The Dangers of Dehydration

The Dangers of Dehydration

Most adults understand the concept of dehydration. It is the state where the body puts out or loses more water than it takes in. A lot of common sense advice stems from this understanding: “drink plenty of fluids if you are going to be working in the sun” or “Rest and drink lots of fluids while you have that fever.” This is good advice, and is physiologic in a scientific sense. There are other things which can affect hydration and fluid balance.

First of all, the kidneys are highly refined organs which maintain fluid balance. They can deal with a few per cent age points of dehydration by regulating how much urine they put out and how much water is reabsorbed. This fine measure of fluid regulation is increased by the posterior pituitary gland of the brain in its secretion of vasopressin, or anti-diuretic hormone. This hormone causes the distal convoluted tubules of the kidney to reabsorb more water and thus conserve fluids.

Other body organs act in a manner to circulate the fluid which is present. If there is too little plasma present, the heart may increase the pulse. The sweat glands may diminish or cease the excretion of sweat ;( this unfortunately can cause elevated body heat and further dehydration.) The body is geared to lose two to three liters of fluid per day in urine, breath and sweat, and if loss is greater than this without adequate replacement these mechanisms start to kick in to deal with dehydration.

One sign that dehydration is well-recognized is the large container of electrolyte solution at the team bench during a football game. Trainers and coaches recognize that athletic performance can fall off thirty percent due to dehydration. They often use large humidified fans to increase heat loss from the skin and thereby decrease dehydration. Unfortunately a lot of intramural wrestlers don’t realize this when they dehydrate themselves purposely to get in a lower weight divisions.

If you look at the world as a whole, diarrheal dehydration is a leading cause of death, especially in infants. This is due to polluted water supplies and close living conditions. The world Health Organization has tried to widely disseminate a simple recipe for electrolyte solution which could no doubt save thousands of these infants, but its use has not been widely used. The third world countries have, in addition to viral gastroenteritis, shigellosis, yellow fever, and cholera, which can also cause severe dehydrative medical illness.

It is by far on a smaller scale, but here in the U.S. we certainly have our share of dehydration due to gastrointestinal disease, usually vomiting and diarrhea. When a person presents with this sort of illness, the practitioner has to estimate the degree of fluid loss and dehydration. If the condition has reached the stage of increased heart rate, decreased blood pressure, diminished urine output, and decreased mental status, consideration for I.V. fluid and hospitalization has to be a part of the decision process.

There are other pathologic processes which can lead to dehydration. Two such cases would be anorexia and bulimia. In the former, there may be inadequate intake of fluids and electrolytes, and in the latter, these may be lost in the compulsive vomiting behavior. Another scenario is the hemorrhage incurred in trauma, surgery, or childbirth. Hemorrhage victims often complain of extreme thirst, and this in itself is a sign of dehydration. There can be profound dehydration in the case of extreme glucose elevations in diabetic ketoacidosis. The glucose can draw the water out of bodily cells which is then lost by extreme kidney diuresis. Another cause of dehydration can be excessive exercise without appropriate fluid replacement. There are people who are as compulsive about exercise as anorectics are about food, and they can get themselves into dehydration trouble. Other sources of dehydration are excessive intakes of alcohol, burns, and use of amphetamines and stimulants.

What might you look for in a person suspected of dehydration? Increased heart rate and increased respirations might be present. There may have fever, dry skin, and a dry mouth. Urine may be scarce and dark in color. The dehydrated person may have a hangover-like headache, and complain of extreme fatigue. If there is delirium, dehydration may have reached a critical stage. Ideally treatment would be started with I.V. electrolyte fluids. Under less ideal circumstances sips of electrolyte oral fluids would be in order, and if this is not available, very small sips of water would be indicated.

There is a certain amount of debate about the eight glasses of water a day rule. Some experts argue that if you drink when you are thirsty, this will be sufficient, and that eight glasses is too much. The elderly tend to lose their sense of thirst, so a certain pre-determined amount of water intake may be wise. Certainly if one had nausea, it might be difficult to match fluid intake with thirst, and anti-nauseates may be necessary. If you think you or a member of your family is dehydrated, contact your M.D.

John Drew Laurusonis

Doctors Medical Center

www.doctorsmedicalctr.com

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