As our summers are becoming increasingly hotter due to loss of forest cover, increased de-vegetation etc we find more and more people in Goa falling prey to dehydration. Coupled with this, our inability to drink sufficient water to maintain sufficient health of our body. We only drink when we are thirsty and not a minimum fixed quota for good health. Normally 10 -12 glasses of water per day are minimum to maintain good health. This can be divided as 3-4 glasses an hour before breakfast or as soon as you get up in the morning, 3-4 glasses an hour before lunch and 3-4 glasses an hour before dinner. In the summers this requirement increases drastically. Our human body is roughly 75% water and this is found within cells, in between cells and within blood vessels. Although water is constantly lost throughout the day as we breathe, sweat, urinate and defecate we can replenish the water by drinking sufficient fluids. Also the water can move around to those areas of the body where it is needed most. People at risk of dehydration include athletes, those living at high altitude and older people.
Causes of dehydration
Basic causes of dehydration include not taking in sufficient water, losing too much water or a combination of both. Many times we are busy, lack the strength to drink or are at places where there is insufficient potable drinking water eg. while camping or hiking.
Diarrhoea
The large intestine absorbs water from food matter and diarrhoea prevents this. The body excretes too much water leading to dehydration.
Vomitting
This can lead to fluid loss difficult to replace by drinking fluids leading to dehydration.
Sweating
The body’s cooling mechanism releases a significant amount of water. Hot and humid weather and vigorous physical activity can further increase fluid loss from sweating. Similarly, a fever can cause an increase in sweating and may dehydrate the patient, especially if there is also diarrhoea and vomitting. Usually caused by uncontrolled diabetes, but also can be due to alcohol and medications such as diuretics, antihistamines, blood pressure medications, and antipsychotics. Blood vessels can become damaged, causing fluid to leak into the surrounding Tissues.
Symptoms of dehydration
Early symptoms include dry mouth, lethargy and dizziness. Later on decreased urination and dark urine. In fact the colour of urine is a good guide to the degree of hydration. A clear urine indicates that the person is well hydrated and darker urine various levels of dehydration. In older adults dehydration can occur without thirst, hence it is important to drink more water when ill or during hot weather.
Severe dehydration (loss of 10-15 percent of the body’s water) may be characterized by extreme versions of the symptoms above as well as:
* Lack of sweating
* Shriveled and dry skin
* Increased heart rate
* Delirium
* Sunken eyes
* Low blood pressure
* Fever
* Unconsciousness
Symptoms in children
* in babies – a Sunken fontanel (soft spot on the top of the head)
* dry tongue and mouth
* irritable
* no tears when crying
* Sunken cheeks and/or eyes
* no wet diaper for 3 or more hours
Complications of dehydration
Unchecked dehydration can cause serious problems like
1. Less blood volume leading to lowered blood pressure and less oxygen reaching the organs and tissues.
2. Seizures, due to imbalance of electrolytes like sodium, potassium and calcium
3. Kidney problems like kidney stones, urinary infection and even kidney failure
4. Heat injury ranging from mild cramps to heat exhaustion or even heat stroke
Diagnosis
From both clinical symptoms and signs and mental assessment. Tests for blood electrolytes like sodium, potassium and calcium which regulate the degree of hydration and essential for nerve and muscle function.
Tests for kidney functions
Urine analysis- In a dehydrated person, the urine is usually darker in colour and more concentrated containing certain level of ketone compounds.
In infants look for certain soft spot on the skull. Also loss of sweat and certain muscle tone characteristics.
Treatment
Dehydration must be treated by replenishing the fluid level in the body. This can be done by consuming clear fluids such as water, clear broths, frozen water or ice pops, or sports drinks (such as Gatorade). Some dehydration patients, however, will require intravenous fluids in order to rehydrate. People who are dehydrated should avoid drinks containing caffeine such as coffee, tea, and sodas.
Underlying conditions that are causing dehydration should also be treated with the appropriate medication. This may include anti-diarrhoea medicines, anti-emetics (stop vomitting), and anti-fever medicines.
However prevention is the best medicine and one should always keep adequate body fluid level by consuming proper and sufficient fluids.
Dr Edgar Menezes