Oral rehydration solution
by Robert Stone
In brief, that we need to drink 2 to 4 L/day is really more of a wives tale, makes no adjustment for environment, a poor measure and leads some into a false sense of self care. The facts: The kidneys need to make 1.5 to 2L/day of urine to keep us healthy. We will lose a pint or so/day in respiration depending on many factors not including perspiration. This puts the sedentary indoors at 3 Liter /day.
In Arizona, a construction worker can go through 8 gallons/ day and only urinate barely 2 quarts. It varies so much that I teach, we need to drink enough to urinate 2 quarts/day... whatever that takes. The need varies widely from those that work concrete in the sun to those that are able to work in the shade.
Headache, neck or back pain, severe stomach pain, cramping, diarrhea, constipation, heartburn, c/o heat, stop sweating, sore throat and glands are not swollen, dry skin, runny nose, sinus congestion, dry mouth, irritated eyes, c/o allergies, asthma. (I also work ER and ICU and every asthma pt I have met has had very poor intake of water- most say, "I just don't like it..") the wilderness protocol required the individual to drink a liter before using an inhaler-- 9 out of 10 times, they would say after drinking, never mind, I don't need it.
Dehydration also makes you dizzy on standing, irritable, increased animation (from running on adrenalin), sleepy during the day, keeps you awake at night, poor energy, heavy legs, muscle aches, nausea vomiting-- unable to drink water> late signs.
These symptoms do not come from being a glass or two low, rather from being a minimum of 2 quarts low. Typical rehydration with IV fluid until a dehydrated pt starts urinating again, 3 Liters. The most I had to give an individual before they urinated, 7 liters... He was a meth drug user that had sprayed himself with insecticide from the tactual hallucinations... he thought he had worms in his skin and sprayed himself.
To reduce the need for IV fluids, and looking for a way to rehydrate orally. I researched and found on the W.H.O.; World Health Organization's study and their rehydrating solution for oral rehydration. It runs a couple of dollars a packet and not that effective... doesn't make very much.
What I found that was available over the counter and locally and works better is using soup: Campbells Health Request, chicken noodle soup with a teaspoon of Morten Lite Salt an electrolyte blend )> this is equivalent to 10 quarts of gatorade or about 4 quarts of Pedialyte. It will go and stay down even with someone who is nauseous. The one rare person who throws up, wait 15 minutes and eat again. If they throw up, repeat.
The bottom line in a wilderness setting, they have to get it down and restart being able to eat and drink. In the 100s of patients I have treated with acute dehydration, the few who threw up said they felt better in spite of that... and then went ahead and ate without a problem. The lag time to feeling better is one hour. It takes longer than that to register at an ER and they will charge you $1000 to $2000 for the visit.
I also carry an instant chicken soup packet with the Morten Lite Salt and that works almost as good as the can soup. I don't carry cans when backpacking.
As you can see, there is a lot more than "just drink a lot." Everyone says they drink a lot.
How to check for dehydration
How to evaluate for dehydration and diet; A quick check is to count their standing heart rate. Every one (except a heart disease pt) will be in the low 60's. (The textbooks say 60 to 80 is normal. Doctors never ask about the diet or water, they are not required to take a single nutrition coarse.. and so don't know). The heart will speed up to compensate for low water and poor diet. I have seen kids and adults in the 140's that dropped to low 60's once they got on track. After a bout of dehydration, it takes 2 to 3 days of good nutrition and pushing the fluids to fully recover.
This information comes from having evaluated year round: 350 kids and 200 staff over a 2 year period, in Arizona desert and high country in all seasons. This was not a little 2 week in the bush experience, we had kids that were in the program as long as 17 weeks, minimal gear, covering 35 to 50 miles / week. We never had a serious problem or incident while I was with the program. These kids did not even see paved roads, or buildings for the several months they were in the program... it was remote.
Robert Stone, RN
As a wilderness Registered Nurse working in Arizona, USA; I developed and researched water consumption/ dehydration. I was the chief medical officer for a wilderness behavior program. I had 50 inpatient adolescents year round and 70 field staff to monitor. This was a minimal gear, move across the land, no cabin program. I was the one who evaluated and intervened/responded to medical situations... I have pics of giving IV fluids under a tree with the bag hanging from a limb.