Have you ever heard of Samuel Taylor Coleridge? One of his most famous lines: “Water, water everywhere, nor any drop to drink” refers to a mariner that is surrounded by the sea, yet unable to quench their thirst.
Today, our technology is so greatly advanced that obtaining fresh drinking water is no longer an issue. We have invented various processes to purify the water around us and make it potable to drink. Yet despite water being readily accessible, we still do not drink enough of it.
In 2018, a survey by Quench USA revealed the following:
80% of working Americans do not consume enough water daily.
Some of the main reasons cited were a lack of thirst, and not having enough time to access it
Those who live in the South tend to consume more water compared to those in the Northeast
People who do not exercise on a regular basis also tend to consume less water (Goodman et al., 2013).
Why is it important to stay hydrated?
1) It is an essential tool against COVID19.
Staying hydrated is important, especially during these uncertain times. The current pandemic has infected millions and has most of at least concerned. Keeping yourself hydrated is important for every process in our body, including our immune system, fighting off the virus and recovering from it.
In fact, The American Society for Parenteral and Enteral Nutrition (ASPEN) recently released a guideline for COVID-19 suspects or patients who are recovering at home.
One of the key manifestations of the COVID-19 infection is fever. At a body temperature of 102°F, we lose approximately 30 ounces of body fluid in a day. This does not include fluid loss from COVID-19 symptoms such as coughing and breathing.
Other symptoms such as vomiting, diarrhea and loss of appetite may further contribute to fluid loss. As a result, many patients who become infected are at high risk of dehydration.
Dehydration may also predispose COVID-19 patients to pneumonia, as it thickens respiratory secretions such as mucus. If not cleared, these secretions can accumulate in the lungs and make breathing difficult.
ASPEN (2020) advises recovering patients to drink small, frequent sips or 2-4 ounces of water every 15 minutes. To monitor your hydration status, check the color of your urine and how frequently you urinate. Urination should occur every 3-4 hours, and be a color shade of light yellow.
Adding a dash of lemon or cucumber can help to improve the taste of water. Other alternatives include sugar-free electrolyte rich drinks or sports drinks with no added sugars.
Stay away from carbonated sodas and other sweetened beverages - they contain high amounts of sugar that will make you more prone to dehydration.
Even if you do not contract the infection, it is important to always stay adequately hydrated. Your body will stand a much better chance at fighting any illness.
2) It can promote weight loss.
The role of water in regards to weight loss has been studied extensively over the years. One study involving obese individuals led to the discovery that drinking at least 2 cups of water before each meal helps with reducing weight. As drinking large amounts of water provides a sensation of fullness, it leads to less food consumption overtime (Dennis et al., 2009).
When the temperature rises, so do our cravings for cold and sweet beverages – especially during mealtimes. According to one study, the total energy intake of people who drink sugar-sweetened beverages is 7.8% higher, compared to those who drink water with their meal (Daniels & Popkin, 2010).
In some animal studies, weight loss was even directly correlated to water consumption. The more water they drank, the more weight they lost. Keeping your body hydrated is important, as dehydration leads to several mechanisms within our body that promotes weight gain, as well as increases the risk for diabetes, cancer and cardiovascular diseases (Thornton, 2016).
If you’re looking to shed a few pounds this summer, start by increasing your water intake!
3) It can lower your risk for certain diseases.
Adequate hydration can lower the risk of developing specific conditions. For example, a high fluid intake has been shown to improve outcomes for patients with urolithiasis or kidney stones, as well as lower the risk of stone recurrence.
The frequency of urination is directly correlated to the amount of fluid you take in. You may have even noticed this yourself - when you drink a large amount of water, you feel a need to urinate more frequently. Water plays a vital role in keeping your urinary tract healthy.
Frequency of urination is associated with recurrent UTI in women. Those that urinate less frequently are at higher risk of developing UTI’s.
4) It can prevent pregnancy complications.
During pregnancy, the last thing on your mind is to keep yourself hydrated. You’re more likely to be worried about your appearance, or when the baby will be due. However, it is something that should not be ignored. Besides taking responsibility for themselves, pregnant women are also responsible for their baby, which requires plenty of energy and water.
The amount of food you consume correlates to the amount of water you need. As pregnant women need more calories, they also require greater amounts of water. To put it into comparison, an increase of 300 calories would require an additional 300ml of fluids.
Water consumption also plays a vital role for nutrient absorption in the gut. For optimal absorption, take a glass of water alongside water-soluble vitamins such as Vitamin C, nicotinic acid, Vitamin B12 and Vitamin B6.
The total amount of fluid in the body increases during pregnancy. Blood volume increases in preparation for blood loss during childbirth, and higher amounts of fluid are also required for fetal circulation, and for adequate amniotic fluid volume (Montgomery,2002). Without sufficient amniotic fluid, a fetus will not have enough room to develop and grow, which can lead to complications.
In fact, one study on pregnant women showed that dehydration was associated with lower infant birth weight and length, compared to those who were adequately hydrated in their pregnancies. This highlights the importance of fluid intake in fetal growth and development (Mulyani et al., 2018).
If you’re pregnant and feel like you don’t drink enough water, don’t fret just yet! Studies show short-term mild dehydration won’t significantly affect your pregnancy (Villines & Ernst, 2018). Later on, we’ll discuss the differences between mild, moderate and severe dehydration.
What causes dehydration?
You may not be aware of it, but you lose bodily fluids every single day. Many metabolic processes in our body require water to properly function. We lose water through our sweat, breath, urine and even feces. These are all normal everyday losses that are easily replaced by drinking and eating water-containing foods.
When this balance is disrupted, it leads to dehydration. Excessive fluid loss or a deficiency in fluid intake can cause the body to become dehydrated. Common causes of dehydration are fever, diarrhea and vomiting, which can also be associated with infections. Other medical conditions that can cause dehydration are sepsis, hyperthyroidism, COPD and diabetes (Taylor & Jones, 2020).
Dehydration is more common than you think. Recall a time where you had too much alcohol: how did you feel? Most likely you felt dry and thirsty. This is because alcohol suppresses the action of vasopressin - also known as the antidiuretic hormone. Vasopressin prevents too much water loss by increasing the reabsorption of water in the kidney tubules.
If this action is suppressed, more water is lost through the urine, which can lead to dehydration. Additionally, our kidneys use more water in an attempt to remove the toxic by-products of alcohol. This further increases fluid loss (Jewell & Weatherspoon, 2019).
Be wary of becoming dehydrated this summer season. High temperatures and increased humidity work together to make you sweat, which can increase your risk of dehydration.
What are the signs and symptoms of dehydration?
Dehydration manifests as different signs and symptoms depending on how much fluid is lost. Recognizing these signs in adults and infants is important so you can know when you should bring them to the clinic for hydration, or to the emergency room for immediate intervention.
Mild dehydration occurs when you have lost approximately less than 5% of total body fluids. You may not notice any symptoms besides a mild thirst or a yellow-orange to orange urine color.
For infants and children, mild dehydration occurs at <3% fluid loss. During this stage, they will appear well and alert with normal vital signs. Take care around children or infants, as their symptoms are less noticeable.In adults, moderate dehydration manifests as thirst, decreased urine output, dried lips, fatigue and lightheadedness.
- In some cases, postural hypotension may occur, which is characterized by a drop of more than 20mmg Hg in your blood pressure when you stand up. If you’ve ever blacked out after standing up, chances are you were moderately dehydrated.
- Unlike mild dehydration, the symptoms of moderate dehydration are easily recognized. If you are moderately dehydrated, you can tell something’s wrong with your body (PACO, 2015).
- They may become irritable due to a lack of fluids. If they’re crying, there may be fewer tears than expected.
- The area around their eyes may appear slightly sunken, due to a lack of water.
- Their pulse rate and breathing can also be rapid.
- Their extremities, such as the hands and feet, would be cool to touch and their urine output decreased. Intervention should be done at this point to prevent escalation to severe dehydration.
- It can manifest as increased thirst, a quickened heart rate, cool extremities, and low blood pressure.
- Noticeable changes in mental state are also prevalent, as they become confused about their surroundings. (PACO, 2015).
Severe dehydration in children requires immediate intervention.
- At this point, they would need to have lost >9% of their total fluids.
- They may appear lethargic and sluggish. In a worse case scenario, they may lose consciousness or faint.
- Their heart rate can range from beating at a very slow pace, or beating rapidly.
- For infants, their anterior fontanelles - the area above their foreheads, would be sunken.
- Dry lips and cold extremities are also symptoms of severe dehydration.
- Lastly, their last urine output would be more than 10-12 hours ago (Freedman & Thull-Freedman, 2008).
What can I do if I am dehydrated?
If you are mildly dehydrated, the solution is simple: drink more water! At times, the symptoms of mild dehydration can be so subtle that you don’t even notice them.
However, if you’re running a fever, or if you’ve just had a vomiting or diarrhea episode, don’t wait for signs and symptoms to appear before drinking - replace lost fluids as soon as possible.
If you’ve recently vomited or had diarrhea, water alone won’t make up for what’s lost. As fluid loss from the gut contains essential electrolytes like calcium, potassium, sodium and chloride, you’ll want to replenish them as well. Mix in some salt, or drink an oral rehydration solution such as Jigsaw Electrolyte Supreme Oral Rehydration Solution (ORS) to replenish lost electrolytes.
If you don’t have an ORS pack readily available in your home, you can create your own rehydration drink. Based on the guidelines given by ASPEN (2020), mix ½ teaspoon of salt, 1 cup of squeezed fruit juice (orange, apple, cranberry), and 3 ½ cups of water together.
With moderate or severe dehydration, drinking water or an ORS may not be enough to replenish lost fluids. Fluids taken this way would have to go through the gastrointestinal tract to be absorbed, which takes too much time. You may need to go to the hospital or a clinic to receive intravenous or IV fluid hydration.
In a hospital or clinic, the first thing healthcare workers do is assess your level of dehydration, in order to identify the source of the fluid loss. Severe dehydration can occur as a result of serious injuries like second or third-degree burns that span a large area of the body, or massive blood loss from a severed major artery. If you think you know the cause, make sure to let them know.
Some causes of dehydration can also be simple and easily identifiable. If you’ve been binge drinking the night before, you should disclose that information to the healthcare worker. Otherwise, you risk being sent to the ER for something completely unrelated.
Other pieces of information that are helpful are the number of times you vomited or had a loose bowel movement. This information allows the clinician to assess how much fluid is lost. You may also be asked about your last urine output, to assess the possibility of an acute kidney injury. Additional laboratory work-up may be requested, such as your electrolyte levels.
In serious cases, intravenous access through a cannula - also known as an IV drip, would be inserted into a vein in your hand or forearm. The choice of fluid depends on many factors - for example, isotonic crystalloid fluid is used to quicken hydration and stabilize vitals.
If you have any other comorbidities like chronic kidney disease, the choice of IV fluid will differ. The most common crystalloid fluids available are normal saline and lactated ringer’s solution, which contain concentrations of glucose, potassium, sodium, and chloride.
Visiting the hospital can sound rather intimidating. However, administering an IV drip is not something you can do at home. There are many factors that come into play, which healthcare workers are trained to know.
For example, if IV fluid is given too fast, it can result in heart congestion or edema, and if given too slowly, the patient may deteriorate. In a clinic or hospital, someone can also monitor your vital signs and ensure your body tolerates IV hydration (Taylor & Jones, 2020).
The good news is that an outpatient clinic like The Injection and Infusion Clinic of ABQ can administer IV fluids for dehydration more quickly and cheaply than the ER. Our IV hydration therapy provides you with replacement electrolytes that you need after illness, excessive perspiration or over-consumption of alcohol.
Best of all, unlike hospitals which may be operating at or above maximum capacity, our clinic offers our patients as much time, patience, and care needed to ensure a blissful recovery.
We have “water, water everywhere”, yet most of us take it for granted. Many people do not consume enough water daily, and risk dehydration. To avoid this, drink water as often as possible during the day.
If you are eating, take it before your meals to ensure your fluid levels stay balanced. For periods of intense exercise, you’ll want to hydrate before, during and after your workout. With febrile, vomiting, or diarrheal episodes, replenish lost fluids as well as lost electrolytes.
Make sure to know the causes of dehydration, take note of the symptoms, and know when to visit a clinic or hospital. At the end of the day, prevention is better than cure. Drink 8 glasses of water a day to keep the ER away!