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March 27, 2016

Hydration and Drinking Water

Hydration and Drinking Water play countless roles in keeping your body alive and healthy. Water allows your body to perfuse your organs with nutrients and oxygen while carrying away metabolic waste to be disposed of. The World Health organization estimates world wide about 1.1 billion people do not have access to safe drinking water. In the emergency department such as FRONTLINE ER we see dehydration on a daily basis.

Things that can cause dehydration:
  1. Vomiting, diarrhea. Pretty obvious.
  2. Excessive sweating. No explanation needed here.
  3. Hyperthermia causes water loss through “insensible loss”, such increased perspiration to keep the temperature down, or fluid loss from the increased respiration rate that accompanies the increased metabolism.
  4. Excessive urination production. People on diuretic medications, or people with diabetes insipidus where the ability of the kidney’s to respond to antidiuretic hormone or the pituitary’s ability to produce antidiuretic hormone is impaired (Sheehan Syndrome).
Symptoms of dehydration are:
  1. Thirst: duh.
  2. Dry mucus membranes: If you body has little water to keep it alive, it will divert all the water it can to your vital organs instead of letting moist escape through your mucus membranes.
  3. Poor capillary refill: when you press on your nail bed, it will turn white but will return to its pinkish state as soon as you let go. For patients suffering from dehydration, this respond is delayed by a few seconds because the body is diverting water away from your extremities and towards your vital organs (brain, heart, kidneys).
  4. Poor skin turgor: this is seen in severe dehydration when your skin doesn’t even have the moisture it needs to maintain its shape.
  5. Dark colored urine: As your get dehydrated, your pituitary produces anti diuretic hormone which allows the kidneys to reabsorb water. More anti diuretic hormone activity means more concentrated urine.
  6. In infants sunken anterior fontanelle is finding of dehydration.
Treatment for dehydration
  1. Anti emetic medications: combats the vomiting so the patient’s gastrointestinal tract has enough time to absorb the water the patient drinks.
  2. Cooling blanking, anti pyretics: lowers the patient’s temperature to reduce insensible loss.
  3. IV fluids: If you are loosing so much fluid because your gastrointestinal tract is not working, then we will just bypass it and deliver the fluids directly into your veins.
  4. Drink more: the cheapest and quickest alternative for patients that can tolerate oral fluids.

Your doctor may order blood work such as an electrolyte panel to evaluate how much damage your kidneys have taken, or derangements of electrolytes (such as sodium and potassium) from vomiting and diarrhea. The good news is acute renal failure from dehydration is reversible if treated promptly. Electrolyte depletion can be replenished before the patient suffers from cardiac arrest or seizures.

Hydration and Drinking Water – Too much of a good thing?

No extra health benefits have been proven from drinking more water than your body requires. Over hydration can be dangerous. Your kidneys work hard to maintain a steady level call homeostasis.  Too much water can dilute your serum sodium levels. This condition is called hyponatremia.  Hyponatremia from fluid overload can cause seizures, brain swelling, irregular heart beats, confusion, headaches, and death.

Patients who suffer from end stage renal disease or congestive heart failure should also be very careful to not drink too much water. Without adequately functioning kidneys to get rid of excess water, the extra fluid puts strain on the right heart and exacerbates symptoms of congestive heart failure.

What are the best and cheapest ways to see if you are adequately hydrated? Two easy ways are checking your urine color, and paying attention to feelings of thirst. Your urine should be the color of yellow lemonade. Clear colorless urine means you are too hydrated and English tea colored urine means you need to drink more. Certain habits and medications interfere with this method, such as, hypertension medications, drinking beer and caffeine acts as diuretics and inhibits your kidney’s ability to reabsorb water, thus making your urine appear lighter than usual.  Pyridium, a common medication given for urinary tract infections can make your urine orange or red.  In young healthy individuals, thirst is a good way of letting you know you need more water. The thirst mechanism may not be as responsive in elderly individuals or individuals suffering from dementia.

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