In order for us to maintain homeostasis and thrive, adequate water intake is essential. This is because water is crucial to our existence. It comprises up to 75% of an infant’s body weight and up to 55% of body weight in the elderly.[1] Yet up to 75% of Americans do not consume the recommended daily amount of water and may therefore be operating in a state of chronic dehydration. As practitioners, there is much that we can do to help ensure that our patients are adequately hydrated and avoiding dehydration.
What conditions and states of being can lead to dehydration?
Dehydration can be the result of not drinking adequate water. It can also come about when patients are drinking adequate water, but are excreting more water than they are consuming. This is common in some athletes, individuals who work or spend extended periods of time outdoors during the warmer months, individuals who are fighting infection and dealing with prolonged fevers, and those who are vomiting or have diarrhea.
Drinking diuretic beverages such as coffee and caffeinated sodas is very common in America today. Yet these practices can also increase our bodies’ net loss of fluid and contribute to dehydration. Drinking alcohol and consuming diets high in sodium, such as the standard American diet, can also increase our patients’ risk for dehydration. By making recommendations against these practices, we can help reduce our patients’ risk of dehydration.
What are some common (and not-so-common) symptoms of dehydration?
One of the most common symptoms of dehydration is thirst. In fact, thirst can be triggered by as little as 1-2% fluid loss.[2] Therefore, by the time our patients feel thirsty, they’re likely already experiencing some degree of dehydration.
Another symptom of dehydration is fatigue. Unfortunately, however, many of our patients may not recognize fatigue as a symptom of dehydration. As practitioners, we can educate our patients regarding this fact and help ensure that they consider fatigue as a cue to drink water.
Other symptoms of dehydration include brain fog, difficulty concentrating, irritability, tachycardia, tachypnea, lethargy, and, in more severe cases, syncope. We can educate our patients who are at risk for dehydration to be on the lookout for these symptoms as well.
How can we prevent and treat dehydration?
In the early stages of dehydration, drinking adequate water (and, in some cases, electrolyte-containing beverages) can be corrective. Therefore, if our patients pay attention to their bodies and take notice of those early cues, they can actually restore homeostatic balance by drinking their recommended daily water intake.
How to calculate your patients’ daily recommended water intake
To help my patients calculate their recommended daily water intake, I have them take their body weight in pounds, and divide that number by two. This enables them to find the minimum amount of ounces of water they should be drinking daily. There are 8 ounces in each cup, so to convert this number to cups, they would need to divide the number of ounces by 8. As an example, a 160-pound person would need to drink 80 ounces of water per day (160 divided by 2 is 80), and this is the equivalent of 10 cups (80 divided by 8 is 10).
How to use IV therapy to address dehydration
As dehydration progresses to moderate or severe, however, or if the goal is to restore hydration as rapidly as possible, intravenous hydration is an important consideration. Intravenous or IV hydration is the use of medical-grade, sterile fluid administered directly into a vein, in order to achieve and maintain fluid balance within the body. Normal saline (NS) and lactated Ringer’s (LR) are two isotonic solutions that are commonly used for this purpose. Normal saline IV bags contain water and 0.9% sodium chloride, while lactated Ringer’s bags typically contain calcium chloride, potassium chloride, sodium chloride, sodium lactate, and water.
Should we use lactated Ringer’s or Normal saline to address dehydration?
Lactated Ringer’s solution is traditionally used in the hospital setting for hydration in cases of trauma, surgery, and burns, and in cases of mild dehydration. One reason why lactated Ringer’s may be utilized over normal saline for hydration purposes in a private practice setting is that it contains sodium lactate. The sodium lactate in this solution is metabolized into bicarbonate within the body. Because bicarbonate is basic or alkaline, lactated Ringer’s can help make the body less acidic. Therefore, lactated Ringer’s may be selected over Normal saline for patients at risk for metabolic acidosis. Another reason why lactated Ringer’s would be selected over Normal saline in these patients is that NS has vasodilator effects that can further increase patients’ risk of metabolic acidosis.
In patients at risk for alkalosis, such as individuals who are vomiting or those with severe hypokalemia, Normal saline is typically selected over lactated Ringer’s. Again, this is because lactated Ringer’s solution is metabolized into bicarbonate and increases alkalosis, an unwanted effect in these cases.
Contraindications and when to exercise extreme caution in IV hydration
In order to avoid fluid overload, there are a few cases where IV hydration should be either avoided or accompanied by close monitoring. These include congestive heart failure, chronic kidney disease, and liver cirrhosis. To learn more about how to safely and effectively incorporate IV hydration and IV nutrient therapy into your practice, check out the IV Therapy Academy.
References
1. Nicolaidis S. Physiology of thirst. In: Arnaud MJ, editor. Hydration Throughout Life.Montrouge: John Libbey Eurotext; 1998. p. 247.
2. McKinley, M. J., & Johnson, A. K. (2004). The physiological regulation of thirst and fluid intake. Physiology, 19(1), 1-6.