What is chronic dehydration?
Chronic dehydration is persistent water deficiency that results in loss of more than 1% of body weight. By definition, dehydration is called chronic if it lasts for more than one day .
Causes of chronic dehydration are same as causes of acute dehydration. Common causes of chronic dehydration that may go unnoticed are insufficient drinking, excessive sweating and excessive urination triggered by diuretic pills or untreated diabetes mellitus.
1. Old Age
Elderly people may be at increased risk of dehydration due to:
- Decreased feeling of thirst
- Anorexia due to a chronic disease
- Swallowing problems
- Fear of incontinence
- Long-term use of diuretics
- Being bedridden
- Being neglected in a nursing home
- Reference: 12
2. Insufficient drinking
- Skipping meals
- Young athletes 
- Constant nausea that leads to avoiding drinking and eating, for example, in pregnant women with severe morning sickness (hyperemesis gravidarum)
- Chronic stress 
- Anorexia nervosa
- Chronic alcoholism or drug addiction in combination with irregular diet
- Low salt consumption that can lead to less thirst
- Working in a hot climate (miners, workers in rubber, iron-producing factories and such)
- Traveling, hiking, climbing and outdoor work
- Thyroid disease (hyperthyroidism)
4. Chronic diarrhea
- Recurrent diarrhea due to gastroenteritis (rotavirus infection, cholera) in small children
- Celiac disease or Crohn’s disease, mainly in young adults
- Parasitic infections, mainly in poor areas of India, Central and South America and Africa
- Untreated diabetes mellitus or diabetes insipidus
- Taking diuretics (water pills)
6. Chronic vomiting
- Chronic kidney failure, cirrhosis, pancreatitis
- Pregnancy with morning sickness
- Bulimia nervosa
A doctor can make a diagnosis of chronic dehydration from symptoms (problems you tell the doctor) and signs (physical abnormalities a doctor finds during a physical examination) [6,10,12].
- Thirst (often absent), dry mouth, bad taste, bad breath
- Fatigue, sleepiness and yawning
- Constipation and eventual bloating
- Poor appetite, nausea
- Headache, worsening of migraine attacks
- Dry skin, less sweating than expected from the ambient temperature
- Anxiousness, depression, impatience, irritability, difficulty falling asleep (insomnia)
- Short attention span, impaired short-term memory
- Joint stiffness and pain, such as knee pain, muscle soreness
- Craving for sugar and other carbohydrates
- Fast heart rate or palpitations (in more severe dehydration and in people under stress)
- Drop of body weight
- Dry mouth mucosa and tongue
- Dry skin, brittle hair
- Prolonged skin turgor (the time needed for skin to recoil after being pinched and released)
- Prolonged capillary refill time (the time in which a nail regains its normal pink color after being pressed for few seconds)
- Dark urine
Blood and urine tests are not very useful for the estimation of chronic dehydration . A doctor can check sugar and electrolytes in the urine, when he or she suspects an underlying disease, such as diabetes mellitus or insipidus.
Chronic dehydration is a risk factor for kidney stones, especially in the individuals with other risk factors, such as high dietary oxalate intake and genetic predisposition for kidney stones [4,5,6].
“Chronic cellular dehydration”
Dehydration leads to dehydration of the body cells, and chronic dehydration leads to “chronic cellular dehydration.” The term has no specific meaning and it just means “chronic dehydration;” advertisers who try to sell remedies that “cure” dehydration tend to use it.
Other Possible Effects of Chronic Dehydration
According to the medical literature, other consequences of chronic dehydration may include:
- Urinary tract infections (UTI) and incontinence [6,12]
- Acid reflux, which can cause heartburn 
- Poor digestion due to lack of saliva and digestive juices 
- An increased release of histamine, which stimulates the release of cortisol, which suppresses the development of white blood cells (leukocytes), which can result in a greater susceptibility to allergies
- An aggravation of symptoms of asthma because thick mucus can be harder to cough up 
- Postnasal drip 
- Constipation, which results in a need to strain and eventually in a development of hemorrhoids or large-intestinal diverticles (diverticulosis) 
- Craving for food, which can result in weight gain 
- High blood cholesterol levels 
- Diabetes 2 
- Decreased kidney function that may lead to chronic kidney failure in individuals with pre-existing kidney disease 
- Pressure ulcers in bedridden patients 
- Increased risk of hospital-acquired pneumonia 
- Increased risk of stroke 
- Liver damage 
Less Likely Effects of Chronic Dehydration (Lack of Evidence)
- Acne, Candida infection, eczema, hives (urticaria), hair loss
- Irritable bowel syndrome (IBS)
- High blood pressure
- Muscle spasms
- Ringing in the ears (tinnitus)
- Fluid retention (edema)
How to recover from dehydration?
- Drink as much fluid as needed to maintain clear (colorless or pale yellow) urine. How much water do I need to drink in a day?
- If you think you may have a disease that causes dehydration, such as diabetes mellitus or kidney disease, visit a doctor.
Are there any remedies to treat dehydration?
The only remedy for chronic dehydration is drinking enough water. Water that contains some sodium, such as certain mineral waters, can make water tastier and therefore easier to drink. Vegetables, fruits, cooked cereals and soups also contain water.
Zinc supplements can help individuals with chronic diarrhea caused by zinc deficiency .
What are signs of recovery from dehydration?
You can assume you are well hydrated if:
- You excrete at least 300 mL of clear or pale yellow urine in the morning
- The skin on the back of your hand recoils instantly when you pinch and release it (except if you have wrinkled skin)
- Fiu.edu (Dehydration in athletes)
- PubMed (Fasting, dehydration and cholesterol levels)
- Batmanghelidj, F., MD, Water for Health, for Healing, for Life, Warner Books, 2003
- PubMed (Kidney stones statistics)
- PubMed (Urolithiasis)
- Hawaii.edu (Dehydration consequences)
- WebMD (Dehydration and stress)
- Uark.edu (Dehydration in young athletes)
- Nyee.edu (Dehydration, allergies and laryngitis)
- PubMed (Terminally ill patients)
- Lazzerini M et al, 2013, Oral zinc supplementation for treating diarrhoea in children Cochrane
- Nursingtimes.net (Dehydration in the elderly)
- NHS.uk (Dehydration complications)