Dr Nandini Saini writes about understanding dehydration and preventing it.
Water is one of the most important components of the body. The human body is composed of about 75% water; our skin, organs, even bones have water as a component. Water balance is maintained in the body by various mechanisms, and we replenish water by drinking more, whenever our body sends a signal (thirst).
Dehydration is a condition where the fluid output from the body is more than the intake, which means you’re losing more fluids and water than you’re drinking. The body ceases to function normally and begins to show signs and symptoms which should tell you that you’re dehydrated.
When you lose fluid, you also lose a little salt and electrolytes, which would also need to be replaced.
Infants and young children are most at risk of dehydration. However, certain conditions and circumstances can cause water depletion in adults too.
Causes
Normal body functions
Regular body functions like perspiring, urination and defecation cause water depletion in the body. Minor functions like salivation and crying also cause the body to lose water. Our body can easily replace this loss with the water we drink. However, certain conditions can cause these regular functions to lose excessive water, causing dehydration.
Hyperhidrosis (excessive sweating) can cause you to lose water as well as salt and electrolytes.
Frequent urination can also result in loss of fluids and electrolytes from the body, causing dehydration.
Outdoor activities
Exposure to sun or a high temperature for an extended period of time can cause dehydration. Athletes, swimmers and people working outdoors, like builders and landscapers, can be at risk.
Fever
A high body temperature (over 101 degrees F) causes you to perspire, possibly causing dehydration. This is because the body, in an attempt to lower temperature, loses fluids and electrolytes through the skin.
Diseases
Any disease which results in the body throwing out fluids can cause dehydration.
Gastric diseases resulting in excessive vomiting or diarrhoea, which an individual is unable to replenish, would result in dehydration.
Excessive urination, due to infection, diabetes or taking diuretics, could also cause you to lose fluids.
Uncontrolled diabetes can cause dehydration due to UTI.
Injuries
Severe injuries to the skin, such as burns, infections, and conditions such as psoriasis damage the blood vessels and cause fluid depletion through the skin surface.
Inability to get water
At times, there is no access to potable water (in a desert, or hikes for example). Eventually, the person would suffer dehydration, if access to water is not available.
Inability to consume water
Infants or geriatric patients are often unable to consume fluids independently. Left unattended, they could get dehydrated. Similarly, patients in a coma could suffer.
Inability to detect dehydration
As the body ages, its ability to detect fluid depletion can also reduce. Seniors may not realise they are dehydrated till it becomes a severe problem.
Very often, it is simple neglect on our part, such as ignoring thirst or abstaining from fluids to avoid a visit to the washroom, which can get us into a state of dehydration.
Symptoms
Dehydration ranges from mild to severe, depending on the amount of fluid lost. One would start noticing symptoms after loss of 2% fluid, or more. Loss of 5 % to 6 % fluid would cause symptoms of mild to moderate dehydration…15 % or more is considered severe and can prove fatal, if not treated in time.
Mild to moderate:
- Polydipsia (Increased thirst)
This is one of the first symptoms of dehydration. Unfortunately, it occurs only after dehydration has occurred. Any condition that causes fluid loss can trigger excessive thirst. It can, however, be masked in the elders, so it’s important to keep them hydrated, especially in sickness.
- Food craving
Dehydration causes energy sources in the body to deplete. Also, it becomes difficult for organs like the liver to process and use stored glucose in the body. As a result, the body craves food, especially sweets.
- Dry mouth
Reduced fluid in the body results in reduced formation of saliva in the mouth, causing dryness. People often describe it as cotton in the mouth.
- Halitosis (Bad breath)
Loss of fluid in the mouth causes saliva to reduce, resulting in an increase in the bacteria, hence the halitosis.
- Fatigue (Tired or sleepy)
Most people complain of fatigue, tiredness when they are dehydrated. This is due to the drop in BP as well as loss of electrolytes.
- Decreased urine output
Urine is low in volume and more yellowish to amber in colour. This should tell you that you could be dehydrated; the colour of urine in a hydrated person is clear to light yellow.
- Headache
A headache is a common symptom of dehydration, very similar to a migraine. It occurs because the brain cells temporarily shrink in response to fluid depletion. Also, blood vessels dilate in an attempt to provide enough fluid and oxygen to the brain.
- Dry skin
The skin loses water due to heat as well as cold. It can become rough and flaky, shriveled, flushed, cold and clammy. The elasticity is lost.
- Nausea
Dehydration can cause nausea and vomiting, which in turn increases the fluid loss, forming a viscous cycle.
- Muscle cramps
Extreme heat, while causing dehydration, also causes the muscles to seize up, resulting in painful cramps in the calves. Loss of electrolytes can further worsen the condition.
- Dizziness
The brain is made up of 73% water; reduction of fluid can, therefore affect the brain, causing dizziness in patients. It can also get compounded by low BP and the reduction of blood flow to the brain due to low volume of fluid.
- Few or no tears
When you lose fluids, the body diverts the balance fluid to organs which need it more. This causes reduction in tears.
- Constipation
Water is important to maintain a normal bowel movement, to keep the waste moving in the GIT. Dehydration will cause the waste to back up, causing hard, lumpy stools that are difficult to evacuate.
- Impaired brain functions
Dehydration can cause a person to act confused and disoriented, loss of memory and coordination. It is known to affect driving, like crossing lanes without realizing or failing to brake in time.
Severe:
- Decreased urine output
Severe dehydration results in severely decreased or no urine output. The urine, if any, produced is concentrated and dark colored.
- Hypotension
Blood has fluid as a major constituent…fluid reduction can cause blood pressure to drop, especially when the person tries to stand after lying down (low blood pressure or orthostatic hypotension)
- Dizziness or lightheadedness
Advanced dehydration does not allow the person to stand or walk normally, probably due to low blood pressure.
- Fainting
Fainting occurs due to fall in blood pressure and blood volume, especially on sudden movement.
- Rapid heart rate and respiratory rate
Fluid loss leads to low blood volume, making the heart work harder to pump blood to all parts of the body. You may experience palpitations. The low blood volume also results in less oxygen reaching the lungs, causing an elevated respiratory rate.
- Fever
Dehydration, caused by exposure to heat, can show symptoms like fever, which in turn increases the dehydration further, as the body tries to cool off, causing perspiration. Fever above 102F should not be ignored.
- Shrunken skin with reduced elasticity (skin slowly sinks back to its normal position when pinched)
Dehydrated skin feels dull and tight, and loses its elasticity. You could observe more wrinkles around your mouth and eyes.
- Sunken eyes
Hollows under the eyes, dark circles, fragile skin under the eyes, are all signs of dehydration, most commonly seen in children.
- Mood changes
Severe dehydration can trigger mood changes, ranging from anxiety to confusion to delirium. Cognition is impaired, higher levels of irritability can be seen.
- Shock and Seizures
The loss of electrolytes, along with fluid, can cause the person to go into shock. This and the low BP can also trigger seizures.
- Unconsciousness
Dehydration, especially due to heat exposure, can cause a person to become delirious and lose consciousness.
Specific symptoms in children
A sunken fontanel (soft spot on the top of the head).
Sunken cheeks and/or eyes
Dryness of mouth and the tongue.
Increased irritability.
No tears when crying
No diaper wetting for 3 or more hours (reduced or no urination).
Testing for dehydration
Pinch the skin of your forearm or abdomen for a second and let go. If it doesn’t resume its normal shape less than 3 seconds, you could be dehydrated.
Apply pressure on your nailbed, draining it of blood. If it doesn’t refill within 2 to 3 seconds, it could be a sign of dehydration.
Treatment
The most important treatment is to replenish not only the lost water, but salt and electrolytes as well. If only water is replaced, the symptoms might persist.
Encourage the person to have small sips of fluids – preferably with electrolytes.
They can suckle ice popsicles, which will also moisturize the mouth and tongue.
Sipping through a straw is a good option for those on bed.
In emergency, mix a spoonful of salt and sugar to water and administer to the patient.
If they have been exposed to heat, reduce the amount of clothing they wear.
Maintain a cool atmosphere, like an air conditioned room, to reduce heat.
Place a wet towel on the person’s forehead.
Be careful NOT to give icy water quickly, as it might increase dehydration by constricting the blood vessels further.
If the person seems disoriented or semi-conscious, hospitalization is required, where fluids and electrolytes can be given intravenously.
If children are affected, do not hesitate to seek medical assistance, as their health can deteriorate suddenly. This also holds true for elderly people.
Prevention
As we all know, prevention is always better than cure…here are a few suggestions for keeping yourself hydrated.
Always keep a bottle of water within reach; if it’s in front of you, chances are you will drink it.
Include fruits and veggies with high water content in your diet – watermelons, cantaloupe, and green leafy vegetables are all good.
If you are exposed to heat, increase your fluid intake. Try consuming drinks with electrolytes, like coconut water, lemon juice or sports drinks.
Similarly, if you are an athlete, or frequently workout, your fluid requirements will be more than others. Adjust liquids accordingly.
Where children or elderly people are concerned, be extra cautious- keep hydrating them frequently.
Limit your exposure to heat, and dress in loose clothing.
Try to avoid alcohol, especially if it’s very hot, as alcohol causes loss of fluids from the body.
Some foods and drinks that are very good alternatives to water are:
Coconut water
Coconut water is one of the best alternatives to plain water. Not only is it refreshing, it is very rich in electrolytes and can replenish any that you may have lost. Drink it slowly instead of guzzling it down, for better results. Try to have fresh coconut water; if you’re depending on packaged coconut water, be sure to check the ingredients and avoid any with added sugar.
Milk
Milk is a very healthy drink, rich in electrolytes, proteins and carbs. It also has a small quantity of sodium, which helps in retaining fluid. It can be consumed cold, especially if you’re feeling nauseous. It is also a good option for children, who are usually comfortable with milk.
Soups
Soups are a healthy and wholesome food, rich in proteins, vitamins and electrolytes. They provide a good quantity of fluid too. If you’re having an animal based broth, you get the added benefit of collagen, which helps in strengthening the joints.
Tomato based soups like gazpacho and minestrone have the added benefit of fluid, as tomatoes have a very high liquid content.
Smoothies
Smoothies, again, are very versatile, with a liquid base like juice or milk, and the added benefits that the fruits and veggies impart.
Dehydration is a common and often preventable condition. You should make it a habit to hydrate yourself, having liquids at short intervals.
