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This is an anomaly that exists when the loss of water in the body has exceeded the net gain. It becomes a major problem when the level of body water is so low that the blood is no longer able to deliver oxygen and nutrients to the cells. Worse, the blood is also not able to remove the toxins that are building up in the body. This combination of factors bodes ill for anyone, particularly so at the extremes of life. This is important for us in our part of the world during this period of the year when the weather is so hot and the humidity varies widely.
In Nigeria, for example, the southern part is mostly humid. Thus, the accompanying heat makes the environment oppressive because the atmosphere makes it easy to sweat. In the northern part of the country, there is less sweating because the humidity is lower. There is a dry sort of heat. Sweating is thus less, and even in the absence of any illness, the body loses huge amounts of fluids in what is known as insensible losses of body water. During the dry season, therefore, it is wise to have some water handy when venturing outdoors. It is more so when you are likely to be outdoors for several hours at a time, especially when one is travelling.
There are no special warnings when the body has lost too much water and requires some replenishment. Certain cells in the hypothalamus of the brain detect changes in the salt concentration of the body water and send signals to the relevant centre of the brain stem that stimulates the desire to drink water. For most people in this world, this is a precise mechanism that helps to determine when to drink water or other fluids and when that requirement is not necessary. Sometimes, it may be risky to assume that when you are already on your way, you could have access to drinking water and so could get it whenever you need to do so. Sometimes, that is not the case and it is often a good thing to be prepared rather than be hopeful. Water is life.
Certain common situations in our lives make this scenario possible. They are problems we come across on a daily basis, especially in the dry season. Among people of all age groups, diseases like diarrhoea and vomiting occur at every time of the year and can quickly lead to dehydration. Besides these, physical exercise also quickens dehydration. This is particularly true for those people who do outdoor sports. That is why footballers and other sportsmen use every opportunity they get in the course of play to drink as much water as possible. That could be done during an injury break or at some other time when there has been a stoppage of play for whatever reason. This is also a similar scenario for those who exercise outdoors for pleasure. In team sports, therefore, the managers or the handlers are in custody of the fluid requirements for the entire team. For those who are involved in individual sports, especially for pleasure, it is wise to have a flask or pet bottle of water handy in case the feeling of dehydration becomes overwhelming.
Other causes of dehydration are both heat exhaustion and heat stroke, which are awful periods of extreme weakness, confusion and even collapse resulting from dehydration. That combination often would occur during a heat wave, which mostly occurs in the tropics, but is also seen in temperate climates. The elderly are particularly prone to this condition and death can occur. For the elderly, it is not enough to drink fluids; they should also take frequent baths to diminish the core temperature and therefore minimise the overall amount of fluid loss. That means that such people should not live alone in their homes so that these little, but important things can be provided for them by those who are caring for them.
In addition, the use of drugs – both legally prescribed medications such as diuretics used in hypertensive patients, and those that are not legal – can cause dehydration. They are, thus, to be used in accordance with the prescription and any adverse effect reported to the attending physician without delay. Besides, the use of alcohol also leads to dehydration, especially when large amounts are taken. This is because alcohol has a diuretic effect on people and so would increase one’s production of urine. Infection is also a common way to lose body water and eventually get dehydrated. As stated earlier, the most common infections that can lead to this situation are those which cause diarrhoea and vomiting. Other infections lead to this effect by causing a fever which drives up the metabolic rate and loss of body water. Without treatment, severe consequences result. So, the focus must be on replenishing the lost body fluids while also treating the infection that led to the problem.
Certain metabolic diseases such as diabetes mellitus caused by high blood sugar also lead to dehydration. Excessive production of urine is a major component of this baffling illness. Such losses, when not replaced, are life threatening and usually requires hospital attention. This is because it is not sufficient to simply replace the lost body fluids in this case; the diabetes must be treated with the aim of bringing the blood sugar to normal levels. Diabetes insipidus, a less common disease that is associated with an abnormal production by the body of excess urine can also cause dehydration. Lost body fluids must be replaced.
The consequences of dehydration are multiple and are often amenable to simple treatment involving the replacement of lost body water. However, it is not only body water that is lost in this circumstance. Body salts are also lost and these require replacement as well. The combination of both water and salt loss leads to dizziness initially. After a while, headaches ensue and then the mouth can become dry. Often, the nose also becomes dry and can be perceived with some ease. There is associated weakness as the muscles become sluggish having been deprived of the potassium salt which is so indispensable for their activity. At some point, the urine becomes somewhat dark with a deep amber hue and could also have a strong odour. Besides, the amount of urine produced diminishes with the passage of time as the body tries to conserve its available water.
In children, there are no tears made when they cry. The mouth and the tongue are often dry. The lips may be involved also. They then become irritable and are obviously aggressive. They may then develop a fever which is not due to an infection but an inefficient ability to get rid of excess body heat. Also, the nappies are observed to be dry as there is no urine in them for three or more hours. The eyes are also noticed to be sunken as though they are in a tunnel. In the very young, often at less than 18 months of age, the fontanel, just above the forehead, is observed to have also sunken. It fails to move up and down in the accustomed manner. At this stage, the child must be taken to a hospital. Also, when the skin is pinched, it fails to flatten back to normal.
The treatment must be aggressive and with a clear purpose in mind. Water must be given even if the person would vomit afterwards. This is because not all the water can possibly be vomited. Electrolytes would be obtained by drinking soups or broths, by taking fruit juice, vegetables and fruits. In children, certain preparations are available even over the counter to combat this problem and they include such salt-rich compounds as pedialyte, oralite and several others. For everyone in this season, do not go out without some form of fluid that you can drink.
Culled from Sunday Doctor in Sunday Punch, by DR. SYLVESTER IKHISEMOJIE
