Health Check: how do I tell if I’m dehydrated?



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Our bodies are pretty good at telling us when we need to drink water.
from www.shutterstock.com

Karen Dwyer, Deakin University

It’s a message that’s been drummed into us since childhood. Drink water, especially when it’s hot, otherwise you’ll get dehydrated.

But how do you know if you’re dehydrated? Who’s more at risk? And what can you do about it?




Read more:
We asked five experts: do I have to drink eight glasses of water per day?


What’s dehydration and why does it matter?

When people use the term dehydration, they usually refer to what doctors call “volume depletion” or hypovolaemia.

Volume depletion is a reduction in the volume of water in the blood vessels. But dehydration is quite different and is less common. It’s the loss of water from both blood vessels and the body’s cells.

Doctors are concerned about volume depletion and dehydration because adequate hydration is required for the body to function normally. Water maintains our body temperature and lubricates our joints. Our body’s cells rely on water as does our circulatory, respiratory, gastrointestinal and neurological systems.

Severe cases of volume depletion can lead to shock and collapse. Without resuscitation with fluid, the consequences may be devastating.

Water, water everywhere

A 70kg person is made up of 40L (40kg) is water. Two-thirds of that water is in the cells (intracellular), one-third outside the cells (extracellular).

Outside the cells, 20% of body water is in plasma (around 3L), which together with red bloods cells (2L) gives a total 5L of blood. It’s the movement of water between compartments that maintains each one’s biochemical composition, allowing your cells and body to work normally.

The total body water volume (water in both the blood vessels and the body’s cells) is remarkably constant given the large variation in how much an individual might take in and lose each day.

Water intake is accounted for mostly by how much and what you drink and eat, and the daily variation is regulated by the kidney, which alters your urine output.

The main function of the kidney is to regulate the volume and composition of body fluids within narrow limits by altering output.




Read more:
Kidneys are amazing for all they do, be sure to look after yours


When you drink large volumes of fluid, your body can afford to get rid of increased amounts of dilute urine. But when you drink a minimal amount of fluid, your urine is concentrated and you pass only a small volume.

If you’re urinating less often than normal, or urinating small volumes of darker coloured urine, it may be time to drink more water.




Read more:
Health Check: what can your doctor tell from your urine?


Other small losses of water include through stool, sweat and lungs.

So if you have diarrhoea or are exercising in the heat, for instance, you will need to drink more fluids.




Read more:
Drink plenty of fluids to cope with the heat, but there is no need to avoid caffeine


As fluid is lost from the extracellular compartment such as in cases of diarrhoea and vomiting or bleeding, you can develop symptoms of volume depletion including:

  • thirst, including a dry mouth
  • dizziness, particularly when standing due to the low blood pressure (a consequence of volume loss)
  • and when very severe, confusion (a consequence of inadequate oxygenation of the brain).

Doctors might also note:

  • that it takes longer for your skin to bounce back when pinched (known as reduced skin turgor)
  • low blood pressure as a reduction in volume directly affects blood pressure
  • an increased heart rate, in an attempt by the body to maintain blood pressure
  • reduced weight as fluid makes up two-thirds of body weight. A loss of 1L of fluid will read as a drop in 1kg on the scales.

Blood testing will often reveal a degree of kidney impairment. That’s because the kidneys require a large blood flow to work normally.

In cases of volume depletion and reduction in blood pressure, blood flow to the kidneys is compromised and they go into a state of “shock”. Mostly this is reversible when volume and blood pressure is restored.

As there’s no single test for volume depletion, doctors will make a diagnosis after taking a note of your history, examining you and a combination of blood and urine tests.

Here’s what happened to Tom

I was on call at the hospital recently when, at 9.45pm on a Sunday, I received a call from the emergency department.

Tom, a 78 year old man, had come in by ambulance after neighbours had found him on his bedroom floor. Tom’s cognition was not great at the best of times, and that night he couldn’t tell us how long he had been on the floor.

There were no obvious injuries, his blood pressure was low (100/60mmHg), pulse rate high (98 beats per minute) and his temperature was normal. Blood tests showed he had low sodium salt levels and kidney impairment.

Tom had been in the emergency department for six hours by the time the call came to me; in that time he had not passed urine. It all pointed to volume depletion.

Elderly people are at increased risk, so keep an eye on relatives and neighbours this summer.
from www.shutterstock.com

We treated Tom with intravenous fluid. He needed 5L over 48 hours, after which he was passing urine again. His blood pressure was back to normal 140/70mmHg, his kidney function had normalised and his weight was up from 46kg on admission to 50kg.

Tom told us he had fallen while getting up at night. He had been on the floor for most of the next day and had not eaten or drunk anything for hours.

Who’s most at risk and why?

Some groups are more susceptible to volume depletion, including:

  • elderly people like Tom, as our total body water reduces with age and the elderly often have a reduced sensation of thirst. Many older people also have other health problems including chronic kidney disease, which may impact the ability to concentrate urine when the volume is depleted
  • babies, because they aren’t able to articulate when they’re thirsty. They have a higher metabolic rate than adults meaning they require more fluid
  • people with impaired thirst mechanisms such as the elderly or people with certain brain injuries
  • people losing large volumes of fluid via the bowel (from diarrhoea or through a colostomy)
  • people taking medications that promote water loss, in particular diuretics, often referred to as water tablets.

These vulnerable groups need to be aware of the increased risk of volume depletion, minimise their risk by maintaining fluid levels, recognise the symptoms of volume depletion early, and seek prompt treatment, including going to hospital if necessary.

If you experience the symptoms of volume depletion it’s important to take heed. At home, start with water if you’re thirsty. Once dizziness is present, significant volume loss has ensued and a trip to the doctor is in order. Confusion mandates emergency treatment.

How about physiological dehydration?

Physiological dehydration, which occurs when water is lost from both the blood vessels and from the body’s cells compartment, is distinct from volume depletion. But there are many overlapping symptoms, such as thirst, a drop in blood pressure and when severe, confusion.

Dehydration can happen with prolonged and sustained high blood sugar levels as can occur in someone with diabetes. This is because the high sugar levels in the blood pull water out of the cells in an attempt to lower the levels. High sugar levels also make you pass more urine. So in this instance there is loss of fluid from both the intracellular and extracellular compartments.




Read more:
Explainer: what is diabetes?


So for those with diabetes, monitoring blood sugar levels is important. If the blood sugar is persistently high it’s important to seek medical advice to reduce the level safely and prevent dehydration.

In a nutshell

Water is vitally important to the normal function of the body. Volume depletion can occur during anytime of the year, but people are particularly prone over the summer months. The key is prevention and knowing what the signs and symptoms are. So in summer keep your fluids up; talk to your doctor about any medications that may need adjusting (such as diuretics) and keep an eye out for friends, family and neighbours.The Conversation

Karen Dwyer, Deputy Head, School of Medicine, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Lao Officials to Expel More Christian Families from Village


Katin chief says previously expelled Christians will be shot if they return.

DUBLIN, November 9 (CDN) — Officials in Katin village, southern Laos have ordered six more Christian families to renounce their faith or face expulsion in early January, advocacy group Human Rights Watch for Lao Religious Freedom (HRWLRF) reported today (Nov. 9).

The Katin chief and the village religious affairs officer, along with local security forces, recently approached the six families with the threat after having expelled 11 Christian families, totaling 48 people, at gunpoint last January. The six families now under threat had become Christians since the January expulsion.

The eviction last January followed months of threats and harassment, including the confiscation of livestock and other property, the detention of 80 men, women and children in a school compound and the death by asphyxiation of a Christian villager. (See http://www.compassdirect.org, “Lao officials Force Christians from Worship at Gunpoint,” Feb. 8.)

Immediately after the expulsion, two more families in Katin village became Christians despite the obvious risk to their personal safety, according to HRWLRF. The village chief allowed them to remain in Katin but warned all villagers that their own homes would be “torn down” if they made contact with the expelled Christians.

In the following months, the expelled villagers suffered from a lack of adequate shelter, food and water, leading to eye and skin infections, diarrhea, dehydration and even the death of one villager. Katin authorities also denied Christian children access to the village school. (See http://www.compassdirect.org, “Christians Expelled from Village Suffer Critical Illnesses,” May 14.)

District officials in early May gave the Christians permission to return to Katin and take rice from their family barns to prevent starvation, said another source on condition of anonymity. Some families then tried to cultivate their rice fields to avoid losing them completely, but the work was extremely difficult as authorities had confiscated their buffaloes, essential to agriculture in Laos.

 

Threat to Shoot

In July, officials from the Saravan provincial headquarters and the Ta-oyl district religious affairs office met with the evicted families in their shelters at the edge of the jungle and encouraged them to return to Katin, HRWLRF said.

The Christians agreed to return under five conditions: that authorities designate a Christian “zone” within Katin to avoid conflict with non-believers; that all forms of persecution end; that their children return to school; that Christians must be granted the right of burial in the village cemetery; and that the village award compensation for six homes destroyed in the January eviction.

When higher-level officials approached Katin leaders with these terms, village officials and local residents rejected them, insisting that they would only allow the Christians to return if they gave up their faith. The higher officials invoked Decree 92, a law guaranteeing the rights of religious minorities, but village heads said they would shoot every Christian who returned to Katin.

Shortly after this discussion took place, a further four families in Katin became Christians, according to HRWLRF.

A communist country, Laos is 1.5 percent Christian and 67 percent Buddhist, with the remainder unspecified. Article 6 and Article 30 of the Lao Constitution guarantee the right of Christians and other religious minorities to practice the religion of their choice without discrimination or penalty.

Report from Compass Direct News

Lao Christians Expelled from Village Suffer Critical Illnesses


One dead, two hospitalized; village chief threatens other residents.

DUBLIN, May 14 (CDN) — In spite of assurances of religious rights by officials in March, Lao Christians expelled from a village in Saravan Province in January are suffering from a prolonged lack of adequate food and clean water.

The lack of basic resources has led to diarrhea, dehydration, eye and skin infections, fainting and general weakness for the Christians expelled from Katin village, and one person has died, Human Rights Watch for Lao Religious Freedom (HRWLRF) reported.

A Christian who went by the single name of Ampheng died suddenly in April while praying for one of two other Christians who were hospitalized with illnesses caused by their living conditions, an HRWLRF spokesman told Compass. The exact cause and date of Ampheng’s death were not immediately known.

Expelled from their village at gunpoint on Jan. 18 for failing to renounce their faith, the 48 Christians were forced to build temporary shelters at the edge of the jungle, about six kilometers (nearly four miles) away from the village.

They have since survived on food found in the jungle and water from a hand-dug well that is unfit for cooking or drinking, sources told HRWLRF.

District officials in early May gave the Christians permission to return to Katin village and take rice from their family rice barns to prevent starvation, said another source on condition of anonymity.

In addition, some of the Christians have returned to tend their family rice fields, fearing that if the fields are completely abandoned they may lose the right to cultivate them next year. Water buffaloes essential for farm work, however, were confiscated in January along with the Christians’ homes and registration papers, according to HRWLRF.

When the Christians interred Ampheng at the local burial ground, district officials fined them for failing to produce the required proof of house registration, according to HRWLRF.

Katin’s village chief recently warned other residents that their personal possessions would be confiscated if they had any contact with the expelled Christians. If any family continued to maintain contact despite repeated warnings, their own homes would be torn down, the chief reportedly said.

Official reactions to the plight of the Christians have been mixed. In March, a delegation of provincial and district officials led by Gov. Khamboon Duangpanya visited the Christians at their jungle site and assured them of their legal right to embrace the faith of their choice and to live anywhere in the district.

Just days earlier, however, the district head, identified only as Bounma, summoned seven of the Christians to his office and said that he would not tolerate the existence of Christianity in areas under his control. (See “Lao Officials Visit Expelled Christians, Give Assurances,” March 19.)

High level officials failed to intervene last July when villagers seized a Christian identified only as Pew and poured rice wine down his throat, killing him by asphyxiation. Village officials later fined Pew’s family for erecting a cross on his grave, and then detained 80 Christians in a school compound, denying them food and pressuring them to renounce their faith.

The heads of 13 families then signed documents renouncing Christianity in order to protect their children, but most resumed attendance at worship meetings within a few months.

Provincial officials did call a meeting in September 2008 asking Katin authorities to respect Lao religious laws and allow the Christians freedom to worship, but their request was ignored.

A communist country, Laos is 1.5 percent Christian and 67 percent Buddhist, with the remainder unspecified. Article 6 and Article 30 of the Lao Constitution guarantees the right of Christians and other religious minorities to practice the religion of their choice without discrimination or penalty.

Report from Compass Direct News 

ERITREA: THIRD CHRISTIAN THIS YEAR DIES IN MILITARY PRISON


LOS ANGELES, July 27 (Compass Direct News) – Another Christian imprisoned for his faith in Eritrea has died from authorities denying him medical treatment, according to a Christian support organization.

Sources told Netherlands-based Open Doors that Yemane Kahasay Andom, 43, died Thursday (July 23) at Mitire Military Confinement Center.

A member of the Kale-Hiwot church in Mendefera, Andom was said to be secretly buried in the camp.

Weakened by continuous torture, Andom was suffering from a severe case of malaria, Open Doors reported in a statement today.

“He was allegedly further weakened by continuous physical torture and solitary confinement in an underground cell the two weeks prior to his death for his refusal to sign a recantation form,” the organization said. “It is not clear what the contents of the recantation form were, but most Christians interpret the signing of such a form as the denouncement of their faith in Christ.”

Andom is the third known Christian to die this year at the Mitire camp, located in northeastern Eritrea. Mogos Hagos Kiflom, 37, was said to have died from torture at the same center in early January. On Jan. 16, Mehari Gebreneguse Asgedom, 42, died in solitary confinement at the Mitire camp from torture and complications from diabetes, according to Open Doors.

It was not immediately known whether Andom was married or how many family members survive him. He had spent the past 18 months at the Mitire camp.

Last October Open Doors learned of the death of another Christian, Teklesenbet Gebreab Kiflom, 36, who died while imprisoned for his faith at the Wi’a Military Confinement Center. He was reported to have died after prison commanders refused to give him medical attention for malaria.

In June 2008, 37-year-old Azib Simon died from untreated malaria as well. Weakened by torture, sources told Compass, Simon contracted malaria only a week before she died.

With the death of Andom last week, the number of Christians who have died while imprisoned for their faith in Eritrea now total nine. Along with the two Christians who died in January and Kiflom and Azib last year, Nigisti Haile, 33, tied from torture on Sept. 5, 2007; Magos Solomon Semere, 30, died from torture and pneumonia at Adi-Nefase Confinement Center, outside Assab, in February 2007; Immanuel Andegergesh, 23, died in Adi-Quala Confinement Center in October 2006 from torture and dehydration; and also at the Adi-Qaula center, Kibrom Firemichel, 30, died from torture and dehydration also in October 2006.

More than 2,800 Christians remain imprisoned for their faith in Eritrea, according to Open Doors.

The Eritrean government in May 2002 outlawed all religious groups except Islam and the Orthodox, Catholic and Lutheran churches. The government of President Isaias Afwerki has stepped up its campaign against churches it has outlawed, once again earning it a spot on the U.S. Department of State’s latest list of worst violators of religious freedom.

Incarcerated Christians from throughout Eritrea have been transferred to the Mitire prison. In April Open Doors learned that 27 Christian prisoners held at police stations in the Eritrean capital of Asmara had been transferred to the Mitire military camp for further punishment.

They included a pastor identified only as Oqbamichel of the Kale-Hiwot Church, pastor Habtom Twelde of the Full Gospel Church, a pastor identified only as Jorjo of the Full Gospel Church, two members of the Church of the Living God identified only as Tesfagaber and Hanibal, Berhane Araia of the Full Gospel Church and Michel Aymote of the Philadelphia Church.

On April 17, according to the organization, 70 Christians were released from the Mitire military facility, including 11 women imprisoned for six months for allegedly failing to complete their required 18 months of military service. The Christians said that authorities simply told them to go home and that they had no idea why they had been released. They had been originally arrested in Asmara, Dekemhare, Keren, Massawa and Mendefera and transported to Mitire for punishment.

Eritrean officials have routinely denied that religious oppression exists in the country, saying the government is only enforcing laws against unregistered churches.

The government has denied all efforts by independent Protestant churches to register, and people caught worshipping outside the four recognized religious institutions, even in private homes, suffer arrest, torture and severe pressure to deny their faith. The Eritrean Orthodox Church and its flourishing renewal movement have also been subject to government raids.

Reliable statistics are not available, but the U.S. Department of State estimates that 50 percent of Eritrea’s population is Sunni Muslim, 30 percent is Orthodox Christian, and 13 percent is Roman Catholic. Protestants and Seventh-day Adventists, along with Jehovah’s Witnesses, Buddhists, Hindus, and Baha’is make up less than 5 percent of the population.

Report from Compass Direct News