Dehydration: Water, Electrolytes and Healthy Rehydration

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Dehydration: Water, Electrolytes and Healthy Rehydration How many times have you heard that so-and-so was “hospitalized for dehydration,” and then after expressing concern, you hear the nonchalant response of, “Oh, s/he's fine, s/he was just dehydrated!” And then you end up thinking, “Well, why didn't so-and-so just drink some water?” or “How does that happen?” or “Could that ever happen to me at some point?” The reality is that dehydration can cause serious complications, and can lead to coma, and even death.1 Be aware, that in elderly people, dehydration occurs often because the perception of “being thirsty” is decreased as one ages;2 it can also happen to middle-aged and young people. Dehydration is, however, most of the time, a preventable and manageable condition.

What Is Dehydration?

It is a fact that 50-75% of the human body is comprised of water. These percentages vary according to age, gender and body composition.3 Dehydration happens when body water and/or electrolytes (sodium, potassium, magnesium, etc.) are lost at a faster rate than it is replaced, and the body is then in negative fluid balance. There are three types of dehydration:

1. Hypertonic Dehydration or Hypernatremic Dehydration (loss of water more than electrolytes, and USUALLY an elevated blood sodium level)

2. Hypotonic Dehydration or Hyponatremic Dehydration (loss of electrolytes more than water – primarily sodium, with USUALLY a low blood sodium level)

3. Isotonic Dehydration or Isonatremic Dehydration (an equal loss of water and electrolytes and normal blood sodium level)4

Who Is at Risk for Dehydration?

Everyone is potentially at risk for dehydration at some point(s) in their lives, but risk is elevated with people who are: elderly, athletes, weekend warriors, hikers, bicyclists, gardeners, joggers, chronically ill, and adults and children who are ill and lose fluids by way of vomiting or diarrhea.

The Importance of Electrolytes

As you can see above, in “What Is Dehydration?”, two of the types of dehydration concern a loss of something called, “electrolytes.” Electrolytes are important minerals our bodies need. These minerals (electrolytes) actually produce an electrical charge. The main ones are: sodium, potassium, magnesium, calcium, chloride, and phosphate. Electrolytes dissolve in your body's fluid, and by way of electrical charges, facilitate the conduction of electrical signals to your nerves, muscles, heart and brain. Your heart beat and the signal that drives it are generated by the movement of electrolytes. Electrolytes move through “channels” in cells (you can think of these "channels" as doors that join the inside and outside of heart cells together). The movement of electrolytes in and out of these channels sends signals which cause excitation in the electrical fibers of the heart, which then conducts the signal that makes the heart beat in a synchronized manner. That is one reason a decrease in the electrolytes, potassium and magnesium, can cause the feeling of a rapid heart rate or heart skipping beats (palpitations) and even heart arrhythmias.5 A similar effect of electrolytes can occur in skeletal muscle. Deficiency of electrolytes in muscle can cause muscle spasms because the proper electrolytes that cause muscle cells to relax will not be present (potassium and magnesium). We usually get electrolytes in foods and drinks we consume. However, for various reasons, electrolyte levels can become unbalanced. The majority of the time, the problems that occur with electrolyte imbalances are with sodium, potassium, and magnesium. In patients with renal failure (kidney failure or kidney disease) or special endocrine problems, calcium, bicarbonate and phosphorus levels can also become compromised (both high and low).6

Symptoms of Dehydration

Some symptoms of dehydration are: thirst, dry mouth, headache, little or no urination, dry skin, tiredness, light-headedness, dizziness, confusion, dark yellow or amber-colored urine, and constipation.7 In the elderly, occasionally confusion can occur with dehydration but can resolve with treatment with an electrolyte solution.

Causes of Dehydration

Some causes of dehydration are: some medications (diuretics or “water pills”), fever, vomiting, diarrhea, and extended periods of exertion without rehydrating. Dehydration can also occur from over-exposure to the sun and/or exerting yourself in a high-heat area thus becoming overheated resulting in loss of water and bodily salts (sodium, potassium, magnesium, calcium, bicarbonate, and phosphate). Dehydration can also occur when a person simply does not drink enough fluids. Oftentimes, elderly people only drink tea or coffee–both of which have a diuretic effect (promotes production of urine and also wastes electrolytes), and then don't drink any water (because of reduced thirst8) or consume enough water-containing foods; these factors alone can easily cause deydration and even hospitalization for such. If diuretic types of medications are involved, it can only exacerbate the situation.9

How To Healthily Rehydrate

Broth

Broth is a good form of rehydration for anyone (especially in the cooler months), and especially so for the elderly. Look for beef, chicken or vegetable broth with no MSG or yeast added, and without artificial additives (i.e., the “Imagine” brand).

Rice Water

Rice water works well for rehydration.10 The key here is to make sure the rice is well washed (washed-to-clear water) before cooking–particularly if it is a type of rice that could possibly be processed with talc such as Basmati rice. Cook some rice in twice as much water as you would normally use. Add some salt to the water. (About ½ teaspoon salt per 4 cups of water). Drink the water left over from cooking the rice. You can eat the rice, too.11

Sports Drinks

Look for a sports drink that does not contain artificial color or flavor, has a relatively low sugar content per serving (22 grams or less), contains potassium (at least 99 mg or 20 mEq) and magnesium – preferably in the form of glycinate or malate (200 milligrams). If you are diabetic, use a sports drink that's sweetened with stevia or monk fruit extract (which is low on the glycemic index).

Rehydration Recipe

A homemade oral rehydration recipe is available at Rehydrate.org12 using: 5 cups of water, 6 teaspoons of sugar, and a ½ teaspoon of salt. This is not suitable for diabetics. This recipe is not recommended for daily use because of its high sugar content, but can be used temporarily (if tolerated) to keep from getting dehydrated.

How to Stay Safely Hydrated

Drink water throughout the day. A general rule of thumb: drink 2 glasses of water between each meal and 1-2 hours after dinner if you do not have acid reflux. Drinking with meals is one way to hydrate, but can dilute digestive enzymes. Make sure to drink water before, during and after exercising. Eat water-containing foods. Some foods with high water content are: cucumbers, celery, radishes, tomatoes, green peppers, yellow peppers, red peppers, cauliflower, watermelon, spinach, berries, broccoli, and grapefruit.13 It is extremely uncommon but it is possible to actually drink too much water thus disrupting your electrolyte balance and causing hyponatremia (loss of electrolytes – primarily sodium with low blood sodium level).14

Consider Supplementation

Doctor Emi carries an excellent replacement supplement for loss of potassium and magnesium called, Potassium and Magnesium Citrate. To learn more about these extremely important minerals/electrolytes, read our article entitled, The Importance of Potassium and Magnesium. As stated previously: If you have congestive heart failure or renal insufficiency, or renal failure (kidney failure), please follow the advice of your physician regarding dietary supplementation, fluid or electrolyte intake. This article is meant to provide general information for generally healthy individuals. The Doctor Emi Team
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References

1. The Mayo clinic Staff. Diseases and Conditions: Dehydration. Complications. February 12, 2014. Accesesd on July 7, 2016. (MayoClinic)
2. Hoffman N. Dehydration in the elderly: Insidious and manageable. Geriatrics. Jun1991, Vol. 46 Issue 6, p35-38. 4p.Accessed July 7, 2016. (EBSCO)
3. Helmenstine AM. How Much of Your Body Is Water? About Education. Updated November 6, 2015. Accessed July 7, 2016. (Chemistry)
4. Antipuesto DJ. Dehyration: Types, Causes and Treatment. Fundamentals of Nursing. November 15, 2010. Acccessed on July 11, 2016. (NursingCrib)
5. Morris S. How to Prevent an Electrolyte Imbalance. Healthline. Medically reviewed by Natalie Butler, RD, LD. May 28, 2015. Accessed July 11, 2016. (Healthline)
6. Fluid and Electrolyte Balance. Medline Plus. U.S. National Library of Medicine. Updated June 16, 2016. Accessed July 11, 2016. (NLM)
7. Mayo clinic Staff. Diseases and Conditions-Dehydration: Symptoms. February 12, 2014. Accessed July 11, 2016 (MayoClinic)
8. Rolls B, Paddy A. Phillips MB. Aging and Disturbances of Thirst and Fluid Balance. DOI: http://dx.doi.org/10.1111/j.1753-4887.1990.tb02915.x 137-144. First published online: 1 March 1990. Accessed on July 11, 2016 (OxfordJournals)
9. Dehydration and eat Stroke. Johns Hopkins Medicine; Health Library. Accessed July 11, 2016 (HopkinsMedicine)
10. Ho TF, Yip WCL. Oral rehydration solution - Rice water is cheap and effective. BMJ. 2001 Nov 3; 323(7320): 1068. PMCID: PMC1121559. Accessed July 11, 2016. (PMC)
11. Dehydration. Hesperian Health Guides. Accessed July 11, 2016 (Hesperian)
12. Recipe for Making a 1 Litre ORS Solution Using Sugar, Salt and Water. Rehydration Project. Updated April 21 2014. Accessed July 11, 2016 (Rehydrate)
13. Hydrating Through fruits and Veggies. Physicians Committee for Responsible Medicine. July 2014. Accessed July 11, 2016. (PCRM)
14. Mayo clinic Staff. Healthy Lifestyle - Nutrition and Healthy Eating. Sept. 05, 2014. Accessed July 11, 2016 (MayoClinic)

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