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It's Drying Time: Dehydration Can be Dangerous and Even Fatal


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AND IT HAPPENS MORE THAN PEOPLE THINK (Lead) By CAROLYN POIROT c.2003 Fort Worth Star-Telegram

Texans tend to associate dehydration with late-summer heat waves, two-a-day football drills and endurance contests like the Cowtown Marathon and the ``Hotter'N Hell 100'' in Wichita Falls in August.

But dehydration is more common than most people think and is most often caused by viruses that can sneak up on anyone in your family, anytime, year-round.

Viral infections, particularly those that cause gastroenteritis, or ``stomach flu,'' lead to most of the severe dehydration that requires the hospitalization of more than 210,000 young children for an average of 4.5 days each year in the United States and that causes the deaths of 4 million to 10 million children annually worldwide, according to the Centers for Disease Control and Prevention.

Water accounts for 55 to 65 percent of total body weight in adults and even more in children, and though you can live without food for weeks, you can live without water for only a few days.

Katie Egger, 16, was already suffering from laryngitis and a sore throat attributed to cheering at a Kenny Chesney concert at Smirnoff Music Centre in Dallas on April 4 when she developed a hoarse cough that was later diagnosed as croup, caused by an upper-respiratory viral infection.

The Fort Worth teen-ager refused to eat or drink much of anything for three days because the infection had caused swelling of her vocal chords and the lining of her trachea, so it hurt to swallow.

Three days after the concert, when her mom took her to a pediatrician's office, the croup had become so severe that the doctor sent her straight to the emergency room at Cook Children's Medical Center in Fort Worth for an emergency breathing treatment that caused her to start throwing up, further aggravating her dehydration.

Doctors started IV fluids while blood tests were run to measure electrolytes, kidney function and blood acidity to rule out a more serious problem.

``By the time we got her to the doctor, she was in bad shape, and he sent us right on over to the emergency room. They had to give her two bags of fluids to rehydrate her,'' recalls Beccy Egger, Katie's mom.

Water is essential to our health. It regulates body temperature, removes wastes, carries nutrients and oxygen to cells, cushions joints, prevents constipation, lessens the burden on the kidneys and liver by diluting and removing some toxins, and helps dissolve vitamins, minerals and other nutrients to make them more accessible.

Lack of water can very quickly lead to dehydration, which occurs when the body loses more fluid than it takes in over a period of time.

Virus-caused vomiting, diarrhea and fever, as well as food poisoning, heat, exercise, diabetes, caffeine, diuretics, certain hormones, dieting and some sports supplements - especially creatine - can contribute to water loss. And it doesn't take much to create an emergency.

Dehydration is a bigger problem for very young children, who may have more difficulty regulating their body temperatures, and the elderly, who may have chronic diseases or may be on medications that can contribute to water loss or whose kidneys may not be working efficiently and so do not respond to signals to conserve water.

Dehydration sends an average of two to three children to Cook Children's for emergency rehydration each day, says Dr. Gary Floyd, medical director of emergency services at the hospital.

``The most frequent reason we rehydrate a child is gastroenteritis. The child is vomiting and can't keep fluids down,'' Floyd says.

Gastroenteritis is an inflammation of the mucous membrane of the stomach, most often caused by a virus and commonly called ``stomach flu,'' even though it is not related to influenza.

Often the younger ones get little sores in their mouths from the virus so they can't or won't swallow,'' Floyd says.Once a child starts vomiting and hits a cycle, it may be difficult to get under control. No one knows why, but certain individuals are prone to vomit at the drop of a hat when they get sick, and others seldom, if ever, throw up. Some get hit with a GI bug and just throw up and throw up and throw up.''

If a child is sick enough to be in the ER, doctors look for sunken eyes, dry mucus membrane, doughy skin and skin turgor. (Pull up a little tent of skin on the hand. If it doesn't bounce back quickly when you let go, it doesn't have much elasticity, a sign of dehydration.)

``Then, we draw blood and send it to the lab to check for blood electrolytes,'' the emergency physician says.

An IV is started to replace lost fluids with normal saline, rapidly at first and then more slowly. The amount depends on the patient's body weight.

In about an hour, the patient normally perks up, and the IV is cut back, and we usually add some IV medication, called Zofran, for nausea. Then liquids are given to sip very slowly. Normally, it's all over in three to four hours and the patient is sent home - but we have a couple of kids going on IV rehydration almost every day. Some of them need at least overnight admission,'' Floyd says.We don't see but a few a year with seizures due to electrolyte imbalance, but that is a danger.''

Electrolytes are substances in the blood, such as sodium, chloride, potassium and bicarbonate, which are required to maintain basic functions, such as heartbeat and breathing.

When fluid is lost through any means - excess bleeding, sweating, urination, vomiting or diarrhea - the overall blood volume is depleted, which can lead to low blood pressure and ultimately to shock, Floyd says.

There is currently some controversy over the number of children taken to emergency rooms for rehydration, because many of them could be brought around slowly at home, with tiny sips of weak broth, Pedialyte or diluted Gatorade, Floyd acknowledges.

``At home, we advise just resting the stomach for an hour after a child has a vomiting episode, then starting with small sips of clear liquid - Pedialyte is great, Gatorade is good. Start with very small, frequent sips. If they tolerate half an ounce or a couple of \Rspoonfuls\S, offer it again, after a few minutes,'' the doctor advises.

Just go slow. The bad thing is people try to give 8 ounces of Sprite or 7Up,'' Floyd says.You put down a carbonated drink on an upset stomach, and it's going to come right back up, nine out of 10 times.''

How much water do we need?

The human body has a very good way of telling us when we're not drinking enough water. We get thirsty, says Dr. Robert Alpern, dean of the University of Texas Southwestern Medical School in Dallas and a kidney specialist.

The thirst mechanism is very sensitive. It kicks in long before there are any health problems related to dehydration,'' Alpern says.While most people have heard the mantra that adults should drink eight 8-ounce glasses of water a day, I don't think there's any physician who knows where it came from.''

Fluid intake should depend on how much fluid we are losing, and that depends on factors like temperature, humidity and what we are doing - in sickness and in health.

People who sweat heavily can lose 1/2 to 1 quart of fluid an hour just through the sweat glands, and runners can easily lose 2 to 3 pounds of water in a five-mile run, says Dr. John Cianca, a sports-medicine specialist at Baylor College of Medicine in Houston.

A good rule of thumb is to weigh before and after strenuous exercise and replenish the fluid supply with at least as much as you lose. Some major marathons now have scales at each water station to assure that runners are getting enough to avoid dehydration.

Though it doesn't happen often, getting too much fluid can also be a problem, Cianca says. Long-distance runners sometimes develop ``hyponatremia,'' an electrolyte problem caused by low concentrations of sodium in the bloodstream.

Cianca recommends weighing without clothing before you run or exercise, running or working out for one hour without drinking water and then toweling off and weighing again when you are finished. He says you should drink 16 ounces of fluid for every pound lost during that hour of exercise.

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