Agitation

Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense,
confused, or irritable.

Causes

There are many causes of agitation, some of which include:

Alcohol intoxication or withdrawal

Allergic reaction
Caffeine intoxication
Certain forms of heart, lung, liver, or kidney disease
Intoxication or withdrawal from drugs of abuse (such as cocaine, marijuana, hallucinogens, PCP,
or opiates)
Hospitalization (older adults often have delirium while in the hospital)
Hyperthyroidism (overactive thyroid gland)
Infection (especially in elderly people)
Nicotine withdrawal
Poisoning (for example, carbon monoxide poisoning)
Theophylline, amphetamines, steroids, and certain other medicines
Trauma
Vitamin B6 deficiency

http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm

Dehydration(From Medline plus)

Dehydration means your body does not have as much water and fluids as it should.

Dehydration can be mild, moderate, or severe based on how much of the body's fluid is lost or not
replenished. When it is severe, dehydration is a life-threatening emergency.

Causes

Dehydration can be caused by losing too much fluid, not drinking enough water or fluids, or both

Your body may lose too much fluids from:

Excessive sweating (for example, from exercise)

Excessive urine output, such as with uncontrolled diabetes or diuretic use
Fever
Vomiting or diarrhea
You might not drink enough fluids because of:

Loss of appetite due to illness

Nausea
Sore throat or mouth sores

Dehydration in sick children is often a combination of refusing to eat or drink anything and losing fluid
from vomiting, diarrhea, or fever.

Infants and children are more likely to become dehydrated than adults because they weigh less and their
bodies turn over water and electrolytes more quickly. The elderly and people with illnesses are also at
higher risk.

Symptoms (gejala)

Dry or sticky mouth

Lethargy or coma (with severe dehydration)
Low or no urine output; urine looks dark yellow
No tears
Sunken eyes
Sunken fontanelles (the soft spot on the top of the head) in an infant

You may also have vomiting, diarrhea, or the feeling that you "can't keep anything down." All of these
can be causing the dehydration.

Treatment

Drinking fluids is usually enough for mild dehydration. It is better to drink small amounts of fluid often
(using a teaspoon or syringe for an infant or child), instead of trying to force large amounts of fluid at one
time. Drinking too much fluid at once can bring on more vomiting.

Electrolyte solutions or freezer pops are very effective. These are available at pharmacies. Sports drinks
contain a lot of sugar and can cause or worsen diarrhea. In infants and children, avoid using water as the
primary replacement fluid.

Intravenous fluids and a hospital stay may be needed for moderate to severe dehydration. The health care
provider will try to identify and then treat the cause of the dehydration.

Most cases of stomach viruses (also called viral gastroenteritis) tend to get better on their own after a few
days. See also: Diarrhea

See also: Heat emergencies

Outlook (Prognosis)

When dehydration is found and treated quickly, the outcome is usually good.
Possible Complications

Untreated severe dehydration may lead to:

Death
Permanent brain damage
Seizures

Prevention

Even when you are healthy, drink plenty of fluids every day. Drink more when the weather is hot or you
are exercising.

Carefully monitor someone who is ill, especially an infant, child, or older adult. If you believe that the
person is getting dehydrated, call your health care provider before the person becomes dehydrated. Begin
fluid replacement as soon as vomiting and diarrhea start -- DO NOT wait for signs of dehydration.

Always encourage a person who is sick to drink fluids. Remember that fluid needs are greater with a
fever, vomiting, or diarrhea. The easiest signs to monitor are urine output (there should be frequent wet
diapers or trips to the bathroom), saliva in the mouth, and tears when crying.

References

Chen L. Infectious diarrheal diseases and dehydration. In: Marx JA, Hockberger RS, Walls RM, et al, eds.
Rosens Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;
2009:chap 171.

Greenbaum LA. Deficit therapy. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of
Pediatrics. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 54.

Which accompanies disease From Medical.net

Diarrhea: Diarrhea is the most common reason for a person to lose excess amounts of water. A
significant amount of water can be lost with each bowel movement. Worldwide, more than four
million children die each year because of dehydration from diarrhea.
Vomiting: Vomiting can also be a cause of fluid loss. Not only can an individual lose fluid in the
vomitus, but it may be difficult to replace water by drinking because of that same nausea and
vomiting.
Sweat: The body can lose significant amounts of water in the form of sweat when it tries to cool
itself. Whether the body temperature is increased because of working or exercising in a hot
environment or because a fever is present due to an infection; the body uses water in the form
of sweat to cool itself. Depending upon weather conditions, a brisk walk may generate up to 16
ounces of sweat (a pound of water) an hour to allow body cooling, and that water needs to be
replaced by the thirst mechanism signaling the person to drink fluids.
 Diabetes: In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine
and water then follows, which may cause significant dehydration. For this reason, frequent
urination and excessive thirst are among the early symptoms of diabetes.
Burns: The skin acts as a protective barrier for the body and is also responsible for regulating
fluid loss. Burn victims become dehydrated because the damaged skin cannot prevent fluid from
seeping out of the body. Other inflammatory diseases of the skin such as toxic epidermal
necrolysis, also may be associated with significant fluid loss.
Inability to drink fluids: The inability to drink adequately is the other potential cause of
dehydration. Whether it is the lack of availability of water, intense nausea with or without
vomiting, or the lack of strength to drink, this, coupled with routine or extraordinary water
losses can compound the degree of dehydration.

What are the signs and symptoms of dehydration? From Medichinenet

The body's initial responses to dehydration are thirst to increase water intake, and decreased
urine output to try to conserve water loss. The urine will become concentrated and more yellow
in color.

As the level of water loss increases, more symptoms can become apparent. The following are
further signs and symptoms of dehydration.

Dry mouth
The eyes stop making tears
Sweating may stop
Muscle cramps
Nausea and vomiting
Heart palpitations
Lightheadedness (especially when standing)
Weakness
Decreased urine output

The body tries to maintain cardiac output (the amount of blood that is pumped by the heart to the
body); and if the amount of fluid in the intravascular space is decreased, the body tries to
compensate for this decrease by increasing the heart rate and making blood vessels constrict to
try to maintain blood pressure and blood flow to the vital organs of the body. The body shunts
blood flow away from the skin to internal organs, for example, the brain, heart, lungs, kidneys,
and intestines; causing the skin to feel cool and clammy. This coping mechanism begins to fail as
the level of dehydration increases.

With severe dehydration, confusion and weakness will occur as the brain and other body organs
receive less blood. Finally, coma, organ failure, and death eventually will occur if the
dehydration remains untreated.

Type dehydration ? from ehealthstar.com

1. Isotonic Dehydration
When proportionally the same amount of water and sodium is lost from the body, the sodium
concentration of the extracellular fluid and hence its tonicity will not change this is isotonic
dehydration. Statistically, in most cases (~ 80%) dehydration is isotonic 2

Possible Causes of Isotonic Dehydration:

Excessive sweating and not drinking enough

Repeated vomiting
Diarrhea, including secretory diarrhea in cholera 10
Severe bleeding
References: 2,3,4,10

2. Hypertonic (Hypernatremic) Dehydration

When proportionally more water than sodium is lost from the body, the extracellular fluid has increased
concentration of sodium and becomes hypertonic regarding the intracellular fluid and therefore attracts
water from the cells. This results in the cell shrinkage, which may cause brain shrinkage.

Possible Causes of Hypertonic Dehydration:

Diarrhea in children, especially young infants (in 20% of pediatric diarrhea) 2

Water deprivation
Excessive sweating (hot weather, exercise, marathon) 20
Hyperventilation (prolonged fever, anxiety)
Poorly treated diabetes mellitus (osmotic diuresis 17, ketoacidosis 18)
Diabetes insipidus (both central and nephrogenic) 19
Heat stroke 11
End-stage renal failure
Drinking sea water in attempt to treat dehydration
Accidental infusion of hypertonic solutions
Certain diuretics
References 2,3,4,6,7,11

3. Hypotonic (Hyponatremic) Dehydration

When proportionally more sodium than water is lost, the sodium concentration of the extracellular fluids
falls, which therefore becomes hypotonic in comparison to intracellular fluid, so water moves from the
extracellular fluid into the cells. This causes cell swelling, possibly resulting in the brain swelling
(cerebral edema) 1

Possible Causes:

Treating dehydration in small children or marathon runners with fluids that contain little or no
sodium 8
Vomiting or diarrhea (in some cases) 8
Gastrointestinal obstruction, fistula, ileus 8
Heat stroke 3,4,11
Heat exhaustion 4
 Pancreatitis 5,8
Burns 3,7,8
Trauma (muscle damage) 6
Addisons disease 5
Ketonuria 8
Chronic malnutrition 4
Cystic fibrosis with excessive salt loss in sweat 9
Renal tubular acidosis 7
Salt-wasting nephropathy 5,7
Diuretics:
o Prolonged treatment of high blood pressure with low-sodium diet and thiazide diuretics
( hydrochlorothiazide) 5,7,8.
o Furosemide 5,7
o Osmotic diuretics (mannitol) 5,7,8
Accidental infusion of hypotonic fluids 4

Summary of electrolyte imbalances in dehydration:

Dehydration can be present without any significant electrolyte imbalance.

Hypernatremia is a result of dehydration.
Hyponatremia is not a result of dehydration but a result of replacing lost fluid by plain water
without sodium.
Hyperkalemia may be triggered by dehydration; it can be also present in acute or chronic kidney
failure, Addisons disease and diabetes 1, or destruction of the red blood cells in burns 18,19.
Hypokalemia can develop in vomiting or diarrhea 16.
Mild and transient hypermagnesemia 13 and hypercalcemia 14 may result from decreased
amount of water in the blood (pseudo-hypermagnesemia and pseudo-hypercalcemia).
Hypocalcemia and hyperphosphatemia can occur in severe diarrhea 15.

How is dehydration diagnosed? from medicinenet

Dehydration is often a clinical diagnosis. Aside from diagnosing the reason for dehydration, the
health care professional's examination of the patient will assess the level of dehydration. Initial
evaluations may include:

Mental status tests to evaluate whether the patient is awake, alert, and oriented. Infants and
children may appear listless and have whiny cries and decreased muscle tone.
Vital signs may include postural readings (blood pressure and pulse rate are taken lying down
and standing). With dehydration, the pulse rate may increase and the blood pressure may drop
because the blood is depleted of fluid. People taking beta blocker medications for high blood
pressure, heart disease, or other indications, occasionally lose the ability to increase their heart
rate as a compensation mechanism since these medications block the adrenaline receptors in
the body.
Temperature may be measured to assess fever. While it is common to measure temperature in
the ear (tympanic) or by mouth (orally), a rectal thermometer may be used to assess core body
temperature if the patient appears warm, but no fever is noted tympanically or orally.
 Skin may be checked to see if sweat is present and to assess the degree of elasticity (turgor). As
dehydration progresses, the skin loses its water content and becomes less elastic. The amount
of sweat is often felt in the armpit or groin, two areas that tend to have moisture normally.
The mouth can become dry and the health care professional may look at or feel the tongue to
see how wet it is.
Infants may have additional evaluations performed, including checking for a soft spot on the
skull (sunken fontanelle), and assessing the suck mechanism, loss of sweat in the armpits and
groin, and muscle tone. All are signs of potential significant dehydration.
Pediatric patients are often weighed during routine child visits, thus a body weight
measurement may be helpful in assessing how much water has been lost with the acute illness.
This is very rough estimate because all scales are not the same, and for infants and children, it is
important to know what clothing they were wearing when the original weight was taken.

Symptoms of heat-related illness? (http://www.betterhealth.vic.gov.au)

It is important to know the signs and symptoms of heat exposure and how you should respond.
Symptoms vary according to the type of heat-related illness. Babies and young children may show signs
of restlessness or irritability and have fewer wet nappies. Older people may become lightheaded,
confused, weak or faint.

Some heat-related illness and common symptoms include:

Deterioration in existing medical conditions this is the most common health problem of heat
stress.
Heat rash sometimes called prickly heat, this is a skin irritation caused by excessive sweating.
It can occur at any age, but is most common in young children. It looks like a red cluster of
pimples or small blisters. It is most likely to occur on the neck and upper chest, in the groin,
under the breasts and in the elbow creases.
Heat cramps these include muscle pains or spasms, usually in the abdomen, arms or legs. They
may occur after strenuous activity in a hot environment, when the body gets depleted of salt
and water. They may also be a symptom of heat exhaustion.
Dizziness and fainting heat-related dizziness and fainting results from reduced blood flow to
the brain. Heat causes an increase in blood flow to the skin and pooling of blood in the legs,
which can lead to a sudden drop in blood pressure. There can be a feeling of light-headedness
before fainting occurs.
Heat exhaustion this is a serious condition that can develop into heat stroke. It occurs when
excessive sweating in a hot environment reduces the blood volume. Warning signs may include
paleness and sweating, rapid heart rate, muscle cramps (usually in the abdomen, arms or legs),
headache, nausea and vomiting, dizziness or fainting.
Heat stroke this is a medical emergency and requires urgent attention. Heat stroke occurs
when the core body temperature rises above 40.5C and the bodys internal systems start to shut
down. Many organs in the body suffer damage and the body temperature must be reduced
quickly. Most people will have profound central nervous system changes such as delirium, coma
and seizures. The person may stagger, appear confused, have a fit or collapse and become
unconscious. As well as effects on the nervous system, there can be liver, kidney, muscle and
heart damage.
The symptoms of heat stroke may be the same as for heat exhaustion, but the skin may be dry
with no sweating and the persons mental condition worsens.

Treatment for heat-related illness?((http://www.betterhealth.vic.gov.au))

Treatment options vary according to the type of heat-related illness. Apply first aid and seek medical
assistance immediately if you, or someone you are with, shows any sign of heat exhaustion or heat
stroke.

Heat rash treatment

Treatment for heat rash includes:

Move the person to a cooler, less humid environment.

Keep the affected area dry.
Try using unperfumed talcum powder to increase comfort.
Avoid using ointments or creams, as they keep the skin warm and moist, and may make the
condition worse.

Heat cramps treatment

Treatment for heat cramps includes:

Stop activity and sit quietly in a cool place.

Increase fluid intake.
Rest a few hours before returning to activity.
Seek medical help if there is no improvement.

Dizziness and fainting treatment

Treatment for dizziness or fainting includes:

Get the person to a cool area and lay them down.

If fully conscious, increase fluid intake.

Heat exhaustion treatment

Treatment for heat exhaustion includes:

Get the person to a cool area and lay them down.

Remove outer clothing.
Wet skin with cool water or wet cloths.
 Increase fluid intake if they are fully conscious.
Seek medical advice.

Heat stroke treatment

Heat stroke is a medical emergency and requires urgent attention:

Call triple zero (000) for an ambulance.

Get the person to a cool, shady area and lay them down while youre waiting for emergency
medical help.
Remove clothing and wet their skin with water, fanning continuously.
Do not give the person fluids to drink.
Position an unconscious person on their side and clear their airway.
If medical attention is delayed, seek further instructions from ambulance or hospital emergency
staff
Last Skenario from blok 4

By. Tommy Akroma (Tutorial 10)

A 68 years old male pilgrim performed the thawaf in the mid day. At the sixth
round of the ritual, he agitated and then fall. Their friends helped and brought him
immediately to the edge. When his body was touched, it was hot. The hajj officer
water him by zam zam water. Before thawaf he had little drink becaused fear to
the urge to urinated during thawaf.

1. Explanation complete about agitated?

2. Explanation complete about dehydration?
3. Which accompanies disease dehydration?
4. What are the signs and symptoms of dehydration?
5. Type dehydration ?
6. How is dehydration diagnosed?
7. Symptoms of heat-related illness?
8. Treatment for heat-related illness?