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Where did all the water go?

Written by Erin R. Mathews, BS, DC


Where did all the water go? Dehydration occurs when the body loses more fluid than it takes in, resulting in insufficient water and other fluids to perform normal functions. “Severe dehydration can lead to changes in the body’s chemistry and kidney failure which may be life-threatening.”(1) This article will focus on issues that can be recognized by direct caregivers and discuss ways to reduce the chances for the issue to become problematic.

“Anyone may become dehydrated, but young children, older adults and people with chronic illnesses are most at risk.” (2) The most common cause of dehydration is inadequate fluid intake. It is important to be aware of and stop those processes that result in the loss of water from the body and to replace fluids regularly. Our bodies require approximately 2 to 3 liters of fluid per day, which must be replaced by the water found in the foods and beverages we consume. Several normal body functions result in a net loss of water from the body, including sweating, urination, defecation and loss of water vapor due to respiration. On average most people make (and swallow) approximately one quart of saliva per day. Individuals who lose saliva through drooling have an enhanced risk of dehydration. The rate of fluid loss can be enhanced, sometimes dangerously, by vomiting, diarrhea and excessive sweating. When a person complains of thirst, he/she may already be mildly dehydrated.

Caregivers may inadvertently contribute to the problem by taking steps to combat those little things that make day-to-day life somewhat unpleasant. Medications to combat drooling and withholding fluids for several hours before bedtime are two practices that can lead to an enhanced risk of dehydration. Drooling may be improved by having the person work with a speech pathologist to treat the root cause of the problem instead of eliminating the symptoms. Swallowing saliva also has a positive effect on the GI tract, reducing the concentration of the gastric contents and helping them to be sluiced from the esophagus back into the stomach. Pushing fluids earlier in the day, using a night time toileting schedule or incontinence briefs can combat bedwetting without depriving the person of essential hydration

“Dehydration is an extremely common finding in individuals seen in the emergency room. Recognition of the problem is the first step to taking action to reverse it.”

There are several medications that can increase the loss of water from the body. Many of them are available over the counter and are frequently used by many people. Diuretic medications are most often used to reduce blood pressure, decrease edema (swelling) or reduce excessive pressure in the eyes. Very simply stated, these medications cause elimination of excess fluid via the kidneys. Medications with anti-cholinergic properties perform a variety of functions by blocking different targets in the nervous system, either intentionally or as a side-effect. These medications include those that are taken for allergies, congestion, diarrhea, dizziness, urinary urgency/frequency, muscular relaxation, movement disorders, dementia and psychiatric purposes (just to name a few.) Many anti-cholinergic medications are associated with an enhanced risk of dehydration. It is important to educate individuals who take these medications and their caregivers to be aware the side effects of these medications

How do we tell when someone is becoming dehydrated?

Dehydration is an extremely common finding in individuals seen in the emergency room. Recognition of the problem is the first step to taking action to reverse it.

Early signs and symptoms of dehydration – teach caregivers to monitor for the following:

• Thirst/dry mouth – Ask the person if they can moisten their lips with their tongue.
• Weakness or light-headedness – Does the person report these or act differently than normal?
• Decreased urination – Time to get into their business
• Weak or rapid pulse – Easy to train caregivers to measure
• Constipation – Again, back in their business…sorry.

Signs of more severe dehydration – these can occur rapidly under the right circumstances and should immediately be brought to the attention of a licensed health care professional:

• Irritability, disorientation, extreme fatigue
• Hypotension (low blood pressure)
• Rapid weight loss (10%
or more of usual body weight)
• Sunken eyes
• Darkened urine, urinary cessation
• “Tenting” of skin
• Bowel impaction or obstruction
• Seizures

Water is the best source of fluid when it comes to re-hydrating the body. Many fruits and vegetables also have a high water content. Other liquids provide water, but often with one or more consequence attached. Milk and liquid dairy products contain protein and other nutrients but can add to the caloric intake of individuals who have weight problems. Juices have vitamins and, in some cases, fiber, but may be a source of excess sugar. These can be useful sources of fluids but calories and sugar content should be taken into account when they are consumed. Coffee, tea, sodas and other soft drinks may contain caffeine and/or excess acid, both of which may contribute to dehydration. Alcoholic beverages have a diuretic effect. These beverages should NOT be counted on as hydrating fluids. In fact, additional fluids (preferably water) should be consumed along with them.

It is important to educate individuals and/or their caregivers about the effects of medications that may contribute to dehydration. They should be given information about:

• How to recognize the signs and symptoms of excessive fluid loss and dehydration from all potential sources
• How to give additional fluids to compensate for fluid loss
• When to report signs and symptoms to a licensed health care provider, including specific information about whom to contact
• How to document incidents associated with dehydration or any other incidents related to nutritional compromise