Hydration V Dehydration.

QRQ 30 · 07-01-2004, 17:30

This is just a question I am throwing up for discussion. Today the trend seems to have swung to the extreme of hydration. You see people carrying and suckiong on bottles of liquid all of the time. A local TV station is handing out bottles to children with marks to show how much they must drink every 30 minutes. At the same time it is a real porker who is handing out the bottles. With all of the talk of an overweight and obese population I wonder how much is just due to excess fluid. I always thought of this as a wive's tale but my parents used to tell me that if I didn't slow down on the iced water, my belly would stretch. There may be something to this after all. Many of the "beer bellys" we see in the AO have nothing to do with being fat -- just distension.

How many hypertensive people in the country are super-hydrating at the same time they are on diuretics?

I guess my point is that the correct action may be somewhere in the middle. What do you boxies think? It might make an interesting study but I doubt if the bottled water and sports drink industry would fund you.

Solid · 07-01-2004, 17:45

I was under the impression that water was like vitamins- if the body needed/wanted it, it would use it, and if not it'd be urinated?

Solid

**The Reaper** · 07-01-2004, 17:54

Quote:

Originally posted by Solid
I was under the impression that water was like vitamins- if the body needed/wanted it, it would use it, and if not it'd be urinated?

Solid

Do a search for "hyponatremia" and get back to us with what you discover.

TR

Solid · 07-01-2004, 18:00

Quote:

Hyponatremia means ‘low concentration of sodium in the blood’. Sodium is an important electrolyte (an element with an electrical charge - in this case Sodium is positive and represented as Na+) which plays a role in water balance and muscle contraction. Sodium is required to draw water through permeable membranes in the body and thereby distribute fluid throughout the body. When you sweat, you lose water and salt, and salt is made up of sodium and chloride and is represented as NaCl, so lots of sweating means you are depleting your sodium stores in the body. If your sodium levels in the blood get too low (hyponatremia) you will no longer be able to move water across permeable membranes and you will become dehydrated - even if you are drinking enough water. You can drink all the water you want, but if you don’t have the sodium present to move it from the gut to the bloodstream, you don’t stand a chance.

Sorry, I was going on what my GP told me when I asked. I guess he didn't think I was threatened by this...

Solid

**The Reaper** · 07-01-2004, 18:06

Quote:

Originally posted by Solid
Sorry, I was going on what my GP told me when I asked. I guess he didn't think I was threatened by this...

Solid

You neglected to mention that it is common among people doing large quantites of water over extended periods, like while rucking.

You also failed to mention that it can kill you.

I have seen it happen many times, and we issue ORS to our students and soldiers.

In the old days, it was why we took salt tablets.

TR

**Roguish Lawyer** · 07-01-2004, 18:09

TR:

What do you think of Gatorade and other drinks that claim to replace electrolytes?

**The Reaper** · 07-01-2004, 18:16

Quote:

Originally posted by Roguish Lawyer
TR:

What do you think of Gatorade and other drinks that claim to replace electrolytes?

Better than just water, plus, IMHO, the flavor causes you to drink more of it.

TR

Guy · 07-01-2004, 18:20

Quote:

Originally posted by The Reaper
You neglected to mention that it is common among people doing large quantites of water over extended periods, like while rucking.

You also failed to mention that it can kill you.

I have seen it happen many times, and we issue ORS to our students and soldiers.

In the old days, it was why we took salt tablets.

TR

I'm a victim of "electrolyte imbalance"...then I went down one time for "over carbohydrates" with out hydrating properly.

P36 · 07-01-2004, 18:40

I was hospitalized for hyponatremia while in 2001 out in Huachuca. It was NOT a good time had by all. Everyone preaches water water water....little did I know it could have killed me.

NousDefionsDoc · 07-01-2004, 21:42

Mmmm

IMO, water is the elixer of life. Like any good thing, you can over do it and I don't believe in forced drinking by the numbers. You should however stay hydrated. I would venture to say that dehydration is much more common than hyponatremia, although Bragg and Benning probably have more than their fair share of the latter.

I drink water, in small amounts, all day long. Not uncommon for me to drink 3-4 32oz Nalgene bottles if its nice out. During what I would call moderate activity.

I like the idea of the Camelbacks. You are forced to take fairly small drinks and work a little to get it. I would be interested to hear of any cases of hyponatremia through their use.

Of course operationally, water comes 3rd behind ammo and comms gear. But a close third. Don't do much good to be well hydrated with a hole in your chest because you ran out of ammo and couldn't get CAS.

P36 · 07-01-2004, 22:50

Well, there I was...knee deep in cactus, 110 degrees out and we were out for a pleasant jaunt. I had a 100oz Camelbak and since I've been a heat casualty before , I knew to take frequent sips off the thing. About 2 hours into the hike, I start getting that dizzy headache feeling and assuming I need more water, drink more. I continue to feel worse and to drink, I still don't have to pee after draining the bag. Hmmm. Boy, I must really be dehydrated. We're near a Ranger station, one of whom gives me some rehydration salts to add to the Camelbak and since I've not had to use the bathroom and my head is splitting, I fill it up again. Anyway, after about another hour, I finally convince someone to get me to the clinic on Huachuca, about a 1 1/2 hour ride away...they run a blood test, look rather concerned and call an ambulance to take me to the ER downtown in Sierra Vista. In the meantime, they start an IV and put some solution in it that IMMEDIATELY causes me to projectile vomit...hahahaha, I feel sorry for those near me :-). I'm put on a gurney and taken to the ER, it's now nighttime. They start me on something that makes me pee every 10 $%@%#$ minutes, along with an IV full of crap like postassium. I finally got discharged at midnight after being forced to drink a cup of liquid postassium and given instructions to eat bananas and salty foods for the next couple of days.

That's my story. I'd never heard that you could almost kill yourself by drinking too much, and after looking it up, learned that a girl in basic training actually died after drinking too much water in too short of a time, trying to prep for a urinalysis.

BTW, this was a "Staff Ride" during ANCOC and one of the FAT piece of shit instructor's actually fucking accused me of trying to sham a ride off the hill we were on. She was rather distant after discovering I came pretty close to not being around anymore. She didn't think I should go at all, then asked if she should perhaps escort me. People always accuse others of what they themselves are guilty of. Fat Piece of Crap. Oh and while I was damn near dying in the van, on the way to Huachuca, the cadre stopped for a rest stop to get ice cream for themselves-relaxing around, until one of the students, pointed out that I looked like I was going downhill. ANCOC, ah, A NCOC, my mentors.

So why is it called a staff ride if you end up walking up and down hills in the desert, studying the history of the US Calvary and the Apache Indians????? Anybody?

Sacamuelas · 07-02-2004, 07:07

P36...
a few questions:

Were you hydrating prior to the your pleasant desert jaunt the night before or even days prior to get "prepared"?
Were you intaking electrolytes the prior days or had you been exercising heavily and replenishing only with water for the days leading up to your episode?
Sipping on a camelbak over a two hours period- Did you finish the whole thing?

ccrn · 07-02-2004, 09:37

Quote:

Originally posted by NousDefionsDoc
I would venture to say that dehydration is much more common than hyponatremia, although Bragg and Benning probably have more than their fair share of the latter

Agreed.

In my flield we consider the general population to be dehydrated overall. People wince when I suggest to them they need to drink 6-8 large glasses of water a day. They prefer to spend money on mountian dew, jolt cola, and 44oz big gulps full of soda.

Dehydration can cause lethargy, difficulty concentrating, confusion, even coma and death. For the average individual not in crisis this is manifested by decreased performance across the board. Students should take note.

Profound hyponatremia can be fatal as previously stated. S/sx are caused by swelling of neurons as a result of decreased osmolality of extracelular fluid causing a fluid shift into the cell.

This can be manifested by CNS S/sx ie malaise, anorexia, nausea, vomiting, HA, confusion, lethargy, seizures, and coma. Much the same as dehydration.

For the provider in the field it is imprortant to take assessment, recent Hx to determine which way to go and then tx according to protocols and training-

ccrn

**The Reaper** · 07-02-2004, 09:54

Not a Doc, but I did stay at a Holiday Inn Express recently, and I have some practical experience at this, so here goes.

Here is my .02.

Keep drinking while moving, especially if you have ORS or other electrolyte replacements.

Keep drinking regardless, even if all you have is water, but salt your food heavily, or if you have plenty of fresh water, consider using your MRE salt packet in one of your quarts. Tastes bad, but works. I would save my salt packets or borrow some.

Drink heavily at water points. Free weight, since you don't have to hump it. See if they have any ORS.

Keep eating. If you do not have pogey bait, save your snack type food from your MREs and munch every few hours while on the move. Food will help some with the elyctrolyte issue, and gives you quick carbs to burn before you are depleted completely.

Urine color and frequency is another very good indicator.

When permitted, move with a buddy and monitor one another.

Recognize the difference between tiredness and pain from exertion, and symptoms of medical issues. Treat at the earliest opportunity. If you are really messed up, see the Doc before you go Tango Uniform. Out on a 12 mile individual movement, there may be no one to hear you scream. This stuff is insidious, and will affect your judgement early on.

Try to prevent it, recognize the symptoms, apply basic treatment, and see the Docs if you do not respond quickly. That is all.

Good luck.

TR

P36 · 07-02-2004, 10:45

Quote:

Originally posted by Sacamuelas
P36...
a few questions:

Were you hydrating prior to the your pleasant desert jaunt the night before or even days prior to get "prepared"?

Were you intaking electrolytes the prior days or had you been exercising heavily and replenishing only with water for the days leading up to your episode?

Sipping on a camelbak over a two hours period- Did you finish the whole thing?

-I don't recall doing anything special to prep. Quite honestly, this was not some sort of forced march, but an actual walk through the desert, visiting historical sites where battles were fought between the calvary and Apaches.

-Just water (and I think that was a KEY ERROR-in retrospect, after gaining some knowledge), no special exercise, just the PT we did for ANCOC and gym workouts.

-After I started to get the dizzy headache, I thought it might be indicative of dehydration and began to drink more. So within 3 hours, I had finished it and started on a new one. (BTW-I too love the Camelbak, but if you don't know there's a limit to how much water you should ingest in a period of time and know how much your Camelback holds, well let's say, it's easy to drink more than is healthy-without realizing it-I corresponded with an Army medical researcher on this topic after the fact, since I'd never heard of HypoN, he had seen some problems with soldiers downing too much with the Camelbak. It's not the device's problem, it's our ignorance of the injury).

The odd thing about this, was that I did not pee more than once throughout the day AND the sypmptoms felt the same as being dehydrated. Dizzy, headache, nausea and weak.

Here are the results of my blood work for those to whom it might mean something:
Sodium: 132 (low)
Potassium 3.1 (low)
Chloride 102
Carbon Dioxide 26
Glucose 116 (high)
BUN 6
Creatinine 0.7
Calcium 8.2 (low)