Dehydration and Rehydration Solutions, by M.A. in Washington State

Thursday, Jul 11, 2013

I would first like to thank you and all of the previous posters on this blog. I have been an avid reader for a few years now and I have learned immeasurably from you all.
Dehydration can be a problem for individuals in the first world today, and a massive problem for those in the third world. In a post collapse situation, life for us in America and the rest of the first world countries could look more like the latter. There are many causes for dehydration, from working outside in the heat and sweating out fluids to a serious illness causing severe nausea and vomiting. Severe dehydration could lead to death, called Terminal Dehydration.

Before I really delve into this subject, let me give a brief summary of my experience. I spent six years in the Navy as a Hospital Corpsman serving with both the Navy onboard ship and at a hospital and also serving with the Marines as a field corpsman. I was charged with the care of sailors and marines, at times on my own. It was a very large responsibility for such a young man as I was. I took my charge VERY seriously. One thing that I was continuously on the lookout for was heat injuries and signs of dehydration, especially in the desert. This carried over from my training at the fleet marine service school. It was repeated constantly throughout my military training. The military is acutely aware of the seriousness of heat injuries and the toll they take. Since I have gotten out of the navy, I have worked in the hospital setting in differing acute care areas such as emergency rooms. I have a love of medicine and a drive to learn as much as I can. Even though I am no physician, I have had providers ask me for my thoughts on certain areas that my previous experience has given me with regards to treating their own patients. I truly love working as a member of the healthcare team. I am taking college courses to become a flight nurse. Now, I am no doctor and I am only writing this for informational purposes. If it is possible, if you or a loved one shows signs of dehydration, you should seek the treatment of a physician.

Now, back to the matter at hand, dehydration in a collapse scenario. Let us first look at dehydration. It not always simply a lack of fluids that needs to be replenished. There are actually three different kinds of dehydration: 1) hypotonic or hyponatremic (referring to this as primarily a loss of electrolytes, sodium in particular), 2) hypertonic or hypernatremic (referring to this as primarily a loss of water), and 3) isotonic or isonatremic (referring to this as equal loss of water and electrolytes). The most commonly seen is isonatremic dehydration. This loss is mostly due to profuse sweating and/or vomiting and diarrhea. The loss of electrolytes, while seemingly insignificant to some, can be very serious. Sodium in particular serves many roles in the human body. Sodium helps the body maintain fluid balance in the body down to the cellular level. Sodium also helps the body regulate blood pressure, as many may already know. Sodium also helps facilitate nutrient transfers at the cellular level. These functions of sodium in the body are done primarily through the process of osmosis. Sodium is just one of the essential electrolytes required by the human body to maintain homeostasis. Both sodium and potassium help carry electrical signals from cell to cell over the entire body.

Now dehydration can have a number of causes. I cannot go over them all, but I can focus on some. One of the most common causes in the third world is unclean drinking water that causes waterborne illnesses such as Cholera, E. Coli, Typhoid, and Salmonellosis. These can be particularly fatal to children and the elderly if not treated properly. In a post collapse situation, clean drinking water will be difficult to come by for most folks once the grid goes down and illnesses such as these will become common in America once more. Another cause of dehydration in a post collapse scenario will be simply due to overexertion and sweating. Even here in the beautiful and comparatively mild climate of northwestern United States, it gets hot enough in the summer months to cause heat injuries. And in a post collapse scenario, we will all be required to do much more work outside in the heat to simply survive. The signs and symptoms of dehydration can be headaches (similar to hangovers or “caffeine headaches), thirst, dry skin, moderate to severe muscle cramping or contractions, rapid heart rate, concentrated dark urine, dizziness or fainting, decreased blood pressure, and at the extreme delirium and death. Now, there is a simple test that can be done at home, in the absence of medical laboratories and the ability to look at blood serum sodium levels and similar testing, that can help determine if a person is experiencing dehydration or not: postural/orthostatic blood pressure and pulse measurement. The procedure is simple, all one needs is a blood pressure cuff and sphygmomanometer, a stethoscope, and the ability to feel the pulse of the patient. The procedure I have used is to have the patient lie down for approximately 5 minutes and measure their pulse and blood pressure, then have the patient stand for another minute and repeat the pulse and blood pressure. What you are looking for is a drop in the measurement of the systolic (top number) of at least 20mm/Hg and/or diastolic (bottom number) of at least 10 mm/Hg, and a significant increase in the heart rate from laying to standing may also show that the heart is trying to compensate for decreased fluid levels in the blood.
 
If the patient is indeed dehydrated, there are treatments that can be done in a post collapse scenario that are similar to those we use in hospitals today. Now, IV fluid rehydration may be indicated but could not necessarily be available. In that case, oral rehydration therapy may be indicated as tolerated by the patient. The history of oral rehydration therapy goes back thousands of years. There is evidence of an Indian physician named Sushruta using a solution of rock salt and molasses in tepid water in the 6th century BC to treat dehydration.  If there is significant vomiting and there are not anti-emetics available such as Ondansetron, there is a delicate balance of reducing vomiting and yet helping the patient replenish fluids that needs to be struck. If the patient simply chugs down the Oral Rehydration Solution/Salts (ORS), they may proceed to vomit it back up. The key is to let them sip some every few minutes as is tolerated. Now, just throwing in a bunch of salt and some arbitrary amount of sugar into some water is not recommended. Just as the body needs to strike a balance in electrolyte levels, so must the solution we are making. There are differing recipes of ORS out there, I will be using the World Health Organization’s recipe since they are the ones who go into the third world countries and encounter such severe dehydration without the benefit of hospitals nearby. The ingredients are easily obtained at even the local grocery store and are most likely already on your list of lists to keep in stock.

The ingredients are 3/8 tsp salt (sodium chloride), ¼ tsp table salt substitute (potassium chloride), ½ tsp baking soda (sodium bicarbonate), 2 tsp-2 tbsp sugar (sucrose) to taste; add these dry ingredients to a 1 liter bottle and fill to the final volume of 1 liter. This solution is best when chilled, but is not exactly great tasting at any time. As a rule of thumb, it should taste similar to tears. It is recommended that the solution should be discarded after 24 hours. The concentrations of electrolytes in the ORS allow for quicker absorption of fluids and reducing the need for IV fluids (if your retreat has the ability to administer them post collapse). These concentrations improve the ability of the body to absorb it in the small intestine and replace vital electrolytes lost. It is recommended that with diarrhea alone, ORS is administered to adults and large children after every loose bowel movement and should at least be 3 liters a day until they are well. For children under 2, the amount should be between a quarter and a half of a cup after each movement. For older children it should be between a half and whole cup after each movement. Do not let the patient chug away at the ORS. Doing so may cause the brain to swell and possibly cause permanent injury because it tries to pull too much fluid into the cells. A simple way to tell if a dehydrated person is well is to check the color and frequency of urine, the urine should be optimally between pale yellow to clear. An average person urinates about 5 times a day. With vomiting, the patient should wait approximately 10 minutes after vomiting before they should be administered the ORS again. The body will retain some of the water and electrolytes even though vomiting is present. The ORS will not treat or stop either vomiting or diarrhea; these will have to run their course. Both are the body’s response to either an illness or poison that it has detected and is trying to flush out.  Diarrhea, for instance, usually resolves after three or five days.

As is the case in most medical conditions, and I am sure many have heard this from their physicians before, the key is prevention. Make sure that the proper precautions have been taken to prevent waterborne illness and your water has been sufficiently treated.  Keep an eye on you and your group for the signs and symptoms of dehydration, the easiest is to watch the color of urine. Again, clear or pale yellow is optimal, a dark/amber color isn’t. Dehydration can occur in both the heat and humidity of summer and the cold dead of winter. The dry cold can zap out moisture just as effectively as the heat; do not get complacent in the winter months.
God Bless and Semper Fidelis


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