In this Annapolis Urgent Care Spotlight, we discuss how summertime dehydration can be a very serious issue but drinking too much water can be just as bad. Symptoms of dehydration, how much water to drink and what happens if you drink too much water are all part of this urgent care spotlight.

The first thing one needs to be able to do is recognize symptoms of dehydration. Mild to moderate symptoms can usually be treated at home but more moderate to severe dehydration requires a visit to an urgent care or emergency room.

Mild to moderate dehydration is likely to cause:

Dangers of Dehydration Annapolis Urgent Care Spotlight

Dangers of Dehydration
Annapolis Urgent Care Spotlight

Dry, sticky mouth
Sleepiness or tiredness — children are likely to be less active than usual
Decreased urine output
No wet diapers for three hours for infants
Few or no tears when crying
Dry skin
Dizziness or lightheadedness

Severe dehydration, a medical emergency, can cause:

Extreme thirst
Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults
Very dry mouth, skin and mucous membranes
Little or no urination — any urine that is produced will be darker than normal
Sunken eyes
Shriveled and dry skin that lacks elasticity and doesn’t “bounce back” when pinched into a fold

Skin tenting is a strong indicator of serious dehydration

Skin tenting is a strong indicator of serious dehydration

In infants, sunken fontanels — the soft spots on the top of a baby’s head
Low blood pressure
Rapid heartbeat
Rapid breathing
No tears when crying
In the most serious cases, delirium or unconsciousness

Causes of dehydration

Dehydration occurs when there isn’t enough water to replace what’s lost throughout the day. It’s that simple. Your system literally dries out. Sometimes dehydration occurs for simple reasons: You don’t drink enough because you’re sick or busy, or because you lack access to safe drinking water when you’re traveling, hiking or camping.

Other dehydration causes include (from Mayo Clinic):

Diarrhea, vomiting
Severe, acute diarrhea — that is, diarrhea that comes on suddenly and violently — can cause a tremendous loss of water and electrolytes in a short amount of time. If you have vomiting along with diarrhea, you lose even more fluids and minerals. Children and infants are especially at risk.


frank-cotham-the-important-thing-is-to-stay-hydrated-new-yorker-cartoonIn general, the higher your fever, the more dehydrated you may become. If you have a fever in addition to diarrhea and vomiting, you lose even more fluids.

Excessive sweating
You lose water when you sweat. If you do vigorous activity and don’t replace fluids as you go along, you can become dehydrated. Hot, humid weather increases the amount you sweat and the amount of fluid you lose. But you can also become dehydrated in winter if you don’t replace lost fluids. Preteens and teens who participate in sports may be especially susceptible, both because of their body weight, which is generally lower than that of adults, and because they may not be experienced enough to know the warning signs of dehydration.

Increased urination
This may be due to undiagnosed or uncontrolled diabetes. Certain medications, such as diuretics and some blood pressure medications, also can lead to dehydration, generally because they cause you to urinate or perspire more than normal.

14_Hydration02How to Stay Hydrated

1. Drink!
Good old H2O is critical for rehydrating. When exercising, sip 7 to 10 ounces of fluid every 10 to 20 minutes. If you exercise for  longer than an hour or doing a particularly intense exercise (like running a marathon or participating in a tough training session), you will probably need to replace electrolytes too—this is where a sports drink or electrolyte-enhanced water comes in handy.

2. Sip on sports drinks and coconut water
When we sweat, we lose electrolytes, which are minerals found in the blood that help to regulate (among other things) the amount of water in the body. Research suggests and sports drinks, such as Powerade and Gatorade, can help prolong exercise and rehydrate our bodies because they contain electrolytes, which plain old water does not.  Not in to sports drinks, or want a more natural alternative? Water-enhancing electrolyte tablets, coconut water, or a homemade sports drink could be potentially effective substitutes.

3. Turn to fruit
fruits1Many fruits are a great source of both electrolytes and fluids, though the dose of electrolytes can differ from fruit to fruit . Bananas and dates are known for having high levels of the electrolyte potassium, making them a great option for refueling during an intense workout (for example, a long run) . To stay hydrated while keeping up electrolytes, it’s important to drink water while munching on fruit (fruit contains some water, but not as much as your water bottle).

4. Weigh yourself
Hop on the scale before and after exercise. For each pound lost during activity, drink an additional 16 ounces of fluid. If your body weight change is three percent or more, you may be experiencing significant to serious dehydration.

5. Look at your pee!
Checking the color of your urine can by easy and very helpful. When properly hydrated, urine should be pale yellow in color. Though it may be tricky to keep an eye on it, try to watch the urine stream, since the color of urine will dilute when it hits the toilet water. Dark yellow urine may indicate dehydration.

6. Pinch yourself
Skin turgor, which is the skin’s ability to change shape and return to normal (or more simply put, it’s elasticity), is an easy way to check your hydration. Using your pointer finger and thumb, simply pinch the skin on the back of your hand and hold for a few seconds. When you let go, if the skin takes a while to return to its normal position, you may be dehydrated.

7. Keep dry mouth at bay.
One of the first signs of dehydration is dry mouth.

8. Stop and immediately hydrate if you feel dizzy
Feeling lightheaded is a sign of impending more serious dehydration and is an indicator that it’s time to hydrate.

Over Hydration

Lethal Dose (LD)50 of Water.

Lethal Dose (LD)50 of Water.

The emphasis over the last few years of “make sure you are hydrated” has led to several deaths among marathon runners due to dangerous condition called hyponatremia, or water intoxication. A recent New York Times article described it this way:  If you drink too much water, the blood becomes too dilate and then osmosis draws water from the blood into body cells to equalize sodium levels, and those cells swell. If the cellular bloating occurs in the brain, it can be fatal.

How much water does it take to kill a person?  Paracelsus, the 16th century scientist said, “Everything can be poisonous, or not, depending on the dose.” The saying stands true for earth’s most essential element: water.

It takes about 6 liters of water to kill a 165-pound person, according to a YouTube video recently released by the American Chemistry Society. Surprisingly, death by water, or water intoxication as it’s officially known, happens quite a lot. It’s common among young people who challenge themselves to “water drinking contests,” or athletes who mistakingly over-hydrate while training, Scientific American reported.

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Primary & Urgent Care-June 2015

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