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Thursday, May 28, 2020  Spokane, Washington  Est. May 19, 1883
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House Call: Stay hydrated this summer

By Dr. Bob Riggs For The Spokesman-Review

We’ve had a bit of cool weather and rain lately, but the forecast for August is looking hot and dry, so dehydration is on my mind. Anyone can get dehydrated, but the very young and very old are more prone to dehydration and are particularly at risk of complications if the dehydration is prolonged.

Diarrhea, vomiting, fever, excessive sweating and increased urination like one can get from uncontrolled diabetes can all cause dehydration. Having more than one of these at the same time makes becoming dehydrated more likely. Some symptoms for infants, children and adults are the same. They include less frequent (less than once every three hours for infants) or no urination, listlessness and fatigue.

Infants can’t tell you what’s wrong, and children might not articulate it very well, either, so it’s important to know other symptoms more specific to them. They include:

Dry mouth and tongue

No tears when crying

Sunken eyes and cheeks

Sunken soft spot on top of skull

Symptoms you might experience when dehydrated include extreme thirst, dark-colored urine, dizziness and confusion. Some medications cause dry mouth that can be interpreted as dehydration. If you think that’s the case, talk to your doctor. Don’t stop a medication without talking to your medical provider.

When dehydration sets in, lost fluids and electrolytes need to be replaced. Using an oral rehydration solution or freezer pops is the best route for kids and infants. Start with a teaspoon every 5 minutes and gradually increase the amount. This is very important if vomiting is an issue. If you’re not able to drink water or are suffering confusion, then I would recommend going to an urgent care for evaluation and perhaps IV fluids.

The approach to prevention of dehydration from sweating is more complicated. If your dehydration is caused by excessive sweating like with exercise in hot environments, you might also need to replace sodium and other electrolytes. Sports drinks are good for this, and you can buy electrolyte replacement tablets from stores for runners and backpackers.

Some people, including me, are “salty sweaters.” I develop a rim of salt on my hat and a crust on my forehead. When I sweat a lot, I need to replace salt, too. I find that a half teaspoon of salt and a quart of water recovers me nicely.

I have a patient who was backpacking in a wild area last year. She kept up on her water but didn’t replace electrolytes. When she got to camp, she felt awful, was not making sense, then had seizures that turned out to be from low sodium. She was lucky her group had a back-country alert unit and called for emergency services. She was helicoptered to an ICU and recovered. She won’t make that mistake again. Others make sweat that isn’t salty, and they don’t need to replace as much salt.

If drinking enough water every day is a challenge for you, consider setting reminders in your smartphone or computer to prompt you to have a drink periodically. When exercising in hot conditions, I weigh myself before and after. Every pound lost in a session is a pint of water to replace. With prolonged exertion in the heat like with bicycling or hiking, I carry 1-2 water bottles and drink all that water to keep my hydration up.

Enjoy these dog days or summer. Try to exercise in the cooler parts of the day, and be certain to stay hydrated.

Bob Riggs is a family medicine physician practicing at Kaiser Permanente’s Riverfront Medical Center. His column appears biweekly in The Spokesman-Review.

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