 grams of sodium lactate, 6 grams of sodium chloride, 0·4 grams of potassium chloride, and 0·7 grams of calcium chloride.... hartmann’s solution

A SERUM sodium concentration that is above normal. The condition is usually caused by dehydration (either from inadequate intake or excessive loss of water); occasionally it may be caused by excessive sodium intake, and rarely by a raised level of ALDOSTERONE hormone.... hypernatraemia

The intravenous or subcutaneous injection of one of a variety of therapeutic solutions, such as saline, glucose, or gum acacia, in the treatment of severe DEHYDRATION, HYPOGLYCAEMIA, or other plasma electrolyte imbalance. Blood infusions may be given in cases of severe ANAEMIA – for example, after heavy bleeding. Infusions may be given in intermittent amounts of around 570 ml (1 pint) at a time, or alternatively by continuous drip-feed over several hours.... infusion

ASPIRIN is a commonly available analgesic (see ANALGESICS) which is frequently taken in overdose. Clinical features of poisoning include nausea, vomiting, TINNITUS, ?ushing, sweating, HYPERVENTILATION, DEHYDRATION, deafness and acid-base and electrolyte disturbances (see ELECTROLYTES). In more severe cases individuals may be confused, drowsy and comatose. Rarely, renal failure (see KIDNEYS, DISEASES OF), PULMONARY OEDEMA or cardiovascular collapse occur. Severe toxicity may be delayed, as absorption of the drug may be prolonged due to the formation of drug concretions in the stomach. Treatment involves the repeated administration of activated CHARCOAL, monitoring of concentration of aspirin in the blood, and correction of acid-base and electrolyte imbalances. In more severely poisoned patients, enhanced excretion of the drug may be necessary by alkalinising the urine (by intravenous administration of sodium bicarbonate – see under SODIUM) or HAEMODIALYSIS.... aspirin poisoning

Linn.

Family: Palmae; Arecaceae.

Habitat: Cultivated chiefly in Kerala, Tamil Nadu and Karnataka.

English: Coconut Palm.

Ayurvedic: Naarikela, Naalikera, Laangali, Tunga, Skandhaphala, Sadaaphala, Trnaraaja, Kuurch- shirshaka.

Unani: Naarjeel, Naariyal.

Siddha/Tamil: Thenkai. Kopparai (kernel of ripe coconut).

Action: Water from tender fruit— cooling, used in thirst, fever, urinary disorders, gastroenteritis, and as a source of K for cholera patients. Fruit—stomachic, laxative, diuretic, styptic, sedative; useful in dyspepsia and burning sensation. Oil from endosperm—antiseptic; used in alopecia. Root—astringent; used in urinary and uterine and disorders.

Tender coconut water is rich in potassium and other minerals and vitamins. It contains reducing sugars 2.222.85%, total sugars 3.5-4.25%; brix 5.56.2%. It is used as a substitute for normal saline in cases of dehydration.

Alcoholic extract of coconut shell (2% in petroleum jelly, externally) was found very effective in dermatophyto- sis. Lighter fractions of the tar oil are used as antiseptics.

Flowers, mixed with oil, are applied to swellings, leaves to treat abscesses, shoots and ashes of dry meat to deep cuts, grated meat to burns, roots to wounds and gonorrhoea.

Shell and fibre—antimicrobial.

Dosage: Dried endosperm—10- 20 g powder. (API Vol. III.)... cocos nucifera

The sensation of thirst is generally felt at the back of the throat, because, when there is a de?ciency of water in the system, the throat and mouth especially become parched by evaporation of moisture from their surface. Thirst is increased by heat, and is a constant symptom of FEVER; it is also present in diseases which remove a considerable amount of ?uid from the system, such as diarrhoea, DIABETES MELLITUS and DIABETES INSIPIDUS, and after great loss of blood by haemorrhage. A demand for water is also a feature of many conditions associated with prolonged exertion, severe exhaustion and DEHYDRATION.... thirst

Substances which increase urine and solute production by the KIDNEYS. They are used in the treatment of heart failure, HYPERTENSION, and sometimes for ASCITES secondary to liver failure. They may work by extra-renal or renal mechanisms.

The potential side-effects of diuretics are HYPOKALAEMIA, DEHYDRATION, and GOUT (in susceptible individuals).

Extra-renal mechanisms (a) Inhibiting release of antidiuretic hormone (e.g. water, alcohol); (b) increased renal blood ?ow (e.g. dopamine in renal doses).

Renal mechanisms (a) Osmotic diuretics act by ‘holding’ water in the renal tubules and preventing its reabsorption (e.g. mannitol); (b) loop diuretics prevent sodium, and therefore water, reabsorption (e.g. FRUSEMIDE); (c) drugs acting on the cortical segment of the Loop of Henle prevent sodium reabsorption, but are ‘weaker’ than loop diuretics (e.g. THIAZIDES); (d) drugs acting on the distal tubule prevent sodium reabsorption by retaining potassium

(e.g. spironalactone).... diuretics

Fasting is the abstention from, or deprivation of, food and drink. It may result from a genuine desire to lose weight – in an attempt to improve one’s health and/or appearance – or from a MENTAL ILLNESS such as DEPRESSION, or from one of the EATING DISORDERS. Certain religious customs and practices may demand periods of fasting. Forced fasting, often extended, has been used for many years as an e?ective means of torture.

Without food and drink the body rapidly becomes thinner and lighter as it draws upon its stored energy reserves, initially mainly fat. Body temperature gradually falls, and muscle is progressively broken down as the body struggles to maintain its vital functions. Dehydration, leading to cardiovascular collapse, inevitably follows unless a basic amount of water is taken – particularly if the body’s ?uid output is high, such as may occur with excessive sweating.

After prolonged fasting the return to food should be gradual, with careful monitoring of blood-pressure levels and concentrations of serum ELECTROLYTES. Feeding should consist mainly of liquids and light foods at ?rst, with no heavy meals being taken for several days.... fasting

Any block-age or hindrance arresting the flow of contents of the intestines. May be mechanical (adhesions, hernias, tumours, etc) or paralytic.

Symptoms: distension, dehydration, atony, vomiting, constipation.

Alternatives. Wild Yam. Calamus. Papaya.

Condition may have to be resolved by surgery. Simple obstruction: large doses (4-8 teaspoons) Isphaghula seeds. Lime flower tea. See: COLITIS. ... intestinal obstruction

The unpleasant effects that can be experienced after over-indulgence in alcohol, characterized by headache, nausea, vertigo, and depression. Alcohol increases production of urine, and some of the symptoms of a hangover are due to mild dehydration. (See also alcohol intoxication.)... hangover

A severe form of malnutrition in young children that occurs principally in poor rural areas in the tropics. Affected children have stunted growth and a puffy appearance due to oedema. The liver often enlarges, dehydration may develop, and the child loses resistance to infection, which may have fatal consequences. The more advanced stages are marked by jaundice, drowsiness, and a fall in body temperature. Initially, the child is frequently fed with small amounts of milk, and vitamin and mineral tablets. A nutritious diet is then gradually introduced. Most treated children recover, but those less than 2 years old may suffer from permanently stunted growth.... kwashiorkor

A severe form of protein and calorie malnutrition that usually occurs in famine or semi-starvation conditions. Marasmus is common in young children in developing countries. The disorder causes stunted growth, emaciation, and loose folds of skin on the limbs and buttocks due to loss of muscle and fat. Other signs include sparse, brittle hair; diarrhoea; and dehydration.

Treatment includes keeping the child warm and giving a high-energy, proteinrich diet. Persistent marasmus can cause mental handicap and impaired growth. (See also kwashiorkor.)... marasmus

The treatment of dehydration by administering fluids and salts by mouth (oral rehydration) or by intravenous infusion.

The amount of fluid necessary depends on age, weight, and the degree of dehydration.

Mild dehydration can usually be treated with oral solutions, which are available as effervescent tablet or powder to be made up at home.

In severe dehydration, or if the patient cannot take fluids by mouth because of nausea or vomiting, an intravenous infusion of saline and/or glucose solution may be given in hospital.... rehydration therapy

A solution of salt (sodium chloride).

“Normal saline” solution has the same concentration as body fluids and may be given by intravenous infusion to replace fluids lost in severe dehydration.... saline

An acute infection of the intestine by bacteria of the genus SHIGELLA. The source of the infection is the faeces of infected people; the bacteria are spread by poor hygiene. Endemic in some countries, shigellosis occurs in isolated outbreaks in the.

The disease usually starts suddenly, with diarrhoea, abdominal pain, nausea, vomiting, generalized aches, and fever. Persistent diarrhoea may cause dehydration, especially in babies and the elderly. Occasionally, toxaemia develops.

Shigellosis usually subsides after a week or so, but hospital treatment may be needed for severe cases. Dehydration is treated by rehydration therapy.

Antibiotics may be given.... shigellosis

The term ‘eating disorders’ covers OBESITY, feeding problems in childhood, anorexia nervosa, and bulimia nervosa. The latter two are described here.

Anorexia nervosa Often called the slimmer’s disease, this is a syndrome characterised by the loss of at least a quarter of a person’s normal body weight; by fear of normal weight; and, in women, by AMENORRHOEA. An individual’s body image may be distorted so that the sufferer cannot judge real weight and wants to diet even when already very thin.

Anorexia nervosa usually begins in adolescence, affecting about 1–2 per cent of teenagers and college students at any time. It is 20 times more common among women than men. Up to 10 per cent of sufferers’ sisters also have the syndrome. Anorexia may be linked with episodes of bulimia (see below).

The symptoms result from secretive self-starvation, usually with excessive exercise, self-induced vomiting, and misuse of laxatives. An anorexic (or anorectic) person may wear layers of baggy clothes to keep warm and to hide the ?gure. Starvation can cause serious problems such as ANAEMIA, low blood pressure, slow heart rate, swollen ankles, and osteoporosis. Sudden death from heart ARRHYTHMIA may occur, particularly if the sufferer misuses DIURETICS to lose weight and also depletes the body’s level of potassium.

There is probably no single cause of anorexia nervosa. Social pressure to be thin seems to be an important factor and has increased over the past 20–30 years, along with the incidence of the syndrome. Psychological theories include fear of adulthood and fear of losing parents’ attention.

Treatment should start with the general practitioner who should ?rst rule out other illnesses causing similar signs and symptoms. These include DEPRESSION and disorders of the bowel, PITUITARY GLAND, THYROID GLAND, and OVARIES.

If the diagnosis is clearly anorexia nervosa, the general practitioner may refer the sufferer to a psychiatrist or psychologist. Moderately ill sufferers can be treated by COGNITIVE BEHAVIOUR THERAPY. A simple form of this is to agree targets for daily calorie intake and for acceptable body weight. The sufferer and the therapist (the general practitioner or a member of the psychiatric team) then monitor progress towards both targets by keeping a diary of food intake and measuring weight regularly. Counselling or more intensely personal PSYCHOTHERAPY may help too. Severe life-threatening complications will need urgent medical treatment in hospital, including rehydration and feeding using a nasogastric tube or an intravenous drip.

About half of anorectic sufferers recover fully within four years, a quarter improve, and a quarter remain severely underweight with (in the case of women) menstrual abnormalities. Recovery after ten years is rare and about 3 per cent die within that period, half of them by suicide.

Bulimia nervosa is a syndrome characterised by binge eating, self-induced vomiting and laxative misuse, and fear of fatness. There is some overlap between anorexia nervosa and bulimia but, unlike the former, bulimia may start at any age from adolescence to 40 and is probably more directly linked with ordinary dieting. Bulimic sufferers say that, although they feel depressed and guilty after binges, the ‘buzz’ and relief after vomiting and purging are addictive. They often respond well to cognitive behaviour therapy.

Bulimia nervosa does not necessarily cause weight loss because the binges – for example of a loaf of bread, a packet of cereal, and several cans of cold baked beans at one sitting – are cancelled out by purging, by self-induced vomiting and by brief episodes of starvation. The full syndrome has been found in about 1 per cent of women but mild forms may be much more common. In one survey of female college students, 13 per cent admitted to having had bulimic symptoms.

Bulimia nervosa rarely leads to serious physical illness or death. However, repeated vomiting can cause oesophageal burns, salivary gland infections, small tears in the stomach, and occasionally dehydration and chemical imbalances in the blood. Inducing vomiting using ?ngers may produce two tell-tale signs – bite marks on the knuckles and rotten, pitted teeth.

Those suffering from this condition may obtain advice from the Eating Disorders Association.... eating disorders

A potentially serious disease of the newborn, characterised by haemolytic ANAEMIA (excessive destruction of red blood cells) and JAUNDICE. If severe, it may be obvious before birth because the baby becomes very oedematous (see OEDEMA) and develops heart failure – so-called hydrops fetalis. It may ?rst present on the ?rst day of life as jaundice and anaemia. The disease is due to blood-group incompatibility between the mother and baby, the commoneset being rhesus incompatibility (see BLOOD GROUPS). In this condition a rhesus-negative mother has been previously sensitised to produce rhesus antibodies, either by the delivery of a rhesus-positive baby, a miscarriage or a mismatched blood transfusion. These antibodies cross over into the fetal circulation and attack red blood cells which cause HAEMOLYSIS.

Treatment In severely affected fetuses, a fetal blood transfusion may be required and/or the baby may be delivered early for further treatment. Mild cases may need observation only, or the reduction of jaundice by phototherapy alone (treatment with light, involving the use of sunlight, non-visible ULTRAVIOLET light, visible blue light, or LASER).

Whatever the case, the infant’s serum BILIRUBIN – the bilirubin present in the blood – and its HAEMOGLOBIN concentration are plotted regularly so that treatment can be given before levels likely to cause brain damage occur. Safe bilirubin concentrations depend on the maturity and age of the baby, so reference charts are used.

High bilirubin concentrations may be treated with phototherapy; extra ?uid is given to prevent dehydration and to improve bilirubin excretion by shortening the gut transit time. Severe jaundice and anaemia may require exchange TRANSFUSION by removing the baby’s blood (usually 10 millilitres at a time) and replacing it with rhesus-negative fresh bank blood. Haemolytic disease of the newborn secondary to rhesus incompatibility has become less common since the introduction of anti-D (Rho) immunoglobulin. This antibody should be given to all rhesus-negative women at any risk of a fetomaternal transfusion, to prevent them from mounting an antibody response. Anti-D is given routinely to rhesus-negative mothers after the birth of a rhesus-positive baby, but doctors should also give it after threatened abortions, antepartum haemorrhages, miscarriages, and terminations of pregnancy.

Occasionally haemolytic disease is caused by ABO incompatibility or that of rarer blood groups.... haemolytic disease of the newborn

A strong and persistent need to drink, most commonly due to dehydration. Other causes include untreated diabetes mellitus and diabetes insipidus, kidney failure, treatment with phenothiazine drugs, and severe blood loss. Abnormal thirst may also be due to a psychological condition known as psychogenic polydipsia.... thirst, excessive

A condition resulting from environmental temperatures which are too high for compensation by the body’s thermo-regulatory mechanism(s). It is characterised by hyperpyrexia, nausea, headache, thirst, confusion, and dry skin. If untreated, COMA and death ensue. The occurrence of heat stroke is sporadic: whereas a single individual may be affected (occasionally with fatal consequences), his or her colleagues may remain unaffected. Predisposing factors include unsatisfactory living or working conditions, inadequate acclimatisation to tropical conditions, unsuitable clothing, underlying poor health, and possibly dietetic or alcoholic indiscretions. The condition can be a major problem during pilgrimages – for example, the Muslim Hadj. Four clinical syndromes are recognised:

Heat collapse is characterised by fatigue, giddiness, and temporary loss of consciousness. It is accompanied by HYPOTENSION and BRADYCARDIA; there may also be vomiting and muscular cramps. Urinary volume is diminished. Recovery is usual.

Heat exhaustion is characterised by increasing weakness, dizziness and insomnia. In the majority of sufferers, sweating is defective; there are few, if any, signs of dehydration. Pulse rate is normal, and urinary output good. Body temperature is usually 37·8–38·3 °C.

Heat cramps (usually in the legs, arms or back, and occasionally involving the abdominal muscles) are associated with hard physical work at a high temperature. Sweating, pallor, headache, giddiness and intense anxiety are present. Body temperature is only mildly raised.

Heat hyperpyrexia is heralded by energy loss and irritability; this is followed by mental confusion and diminution of sweating. The individual rapidly becomes restless, then comatose; body temperature rises to 41–42 °C or even higher. The condition is fatal unless expertly treated as a matter of urgency.

Treatment With the ?rst two syndromes, the affected individual must be removed immediately to a cool place, and isotonic saline administered – intravenously in a severe case. The fourth syndrome is a medical emergency. The patient should be placed in the shade, stripped, and drenched with water; fanning should be instigated. He or she should be wrapped in a sheet soaked in cool water and fanning continued. When rectal temperature has fallen to 39 °C, the patient is wrapped in a dry blanket. Immediately after consciousness returns, normal saline should be given orally; this usually provokes sweating. The risk of circulatory collapse exists. Convalescence may be protracted and the patient should be repatriated to a cool climate. Prophylactically, personnel intended for work in a tropical climate must be very carefully selected. Adequate acclimatisation is also essential; severe physical exertion must be avoided for several weeks, and light clothes should be worn. The diet should be light but nourishing, and ?uid intake adequate. Those performing hard physical work at a very high ambient temperature should receive sodium chloride supplements. Attention to ventilation and air-conditioning is essential; fans are also of value.... heat stroke

Jasmine tea is a Chinese tea made from jasmine flowers. This tea is one of the most popular teas in China, being a specialty for over 800 years. It is basically used as a green, white or oolong tea having a subtle sweet flavor. How To Make Jasmine Tea Brewing jasmine tea is not such a difficult process. First of all you will need to boil the water. Add 1 tablespoon of jasmine leaves into your teapot or infuser and pour the hot water over it. Cover it and let it steep for about 3 minutes, but no longer than 5 minutes because you may obtain a bitter taste. If you didn’t use an infuser, make sure you use a strainer when you pour the tea into your cup to catch the jasmine blooms. Since it already has a sweet, floral taste it is advised not to put any sweetener, but if you want you can add some sugar or honey. Jasmine Tea Benefits Jasmine tea is full of antioxidants that protect your body against the damage that free radicals can cause to your body cells. Jasmine tea helps you lose weight thanks to the combination between caffeine and antioxidants. Also, this tea reduces fat and encourages cholesterol absorption. Some studies revealed that jasmine tea may help prevent cancer. Jasmine is also used for its calming effects in aromatherapy as an essential oil. Judging by this fact, drinking a cup of jasmine tea also provides you relaxation. Jasmine Tea Side Effects Over consumption may lead to certain side effects. For example, jasmine tea has caffeine content that heightens alertness and reduces sleepiness. Also, caffeine increases secretion of stress hormones, insomnia and dehydration so try not to drink too much jasmine tea. One or two cups of jasmine tea a day! Needless to say, pregnant and breastfeeding woman are advised not to drink jasmine tea, also because of its caffeine content. Enjoy this wonderful scented tea and all its benefits! Do not drink more than 2 cups of jasmine tea per day, this way making sure you won’t experience any of its side effects.... jasmine tea - a famous chinese scented tea

Nausea and vomiting in early pregnancy are common and are most likely to be caused by changes in the hormone levels. Vomiting occurs most frequently in the morning, but it may occur at any time. It is sometimes precipitated by stress, travelling, or food.

In rare cases, the vomiting becomes severe and prolonged. This can cause dehydration, nutritional deficiency, alterations in blood acidity, and weight loss. Immediate hospital admission is then required to replace lost fluids and chemicals by intravenous infusion, to rule out any serious underlying disorder, and to control the vomiting.... vomiting in pregnancy

acute kidney injury, also called acute renal failure. Dehydration often leads to AKI. The diagnosis is usually based on changes in the serum creatinine concentration or the detection of *oliguria, neither of which is ideal as they tend to lag behind the phase of acute injury.... aki

n. (in microscopy) the process of removing the cloudiness from microscopical specimens after *dehydration by means of a clearing agent. This increases the transparency of the specimens. Xylene, cedar oil, methyl benzoate plus benzol, and methyl salicylate plus benzol are commonly used as clearing agents.... clearing

n. an acute disorder of the mental processes characterized by fluctuating levels of consciousness, responsiveness, and cognitive ability. It may be manifested by delusions, disorientation, hallucinations, or extreme excitement. There are many possible causes, ranging from head injury to hip or other fracture, infection, constipation, dehydration, pain, or drug side-effects. Treatment is by removal of the underlying cause and supportive medical measures.... delirium

Mango tea is a complex type of tea, due to its ingredients: green tea, black tea and mango pieces. It is considered to be ideal both for tea consumers and fruit lovers worldwide. About Mango Tea Mango, originally coming fromsouth Asia, was brought to the United States in 1880. It symbolizes love and apparently, its leaves are a good choice to be gifted at weddings. It is a delicious and juicy fruit, that can be eaten fresh or cooked, sliced, pureed or, as part of several beverages. Mango tea is a type of tea resulting from mixing green tea, black tea and whole mango pieces. It gathers the freshness of mangoes and the strong flavor of the two teas mentioned above. How to make Mango Tea?

• infuse 1 tablespoon per cup
• use boiling water
• infuse it for 3 minutes

Mango tea can be also consumed cold. In this case, ice is recommended to be added. To boost its freshness, connoisseurs indicate the use of fresh mint leaves use. Mango Tea benefits Owing to the high quantity of contained antioxidants, Mango tea is effectively used in treating cancer and helping cells to recover from this disease. This type of tea has proven its efficiency in dealing with:

•  Anemia
•  Stress
• Muscle cramps
• Digestion
• Weight Control
• Bone Growth
• Immune Functions
• Vision
• Wound Healing
• Protein Synthesis
• Dehydration

Mango Tea side effects Mango tea side effects are generallyassociated to overconsumption or, citrus intolerance. It is indicated that individuals suffering from cardiac problems or hypertension to consume it moderately. Pregnant and breast-feeding women are advised to reduce the amount of Mango tea consumed (less than 2 cups per day), in order not to cause agitation to the baby. Mango teacould be successfully introduced in a daily diet, providing energy and enhancing mood for consumers of all ages and thus, carefully strengthening the immune system.... mango tea and its healthy freshness

In severely ill patients – especially those who have had major surgery or those with SEPSIS, burns, acute pancreatitis (see PANCREAS, DISORDERS OF) and renal failure – the body’s reserves of protein become exhausted. This results in weight loss; reduction in muscle mass; a fall in the serum albumin (see ALBUMINS) and LYMPHOCYTE count; and an impairment of cellular IMMUNITY. Severely ill patients are unable to take adequate food by mouth to repair the body protein loss so that enteral or parenteral nutrition is required. Enteral feeding is through the gastrointestinal tract with the aid of a nasogastric tube; parenteral nutrition involves the provision of carbohydrate, fat and proteins by intravenous administration.

The preferred route for the infusion of hyperosmolar solutions is via a central venous catheter (see CATHETERS). If parenteral nutrition is required for more than two weeks, it is advisable to use a long-term type of catheter such as the Broviac, Hickman or extra-corporeal type, which is made of silastic material and is inserted via a long subcutaneous tunnel; this not only helps to ?x the catheter but also minimises the risk of ascending infection.

Dextrose is considered the best source of carbohydrate and may be used as a 20 per cent or 50 per cent solution. AMINO ACIDS should be in the laevo form and should contain the correct proportion of essential (indispensable) and non-essential amino acids. Preparations are available with or without electrolytes and with or without fat emulsions.

The main hazards of intravenous feeding are blood-borne infections made possible by continued direct access to the circulation, and biochemical abnormalities related to the composition of the solutions infused. The continuous use of hypertonic solutions of glucose can cause HYPERGLYCAEMIA and glycosuria and the resultant POLYURIA may lead to dehydration. Treatment with INSULIN is needed when hyper-osmolality occurs, and in addition the water and sodium de?cits will require to be corrected.... parenteral nutrition

Shatavari tea is the main remedy if you suffer from sexual problems. Some say that Shatavari is the most important herb in Ayurvedic medicine. For centuries, the Indians used its roots and rhizomes to treat and even cure some of the most important health problems. Shatavari is a plant with sharp and shiny leaves, white flowers and dark fruits that grows in the rocky areas of the high plains in India, but also in the Himalayan region. Shatavari tea properties Shatavari means “a woman who has a hundred husbands ” because it is well known that this plant is used to treat the female reproductive system and not only: it can also be used for men’s wellness (combined with ashwagandha, makes a great male reproductive treatment and a very good sexual endurance enhancer). Also, the sweet roots of Shatavari could very well replace any meal , turning this particular herb into a “superfood” for women. And let’s not forget the fact that it is also a good remedy for stress, a well-known antioxidant and a great help when it comes to anti-aging solutions.  Treatments- Shatavari tea benefits Shatavari tea is useful for chronic fever and dehydration, ulcers and gastritis, dysentery and diarrhea, infertility, it helps fighting heart problems and calming the nerves. The good news is that you can take it even if you’re pregnant. In fact, Shatavari is a very good galactologue, so it actually helps with lactation (but do not drink too much or it will quickly cause leaking). Also, Shatavari tea helps with menstrual and menopausal problems and strengthens the female reproductive system. How to make Shatavari Infusion First thing you need to do is make sure the roots and rhizomes you’re about to use are clean and very dry. Simmer them in hot water for 15 minutes. For better results, wait another 15 minutes for the wellness benefits of Shatavari tea to be infused and you’ve got your own medicine cabinet in a pot. Take the Shatavari tea once or twice a day. Shatavari tea side effects If you’re sensitive to asparagus, you’ll be sensitive to Shatavari tea as well so it is better to avoid it. The same advice goes for patients with edema due to kidney disorder or impaired heart function. Another aspect you should really keep an eye on is your weight: a well balanced diet will prevent you from gaining weight while taking the tea. Shatavari tea- Contraindications Do not take Shatavari tea in case you have massive fibrocystic breasts or estrogen induced problems. To make sure everything will be fine, talk to your doctor before starting the treatment. It’s not hard to imagine why the Indians named this plant the most important herb of the Ayurvedic medicine: great benefits, few side effects. So, if you are looking for something to boost your energy and health really fast, look for Shatavari tea next time you’re in a tea shop.... shatavari tea benefits

Constipation is a digestive tract problem which involves your body’s incapacity to eliminate the waste. Sometimes, constipation is a reaction to a series of a very unbalanced nutrition, which involved eating seeds and dried solid food. The lack of liquids makes your intestines unable to push the waste out of your body. Dehydration may also be a cause for constipation. Not treating your constipation may lead to blood in stools, internal bleeding and even ulcers. How Tea for Constipation Works If you’re suffering from constipation, it’s best to take teas that are well known for their diuretic and purgative action. The most important thing about these teas is that, thanks to their enzymes and nutrients, they increase the amount of liquid in your intestines, helping them eliminate the waste and irrigating the entire digestive tract. When choosing a Tea for Constipation, you may want to pick the safest one. Of course, the market is abundant in teas for constipation, but some of them have a high level of risk and, since constipation is a minor affection, it’s not really worth it. However, ask your doctor for guidance before starting any kind of herbal treatment in order to avoid other health complications. Efficient Tea for Constipation - Senna Tea – this tea is also helpful for colic, flatulence, fissures, hemorrhoids and gas, thanks to its active ingredients which take action in your digestive tract. Senna Tea is generally a safe Tea for Constipation, its main action consisting of increasing the abdominal muscle activity. However, don’t exceed more than 2 cups of tea per day and only take it while you’re feeling sick. - Licorice Tea – or Glycerrhiza Glabra Tea is a well known decoction used in order to treat a series of affections, such as constipation, blood pressure, heart failure, kidney disease or liver disorders. Licorice Tea has a sweet and pleasant taste so you don’t need to add any honey or lemon. - Yellow Dock Tea – has a bitter taste and therefore it’s used in combination with ginger, honey or lemon. Yellow Dock Tea has a mild laxative effect due to its active ingredients: tannins, oxalates and anthraquinones, so you shouldn’t take it if you’re suffering from liver or kidney disorders. Tea for Constipation Side Effects When taken according to specifications, these teas are generally safe. However, exceeding the number of cups recommended per day may lead to a series of complications, such as diarrhea, nausea, vomiting and upset stomach. If you’ve been taking one of these teas for a while and you’re experiencing some unusual reactions, ask for medical help right away! Don’t take a Tea for Constipation if you’re also pregnant, breastfeeding, on anticoagulants and blood thinners or preparing for a surgery. The same advice if you’re suffering from kidney or liver problems. But if your doctor says it’s ok to start a medical treatment based on a Tea for Constipation, choose the one that fits you best and enjoy its great benefits!... tea for constipation

Hydration represents the ability of the body to manage water. The optimal hydration is not provided by water only. It should be accompanied by fruit and vegetable consumption. There are some symptoms which come with dehydration: little or no urine or urine that is darker than usual, dry mouth, sleepiness or fatigue, extreme thirst, headache, confusion, feeling dizzy or lightheaded, no tears when crying. How Tea for Hydration works A tea for hydration usually helps the body to keep water within. Efficient Teas for Hydration It has been proved that herbal tea as mint and verbena are efficient for hydration. Mint is a well known plant, due to its ability to soothe the digestive tract. It is appreciated for its flavor and taste, being an important ingredient in the pharmaceutical industry. To prepare Mint tea, infuse 2 tablespoons of dried leaves in a cup of boiling water. After steeping it about 15 minutes, you may enjoy the beverage. As a tea for hydration, Mint tea has been used for centuries all over the planet. It enhances the ability of cells to keep water within for a longer period of time. Verbena is a plant originating from South America (Argentina, Brazil, Peru and Paraguay). It has a lemony scent, being preferred in the perfume industry. In cuisine, verbena could replace oregano, especially in fish and poultry dishes. To prepare Verbena tea , immerse about 2 teaspoons of dried verbena herbs or ¼ teaspoon of fresh leaves and tops into one cup of boiling water. Let the mixture soak and steep for about 5 minutes. Drink it slowly. Honey can be added to enhance flavor. As a tea for hydration, Verbena tea is an adjuvant in keeping water in the human tissues. Tea for Hydration: Side Effects Rarely, teas for hydration may induce diarrhea. In these cases, cease consumption and ask for your doctor’s advice. Teas for hydration are a good choice when the body needs extra hydration and also when the person is on a diet, goes outside on a hot weather or practices sports.... tea for hydration

pl. n. localized areas of corneal thinning, usually at the limbus (the junction of the cornea with the sclera), due to local dehydration. They may occur after surgery to correct a squint, due to elevated conjunctiva at the limbus causing poor wetting of the adjacent cornea.... dellen

n. drying up, as may occur in tissues deprived of an adequate supply of water during dehydration or starvation.... exsiccation

n. the presence in the blood of an abnormally low concentration of *sodium: occurs in dehydration. See electrolyte.... hyponatraemia

adj. (of secretions, etc.) thickened or dried by evaporation or dehydration.... inspissated

a tropical disease, common in southern India, caused by a virus transmitted to humans through the bite of the forest-dwelling tick Haemaphysalis spinigera. Symptoms include fever, headache, muscular pains, vomiting, conjunctivitis, exhaustion, bleeding of nose and gums and, subsequently, internal bleeding and the *necrosis of various tissues. General therapy, in the absence of specific treatment, involves relief of dehydration and loss of blood; analgesics are given to alleviate pain.... kyasanur forest disease

The administration of any ?uid into a person’s vein using a drip. This apparatus facilitates a continuous injection in which the ?uid ?ows by force of gravity from a suspended bottle, via a tube that is ?xed to a hollow needle inserted into a vein (usually in the front of the elbow). Saline solution, PLASMA and whole BLOOD (see below) are the most commonly administered ?uids. Saline is used to restore ?uid to a seriously dehydrated individual (see DEHYDRATION) and may be used as a temporary measure in SHOCK due to blood loss while the appropriate type of blood is being obtained for transfusion. Saline may also be useful as a way of administering a regular supply of a drug over a period of time. Plasma is normally used as a temporary measure in the treatment of shock until appropriately matched blood is available or if for any reason, such as for a patient with severe burns, plasma is preferable to blood.

Transfusion of blood is a technique that has been used since the 17th century – although, until the 20th century, with a subsequent high mortality rate. It was only when incompatibility of BLOOD GROUPS was considered as a potential cause of this high mortality that routine blood-testing became standard practice. Since the National Blood Transfusion Service was started in the United Kingdom (in 1946), blood for transfusion has been collected from voluntary, unpaid donors: this is screened for infections such as SYPHILIS, HIV, HEPATITIS and nvCJD (see CREUTZFELDT-JAKOB DISEASE (CJD)), sorted by group, and stored in blood-banks throughout the country.

In the UK in 2004, the National Blood Authority – today’s transfusion service – announced that it would no longer accept donations from anyone who had received a blood transfusion since 1980 – because of the remote possibility that they might have been infected with the PRION which causes nvCJD.

A standard transfusion bottle has been developed, and whole blood may be stored at 2–6 °C for three weeks before use. Transfusions may then be given of whole blood, plasma, blood cells, or PLATELETS, as appropriate. Stored in the dried form at 4–21 °C, away from direct sunlight, human plasma is stable for ?ve years and is easily reconstituted by adding sterile distilled water.

The National Blood Authority prepares several components from each donated unit of blood: whole blood is rarely used in adults. This permits each product, whether plasma or various red-cell concentrates, to be stored under ideal conditions and used in appropriate clinical circumstances – say, to restore blood loss or to treat haemostatic disorders.

Transfusion of blood products can cause complications. Around 5 per cent of transfused patients suffer from a reaction; most are mild, but they can be severe and occasionally fatal. It can be di?cult to distinguish a transfusion reaction from symptoms of the condition being treated, but the safe course is to stop the transfusion and start appropriate investigation.

In the developed world, clinicians can expect to have access to high-quality blood products, with the responsibility of providing blood resting with a specially organised transfusion service. The cause of most fatal haemolytic transfusion reactions is a clerical error due to faulty labelling and/or failure to identify the recipient correctly. Hospitals should have a strict protocol to prevent such errors.

Arti?cial blood Transfusion with blood from donors is facing increasing problems. Demand is rising; suitable blood donors are becoming harder to attract; the processes of taking, storing and cross-matching donor blood are time-consuming and expensive; the shelf-life is six weeks; and the risk of adverse reactions or infection from transfused blood, although small, is always present. Arti?cial blood would largely overcome these drawbacks. Several companies in North America are now preparing this: one product uses puri?ed HAEMOGLOBIN from humans and another from cows. These provide oxygen-carrying capacity, are unlikely to be infectious and do not provoke immunological rejections. Yet another product, called Oxygene®, does not contain any animal or human blood products; it comprises salt water and a substance called per?ubron, the molecules of which store oxygen and absorb carbon dioxide more e?ectively than does haemoglobin. Within 24 hours of being transfused into a person’s bloodstream, per?ubron evaporates and is harmlessly breathed out by the recipient. Arti?cial blood is especially valuable in that it contains no unwanted proteins that can provoke adverse immunological reactions. Furthermore, it is disease-free, lasts for up to three years and is no more expensive than donor blood. It could well take the place of donor blood within a few years.

Autologous transfusion is the use of an individual’s own blood, provided in advance, for transfusion during or after a surgical operation. This is a valuable procedure for operations that may require large transfusions or where a person has a rare blood group. Its use has increased for several reasons:

fear of infection such as HIV and hepatitis.

shortages of donor blood and the rising cost of units of blood.

substantial reduction of risk of incompatible transfusions. In practice, blood transfusion in the UK is

remarkably safe, but there is always room for improvement. So, in the 1990s, a UK inquiry on the Serious Hazards of Transfusion (SHOT) was launched. It established (1998) that of 169 recently reported serious hazards following blood transfusion, 81 had involved a blood component being given to the wrong patient, while only eight were the result of viral or bacterial infections.

There are three ways to use a patient’s own blood in transfusion:

(1) predeposit autologous donation (PAD) – taking blood from a patient before operation and transfusing this blood back into the patient as required during and after operation.

(2) acute normovalaemic haemodilution (ANH) – diluting previously withdrawn blood and thus increasing the volume before transfusion.

(3) perioperative cell salvage (PCS) – the use of centrifugal cell separation on blood saved during an operation, particularly spinal surgery where blood loss may be considerable.

The government has urged NHS trusts to consider the introduction of PCS as a possible adjunct or alternative to banked-blood transfusion. In one centre (Nottingham), PCS has been used in the form of continuous autologous transfusion for several years with success.

Exchange transfusion is the method of treatment in severe cases of HAEMOLYTIC DISEASE OF THE NEWBORN. It consists of replacing the whole of the baby’s blood with Rh-negative blood of the correct blood group for the baby.... transfusion

excessive plasma acidity due to an accumulation of lactic acid. This may be caused by a variety of illnesses, including heart failure or severe dehydration. It can also be caused by the accumulation of *biguanide drugs used for treating type 2 *diabetes mellitus, particularly when kidney failure is present. Biguanides (see metformin) should therefore not be used to treat patients who have established kidney disease or heart failure or who are dehydrated.... lactic acidosis

Binge-eating followed by self-induced vomiting. Disorder of young women. Frequently regarded as psychiatric in origin but has been linked with polycystic ovaries, zinc deficiency, even endorphin activity. Where nervous excitability is marked, the addition of a nerve relaxant (Skullcap, Valerian) proves of value.

Symptoms. Fatigue, digestive problems, irregular menstruation, irregular heart-beat, muscle cramps and weakness, dizziness, dehydration, dental problems, abdominal pain, low tolerance of cold, haemorrhages in the oesophagus, swollen salivary glands, breast tenderness, swollen ankles, unexplained low- potassium in the blood, frequent resort to diuretics.

Alternatives. Teas. Centuary, Chamomile, Hops, Fennel. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 2-3 times daily.

Tablets/capsules. Gentian, Chamomile, Ginkgo.

Powders. Formula. Equal parts: Burdock root, Ginkgo, Gentian. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily before meals.

Tincture. Tincture Gentian Co BP. Dose: 2-4ml.

Antidepressants. Bulimia has been effectively treated using antidepressants. See: ANTIDEPRESSANTS. Supplementation. Vitamins B, C, E. Magnesium, Chromium, Zinc. Active exercising or jogging to stimulate beta endorphin release.

Note: One bulimic in two will recover spontaneously, even if they receive little or no treatment according to a decade-long follow-up of 50 bulimia nervosa patients. (British Journal of Psychiatry, Jan 1994) ... bulimia

Sacred Bark. Chittem Bark. Rhamnus purshiana D.C.

Constituent: to 10 per cent anthraquinone glycosides. Bark – after maturing for one year.

Action: Non-habit forming stimulant laxative, pancreatic stimulant, bitter tonic.

Keynote: stool softener.

Uses: habitual constipation, torpor of low bowel, congestion of liver and gall duct. To assist liver function in cirrhosis. Foul breath.

Sometimes combined with Cardamom, Coriander or Cumin as a precaution against griping. A common ingredient with Figwort, Witch Hazel or Stone root for piles.

Preparations: Once daily.

Tablets: 150mg. 1-2 when necessary.

Liquid Extract: half-1 teaspoon in water, at bedtime; honey to sweeten. Powdered bark: 1 to 2 and a half grams.

Excessive dosage may result in dehydration with low potassium levels. ... cascara sagrada

A rectal infusion chiefly water given as an aid to evacuation of the bowel or, injected slowly can be an aid to dehydration. An enema may also be of great value in the treatment of some diseases. Injection of fluid (herb teas, etc) through a tube into the rectum, via the anus, to relieve constipation or convey medication or nutriment. A herbal tea may be given as a stimulating nervine (to rouse from severe prostration as in apoplexy, meningitis); relaxant (when the body is feverish and tense); or to re-activate after collapse and shock. Usual enemata: 2 pints herb tea.

Bayberry bark, Burdock root, Catnep, Lobelia, Fenugreek seeds, Raspberry leaves, Chickweed, Tormentil, Lime flowers, Mullein.

Evacuant Children. Catnep tea, with 2 teaspoons honey. Adults. Catnep, Raspberry leaves.

Stimulating nervine: Skullcap, Oatmeal, Oats, Bayberry bark.

Relaxant: Lobelia, Lime flowers, Mullein.

To re-activate after collapse: Teaspoon Composition powder. Ginger; or 20 drops tincture Myrrh.

To soothe pain of diverticulosis: Fenugreek seeds, Marshmallow root, Oatmeal.

Alternatives to coffee for cancer: Raspberry leaves, Red Clover flowers, Burdock root, Yellow Dock. For bowel infections: typhoid (Boneset and Skullcap – equal parts): dysentery (raspberry leaves 10, Myrrh 1): diverticulitis (German Chamomile 8, Goldenseal 1). Impacted faeces: Chamomile tea with teaspoon Olive Oil.

When the stomach rejects a medicine an alternative route is by enema into the bowel.

Olive Oil enema: 5oz Olive Oil in 20oz boiled water.

Myrrh enema: 20 drops Tincture Myrrh in 20oz boiled water for bowel infections.

Slippery Elm enema: half a teaspoon Slippery Elm powder in 20 boiled water.

Raspberry leaf enema: 1oz Raspberry leaves in 1 pint (20oz) boiling water; infuse until warm, strain and inject for irritable bowel and other conditions.

Enemas should not be given to children. ... enema

n. 1. the conversion of dead tissue into a hard shrunken mass, chiefly by dehydration. 2. (in dentistry) the application of a fixative to the dental pulp to prevent decomposition.... mummification

n. a group of cells in the *hypothalamus that monitor blood concentration. Should this increase abnormally, as in dehydration, the osmoreceptors send nerve impulses to the hypothalamus, which then increases the rate of release of *vasopressin from the posterior pituitary gland. Loss of water from the body in the urine is thus restricted until the blood concentration returns to normal.... osmoreceptor

Collapse of the circulation from exposure to excessive heat. Possible in the presence of diarrhoea, vomiting or excessive sweating (dehydration) or alcohol consumption.

Symptoms: heavy sweating, failure of surface circulation, low blood pressure, weakness, cramps, rapid heartbeat, face is pale, cool and moist. Collapse. Recovery after treatment is rapid.

Alternatives. Cayenne pepper, or Tincture Capsicum, to promote peripheral circulation and sustain the heart. Prickly Ash bark restores vascular tone and stimulates capillary circulation. Bayberry offers a diffusive stimulant to promote blood flow, and Cayenne to increase arterial force.

Decoction. Combine equal parts Prickly Ash and Bayberry. 1 teaspoon to each cup water gently simmered 20 minutes. Half a cup (to which 3 drops Tincture Capsicum, or few grains red pepper is added). Dose: every 2 hours.

Tablets/capsules. Prickly Ash. Bayberry. Motherwort. Cayenne.

Tinctures. Formula. Prickly Ash 2; Horseradish 1; Bayberry 1. 15-30 drops in water every 2 hours. Traditional. Horseradish juice or grated root, in honey.

Life Drops. ... heat exhaustion

Sunstroke. Should not be confused with heat exhaustion.

Symptoms: skin hot, dry and flushed. High temperature and high humidity dispose. Sweating mechanism disorganised. Delirium, headache, shock, dizziness, possible coma, nausea, profuse sweating followed by absence of sweat causing skin to become hot and dry; rapid rise in body temperature, muscle twitching, tachycardia, dehydration.

Treatment. Hospital emergency. Reduce temperature by immersion of victim in bath of cold water. Wrap in a cold wet sheet. Lobelia, to equalise the circulation. Feverfew to regulate sweating mechanism. Yarrow to reduce temperature. Give singly or in combination as available.

Alternatives. Tea. Lobelia 1; Feverfew 2; Yarrow 2. Mix. 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup freely. Vomiting to be regarded as favourable.

Tinctures. Combine: Lobelia 1; Pleurisy root 2; Valerian 1. Dose: 1-2 teaspoons in water every 2 hours. Decoction. Irish Moss; drink freely.

Practitioner. Tincture Gelsemium BPC (1973). Dose: 0.3ml (5 drops).

Alternate hot and cold compress to back of neck and forehead. Hot Chamomile footbath.

Diet. Irish Moss products. High salt. Abundant drinks of spring water.

Supplements. Kelp tablets, 2 thrice daily. Vitamin C (1g after meals thrice daily). Vitamin E (one 500iu capsule morning and evening).

Vitamin C for skin protection. Increasing Vitamin C after exposure to the sun should help protect against the sun’s ultra violet rays, as skin Vitamin C levels were shown to be severely depleted after exposure. (British Journal of Dermatology 127, 247-253) ... heatstroke

An acute infective inflammation of the bone marrow by pyogenic bacteria – most commonly, Staphylococcus aureus. May take the form of a fistula (abnormal passage between the bone and the skin surface) which becomes a vent for elimination of blood and watery pus.

Infection is usually blood-born from dental abscess, tonsils, boil, or old wounds. Prompt modern hospital treatment is necessary to avoid thrombosis or necrosis of bone. Herbal medication can play a substantial supportive role. Differential diagnosis should exclude Infective Arthritis, Cellulitis, Rheumatic Fever, Leukaemia.

Symptoms. Affected bone painful and hot. Throbbing. Fever. Dehydration. Raised E.S.R. Severe general illness.

Treatment. Should enhance resistance as well as combat infection. Comfrey and Echinacea are principle remedies. Infected bone areas are not well supplied with blood, so oral antibiotics may not reach them; this is where topical herbal treatments can assist. Anti-bacterial drinks are available in the absence of conventional antibiotics.

To promote cell proliferation and callous formation: Comfrey root, Marigold, St John’s Wort, Arnica. (Madaus)

To stimulate connective tissue: Thuja.

Comfrey root. Potential benefit outweighs possible risk.

Teas. Nettles. Plantain. Silverweed, Yarrow. Boneset. Marigold petals. St John’s Wort. Comfrey leaves. Singly or in combination. Abundant drinks during the day.

Formula. Echinacea 2; Comfrey 1; Myrrh half; Thuja quarter. Dose – Liquid extracts: 2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon). Three or more times daily in water or honey.

Madaus: Tardolyt. Birthwort: a sodium salt of aristolochic acid.

Maria Treben: Yarrow and Fenugreek tea. Half cup Yarrow tea 4 times daily. To two of such cups, add half a teaspoon ground Fenugreek seeds.

Dr Finlay Ellingwood: Liquid Extract Echinacea 20-30 drops in water four times daily. And: Liquid Extract Lobelia 20-30 drops in water twice daily. Calcium Lactate tablets.

Topical. Comfrey root poultices to facilitate removal of pus, and to heal.

Diet. No solids. Fruit and milk diet for 5 days, followed by lacto-vegetarian diet. Herb teas as above. Plenty of water to combat dehydration.

Supplements. Daily. Vitamin B12 (50mcg), C (3g), D (500iu), E (1000iu). Calcium (1000-1500mg) taken as calcium lactate, Zinc.

General. Regulate bowels. Surgical treatment in a modern hospital necessary for removal of dead bone (sequestrum) and for adequate nursing facilities.

Treatment by a general medical practitioner or hospital specialist. ... osteomyelitis

(Ringer’s mixture) a clear colourless *physiological solution of sodium chloride (common salt), potassium chloride, and calcium chloride prepared with recently boiled pure water. The osmotic pressure of the solution is the same as that of blood serum. Ringer’s solution is used for maintaining organs or tissues alive outside the animal or human body for limited periods. Sterile Ringer’s solution may be injected intravenously to treat dehydration. [S. Ringer (1835–1910), British physiologist]... ringer’s solution

An uncommon genetic disorder in which an enzyme defect blocks the production of corticosteroid hormones from the adrenal glands. Excessive amounts of androgens (male sex hormones) are produced, which can result in abnormal genital development in an affected fetus. Other effects include dehydration, weight loss, low blood pressure, and hypoglycaemia. Hyperplasia (enlargement) of the adrenal glands occurs and there is excessive skin pigmentation in skin creases and around the nipples.

In severe cases, the disorder is apparent soon after birth. In milder cases, symptoms appear later, sometimes producing premature puberty in boys and delayed menstruation, hirsutism, and potential infertility in girls.

Congenital adrenal hyperplasia is confirmed by measuring corticosteroid hormones in blood and urine. Treatment is by hormone replacement. If this is started early, normal sexual development and fertility usually follow.... adrenal hyperplasia, congenital

An inhaled corticosteroid drug used in the treatment of bronchial asthma to prevent asthma attacks. It is administered using an inhaler. Side effects of budesonide, which include hoarseness, throat irritation and, rarely, fungal infections, can be reduced by rinsing the mouth after administration.

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Buerger’s disease A rare disorder, also called thromboangiitis obliterans, in which the arteries, nerves, and veins in the legs, and sometimes those in the arms, become severely inflamed. Blood supply to the toes and fingers becomes cut off, eventually causing gangrene. The disease is most common in men under the age of 45 who smoke heavily. bulimia An illness that is characterized by bouts of overeating usually followed by self-induced vomiting or excessive laxative use. Most sufferers are girls or women between the ages of 15 and 30. In some cases, the symptoms coexist with those of anorexia nervosa. Repeated vomiting can lead to dehydration and loss of potassium, causing weakness and cramps, and tooth damage due to the gastric acid in vomit. Treatment includes supervision and regulation of eating habits, and sometimes, antidepressant drugs and/or psychotherapy. bulk-forming agent A substance that makes stools less liquid by absorbing water: a type of antidiarrhoeal drug. bulla A large air- or fluid-filled bubble, usually in the lungs or skin. Lung bullae in young adults are usually congenital. In later life, lung bullae develop in patients with emphysema. Skin bullae are large, fluid-filled blisters with a variety of causes, including the bullous disease pemphigus.... budesonide

A stone in the kidneys, ureters, or bladder formed from substances in urine.

Most urinary tract stones are composed of calcium oxalate or other salts crystallized from the urine. These may be associated with a diet rich in oxalic acid (found in leafy vegetables and coffee); high levels of calcium in the blood as a result of hyperparathyroidism; or chronic dehydration. Other types of stone are associated with gout and some cancers. An infective stone is usually a result of chronic urinary tract infection.

In developing countries, bladder stones usually occur as a result of dietary deficiencies. In developed countries, they are usually caused by an obstruction to urine flow from the bladder and/or a longstanding urinary tract infection.

The most common symptom of a stone in the kidney or ureter is renal colic (a severe pain in the loin) that may cause nausea and vomiting. There may be haematuria (blood in the urine). A bladder stone is usually indicated by difficulty in passing urine. The site of the stone can usually be confirmed by intravenous or retrograde urography.

Renal colic is treated with bed rest and an opioid analgesic (painkiller).

With an adequate fluid intake, small stones are usually passed in the urine without problems.

The first line of treatment for larger stones is lithotripsy, which uses ultrasonic or shock waves to disintegrate the stones.

Alternatively, cytoscopy can be used to crush and remove stones in the bladder and lower ureter.

In some cases, surgery may be needed.... calculus, urinary tract

Elevation above normal of body temperature. Normal body temperature is 37oC in the mouth and 0.6oC lower in the axilla (armpit). A fever may be accompanied by symptoms such as shivering, headache, sweating, thirst, faster-thannormal breathing, and a flushed face. Confusion or delirium sometimes occur, especially in the elderly; a high fever may cause seizures in a child under 5 years (see convulsion, febrile) or coma.

Most fevers are caused by a bacterial infection such as tonsillitis or a viral infection such as influenza. In these cases, proteins called pyrogens are released when the white blood cells fight the microorganisms that are responsible for the infection. Pyrogens act on the temperature controlling centre in the brain, causing it to raise the body temperature in an attempt to destroy the invading microorganisms. Fever may also occur in conditions, such as dehydration, thyrotoxicosis, lymphoma, and myocardial infarction, where infection is not present.

Drugs such as aspirin or other nonsteroidal anti-inflammatory drugs, or paracetamol may be given to reduce fevers that are due to infections.

Otherwise, treatment is directed at the underlying cause (for example, giving antibiotic drugs for a bacterial infection).... fever

an electrolyte solution used to prevent dehydration in patients who have a large watery output of faecal fluid from their *stoma, often due to *short bowel syndrome. Originally formulated in St Mark’s hospital in London, the solution consists of 1l water, six heaped 5-ml teaspoons glucose, one level 5-ml teaspoon salt, and half a heaped 2.5-ml teaspoon sodium bicarbonate.... st mark’s solution

common salt: a salt of *sodium that is present in all tissues and is important in maintaining the *electrolyte balance of the body. Sodium chloride infusions are the basis of fluid replacement therapy after operations and for conditions associated with salt depletion, including shock and dehydration (see saline). Sodium chloride is also a basic constituent of *oral rehydration therapy and is used to irrigate the eye (e.g. for intraocular surgery) and to treat infections of the bladder (being instilled) and mouth (as a mouthwash).... sodium chloride

(dimethylbenzene) n. a liquid used for increasing the transparency of tissues prepared for microscopic examination after dehydration. See clearing.... xylene

A highly contagious infectious disease, also called whooping cough, which mainly affects infants and young children. The main features of the illness are bouts of coughing, often ending in a characteristic “whoop”. The main cause is infection with BORDETELLA PERTUSSIS bacteria, which are spread in airborne droplets.

After an incubation period of 7–10 days, the illness starts with a mild cough, sneezing, nasal discharge, fever, and sore eyes. After a few days, the cough becomes more persistent and severe, especially at night. Whooping occurs in most cases. Sometimes the cough can

cause vomiting. In infants, there is a risk of temporary apnoea following a coughing spasm. The illness may last for a few weeks. The possible complications include nosebleeds, dehydration, pneumonia, pneumothorax, bronchiectasis (permanent widening of the airways), and convulsions. Untreated, pertussis may prove fatal.

Pertussis is usually diagnosed from the symptoms. In the early stages, erythromycin is often given to reduce the child’s infectivity. Treatment consists of keeping the child warm, giving small, frequent meals and plenty to drink, and protecting him or her from stimuli, such as smoke, that can provoke coughing. If the child becomes blue or persistently vomits after coughing, hospital admission is needed.

In developed countries, most infants are vaccinated against pertussis in the 1st year of life. It is usually given as part of the DPT vaccination at 2, 3, and 4 months of age. Possible complications include a mild fever and fretfulness. Very rarely, an infant may have a severe reaction, with high-pitched screaming or seizures.... pertussis

Three pairs of glands that secrete saliva, via ducts, into the mouth. The largest, the parotid glands, lie on each side of the jaw; the sublingual glands lie on the floor of the front of the mouth; and the submandibular glands lie near the back of the mouth.

The parotid glands are commonly infected with the mumps virus. Stones may form in a salivary duct or gland. Poor oral hygiene may allow bacterial infection of the glands, sometimes leading to an abscess. Salivary gland tumours are rare, except for a type of parotid tumour that is slow-growing, noncancerous, and painless. Insufficient salivation causes a dry mouth (see mouth, dry) and may be due to dehydration or Sjögren’s syndrome, or it may occur as a side effect of certain drugs.... salivary glands

Infections due to any of the salmonella group of bacteria. One type of salmonella causes typhoid fever; others commonly result in bacterial food poisoning, most often through contamination of hens’ eggs or chicken. Infants, the elderly, and people who are debilitated are most susceptible.

Symptoms of salmonella food poisoning usually develop suddenly 12–24 hours after infection and include headache, nausea, abdominal pain, diarrhoea, and sometimes fever. The symptoms usually last for only 2 or 3 days, but, in severe cases, dehydration or septicaemia may develop.

Treatment is by rehydration therapy.

In severe cases, fluid replacement by intravenous infusion may be needed.... salmonella infections

An inherited blood disease in which the red blood cells contain haemoglobin S, an abnormal type of haemoglobin. This crystallizes in the capillaries, making red cells sickle-shaped and fragile, and leading to haemolytic anaemia. The abnormal cells are unable to pass easily through tiny blood vessels. The blood supply to organs is blocked intermittently, causing sickle cell crises. The disease affects mainly black people.Symptoms usually appear after age 6 months, often beginning with painful swelling of the hands and feet. Chronic haemolytic anaemia causes fatigue, headaches, shortness of breath on exertion, pallor, and jaundice. Sickle cell crises start suddenly; they are sometimes brought on by an infection, cold weather, or dehydration, but may also occur for no apparent reason. The sufferer may experience pains (especially in the bones), blood in the urine (from kidney damage) or damage to the lungs or intestines. If the brain is affected, seizures, a stroke, or unconsciousness may result.

In some affected children, the spleen enlarges and traps red cells at a particularly high rate, causing a life-threatening form of anaemia. After adolescence, the spleen usually stops functioning, increasing the risk of infection in those affected.

Diagnosis is made from examination of a blood smear and electrophoresis.

Supportive treatment may include folic acid supplements, and penicillin and immunization to protect against infection.

Life-threatening crises are treated with intravenous infusions of fluids, antibiotics, oxygen therapy, and analgesic drugs.

If the crisis still does not respond, an exchange blood transfusion may be performed.

This may be done regularly for people who suffer frequent severe crises.... sickle cell anaemia

The formation of a thrombus within deep-lying veins in the leg. The cause is usually a combination of slow blood flow through 1 part of the body (such as when sitting for long periods or when the tissues are compressed, as occurs in long-haul aircraft flights) and an increase in the clotting tendency of the blood, which occurs with dehydration, after surgery or injury, during pregnancy, and in women taking oral contraceptives. Deep vein thrombosis may also be caused by polycythaemia. Deep vein thrombosis is common in people with heart failure and those who have had a stroke or who have been immobile for long periods. Clots in the leg veins may cause pain, tenderness, swelling, discoloration, and ulceration of the skin, but they can be symptomless. A deep vein thrombosis is not necessarily serious in itself, but part of the clot may break off and travel in the bloodstream to the lungs. This is known as a pulmonary embolism.

A diagnosis is made by doppler ultrasound scanning.

Treatment depends on the site and extent of the clots.

Small clots may not need treatment if they are confined to the calf and the patient is mobile.

Otherwise, anticoagulant drugs or thrombolytic drugs are given.

If there is a high risk of a pulmonary embolism, thrombectomy may be performed.... thrombosis, deep vein

A simple compound that is essential for all life. Its molecular structure is H2O (2 atoms of hydrogen bonded to 1 of oxygen). Water is the most common substance in the body, accounting for about 99 per cent of all molecules, but a smaller percentage of total body weight. Approximately 2 thirds of the body’s water content is contained within the body cells, and the remaining third is extracellular (found, for example, in the blood plasma, lymph, and cerebrospinal and tissue fluid).

Water provides the medium in which all metabolic reactions take place (see metabolism), and transports substances around the body. The blood plasma carries water to all body tissues, and excess water from tissues for elimination via the liver, kidneys, lungs, and skin. The passage of water in the tissue fluid into and out of cells takes place by osmosis.

Water is taken into the body in food and drink and is lost in urine and faeces, as exhaled water vapour, and by sweating (see dehydration). The amount of water excreted in urine is regulated by the kidneys (see also ADH). Extra water is needed to excrete excess amounts of substances, such as sugar or salt, in the blood, and high water intake is essential in hot climates where a large amount of water is lost in sweat.

In some disorders, such as kidney failure or heart failure, insufficient water is excreted in the urine, resulting in oedema.... water

(DKA) a metabolic state resulting from a profound lack of insulin, usually found only in type 1 *diabetes mellitus but sometimes arising in people of Afro-Caribbean ethnicity with type 2 diabetes. Inability to inhibit glucose production from the liver results in *hyperglycaemia, which can be extreme and lead to severe dehydration. The concurrent failure to suppress fatty-acid production from adipose tissue results in the excess conversion of fatty acids to ketones in the liver (*ketosis) and the development of a metabolic *acidosis, which can be severe. Patients often present with vomiting (from the ketosis), which contributes to the dehydration. The condition is treated as a medical emergency with intravenous fluid and insulin; patients should be monitored in high-dependency units.... diabetic ketoacidosis

(HHS) a state of extreme hyperglycaemia seen in type 2 diabetes accompanied by dehydration that can be severe, typically triggered by illness in a patient with type 2 diabetes or a patient with previously unknown type 2 diabetes. It was previously known as hyperosmolar non-ketotic hyperglycaemia (HONK). Emergency hospital treatment is required to control blood glucose levels and to treat the dehydration and the underlying precipitating cause. There is a significant mortality, especially in the elderly and patients with other disorders (e.g. vascular disease). While insulin is required as part of the initial emergency treatment, the patient often does not need insulin in the longer term, when well.... hyperosmolar hyperglycaemic state

narrowing of the outlet of the stomach (*pylorus). This causes delay in the passage of stomach contents into the duodenum, leading to recurrent vomiting (sometimes of food eaten more than 24 hours earlier), abdominal distension, dehydration, and weight loss. Pyloric stenosis in adults is caused either by a *peptic ulcer adjacent to or within the pylorus or by a tumour invading the pylorus. Stenosis from peptic ulceration may be treated with antisecretory agents, endoscopic balloon dilatation of the pylorus, or by surgical removal or bypass (see gastroenterostomy). Surgery is usually required for cancerous obstruction; in unfit patients and those with metastatic disease a stent can be placed to relieve the obstruction. Congenital hypertrophic pyloric stenosis occurs in babies about 3–5 weeks old (particularly boys) in which the thickened pyloric muscle can be felt as a nodule. Treatment is by the surgical operation of *pyloromyotomy (Ramstedt’s operation).... pyloric stenosis

n. the condition associated with circulatory collapse, when the arterial blood pressure is too low to maintain an adequate supply of blood to the tissues. The patient has a cold sweaty pallid skin, a weak rapid pulse, irregular breathing, dry mouth, dilated pupils, a decreased level of consciousness, and a reduced flow of urine.

Hypovolaemic shock is due to a decrease in the volume of blood, as occurs after internal or external *haemorrhage, burns, dehydration, or severe vomiting or diarrhoea. Cardiogenic shock results from reduced activity of the heart, as in coronary thrombosis, myocardial infarction, or pulmonary embolism. Shock may also be due to widespread dilatation of the blood vessels so that there is insufficient blood to fill them. This is the case in severe *sepsis (septic, bacteraemic, or toxic shock), with a resultant systemic inflammatory response associated with *disseminated intravascular coagulation and multiple organ failure. Vasodilatation may also be caused by a severe allergic reaction (anaphylactic shock: see anaphylaxis), overdosage with such drugs as opioids or barbiturates, or the emotional shock due to a personal tragedy or disaster (neurogenic shock). Sometimes shock may result from a combination of any of these causes, as in *peritonitis. The treatment of shock is determined by the cause.... shock