Dehydration, Heat Exhaustion, or.....

[le Voyageur]

 

.....hyponatremia?

 

hyponatremia, or "water intoxication", is a condition caused by an excessive intake of water without replacing electrolytes, in particular, sodium...

 

[Bob White]

That is correct for $100 le Voyager. You now take the lead at $1200, and you have control of the board. Choose the next answer, we still have Things That Begin With the Letter I, Famous Cowboys, and Potpourri. While you make your decision we will pause briefly for these commercial messages.

[le Voyageur]

 

a cyber round of Gator Aid, and a bowl of pretzels your way BW...

[FScouter]

I'm not a physiologist, but can not a healthy set of kidneys correct the imbalance in short order?

[le Voyageur]

 

Here's a few good read on this subject...

 

http://www.honoluluclub.com/pulse.php?ID=31

 

http://www.spinalhealth.net/hyponatremia.html

 

http://www.postgradmed.com/issues/2000/05_00/fall.htm

[DDHII]

Good Job Voyageur and you make an excellent point.

 

However, the signs and symptoms of hypokalemia (low potassium) and hypochloremia (low chloride) can also be potentially fatal. Water intoxication can decrease electrolytes (K+, Na+, Cl-) and increase the amount of CO2 in the bloodstream. This wreaks havoc on kidneys the most, adding to acute renal failure.

 

Decreased levels of electrolytes also increase BUN (blood urea nitrogen) levels which also exacerbate renal failure.

 

Good kidney function can help balance this problem, however, doing so adds strain on other vital organs by drawing nutrients away from them. This requires more energy (nutrients, including glucose) and more oxygen (adding to higher levels of blood CO2), thus causing fatigue, retroperitoneal pain (near the kidneys), and sub-gastric pain. Extreme cases, primarily with diabetic patients, can cause ketoacidosis.

 

Source:

Language of Medicine, 6th Edition

Emergency Care and Transportation of the Sick and Injured, 8th Edition

 

YiV,

 

Dale

 

[le Voyageur]

DDHill

 

A big thanks for the additional input....as we all know we teach our scouts about dehydration, and other forms of heat related problems per the program, but never about water intoxication. I've seen this problem several times in the field with folks, including ER nurses, who get it wrong.

 

Just thought it was time for an FYI thread for new unit leaders with little backcountry experience...

 

Speaking of backcountry DDH....fall is in the air, great time for a little camping up in Big Bear, hey...

[packsaddle]

This is a serious safety-related topic that I watch for carefully, especially among adult leaders who are on diuretics or low-sodium diets. Although here in the South, salt seems to be one of the food groups, it is easy to achieve this condition on backpacks or hikes so we watch for it carefully. Thanks for the attention!

[eisely]

So what would be an appropriate first aid treatment for these conditions?

[9muckraker7]

Oh, how I LOVE trivia!

[le Voyageur]

E.

 

Better than treatment is preventative measures. Just as we plan high caloric/fats type menus for winter activities to stoke our inner metabolic fires: we can do likewise for summertime activites by planning menus and snack breaks that hydrate, and add extra sodium to the diet.

 

Gatorade is often recommended, but the problem is that the majority of folks will mix a batch in their Nalgenes that is just too concentrated, turning it into soda pop. Better to cut it in half, and add extra salt. You'll know that it's about right when it taste a little weaker than one's own tears

 

Besides the menu, there are other stratigies that can be use....here's what I like to do with a canoeing crew in our neck of the woods where we have high temps and miserable humidity....first, is an early start to canoe in the cool of the day, frequent shade breaks, canoeing on the shadyside of the river, swimbreaks, and slowing down, or stopping entirely during the heat of the day to slow perspiration rates.

 

 

 

 

 

[DDHII]

The main problem with associated with electrolyte imbalance is that its difficult to recognize in the field. The most common sign with hypoelectrolytemia is muscle cramps. This is easily confused for heat stroke, dehydration, and heat cramps.

 

In order for physicians to diagnose electrolyte imbalances, a bicarbonate test is performed. The bicarbonate level is an indirect measure of the acidity of the blood that is determined when electrolytes are tested. The normal serum range for bicarbonate is 22-30 mmol/L. Remember, higher blood CO2 levels increase blood acidity, causing acidosis. The chemical notation for bicarbonate on most lab reports is HCO3- or represented as the concentration of CO2.

 

Voyageur is right on track with prevention. As my old Scoutmaster would say, its easier to protect yourself than to fix the problem once it has already started. However, I would like to add some caution to adding sodium to the diet. Most processed food already contains high levels of sodium. It may not be necessary to add any more. Increased levels of potassium in the diet can also help prevent this imbalance.

 

Also, thats a good recommendation with the Gatorade tasting weaker than one owns tears. .9% NaCl (normal saline, same as tears) is all thats needed for electrolytes. The purpose is to help encourage isotonic blood levels during physical activity.

 

For first aid, treat the patient the same for heat stroke, heat exhaustion, and heat cramps. Give them a sports drink (e.g. Gatorade). Note: Sports drinks are not energy drinks. Energy drinks contain high levels of caffeine, taurine, and other stimulants that are diuretics which promote dehydration.

 

Dale

[FScouter]

During heavy exercise such as hiking in the sun carrying a backpack, the body sweats for cooling purposes. To maintain a normal water/salt balance in the body, salt is sweat out in proportion to the amount of water.

 

When the thirsty hiker drinks water, the normal water/salt balance changes and becomes heavy on the water. If more salt is lost and more water is drunk, water intoxication could conceivably occur.

 

Eating a little food while hiking should add back most of the lost salt (sodium). Better yet would be to drink plenty of water beforehand. That would cause the body to sweat more water and less salt to keep a good balance.

 

My personal opinion is that Gatorade is a waste of money. If God intended us to drink that stuff, it would be flowing in the creeks.

 

[catsmasher]

Drink lots of water, but eat lots of trail food. The stuff the kids like is loaded with salt.

Whatever you do, do not tell the kids that there is a danger in drinking too much water. I have never had a problem with Scouts wanting to drink too much water. I have to practically beat them with a stick to get them to drink enough.

This issue is like rattlesnakes on a hike. Sure it is a danger, but not very likely under normal circumstances.

 

I also like Gatorade at half stength. It is also cheaper too!

[BigMac]

You would have to paint an extreme picture to get to hyponatremia. It is most common with out of shape marithon runners who take over 3 hours to run, eat nothing and drink too much water. I know of no first aid for the condition other than dialing 911, even then if the case is bad then nothing can be done. 1/2 gatoraid will reduce cramping.