Nikki Sommer, a nurse practitioner with Key West Surgical Group, joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
Dehydration can be a serious issue in the Keys.
Sommer said, “It’s not just meaning you’re thirsty, it actually can become a serious medical problem that can affect your kidneys, your heart, your brain, and your overall health. Dehydration is incredibly common, especially during our Florida hot summers, and many people don’t realize how quickly it can happen. Dehydration occurs when your body loses more fluid than it takes in and since our bodies are made up of more than half water, we rely on adequate hydration for almost every function.”
What does water do for the body?
Sommer said, “It regulates your body temperature, it helps transport nutrients, support circulation, lubrication of joints, so if you have arthritis and you’re dehydrated, you might notice your joints hurt a little bit more. Maintain healthy kidney function, that is important, and support normal brain function. So, when the fluid loss exceeds your fluid intake, that’s when dehydration develops.”
Who is most at risk for dehydration?
Sommer said, “Adults over the age of 65. Children, especially young children, infants, they are susceptible to dehydration quicker than somebody in their middle adulthood. People with diabetes, people with kidney disease, athletes who like to run and bike outdoors in this heat, they are more susceptible to dehydration. Anybody that works outside, especially us in the Florida Keys, we don’t have a lot of shade, and a lot of our bars, our restaurants, construction workers, our utility workers, they’re working outdoors in the heat. Roofers, usually this time of year, people are trying to get their roofs done before the hurricanes come, and the roofers are up on the roof in this heat, so they’re susceptible to dehydration. Anyone with vomiting and diarrhea, so that goes all the time, but especially more important if it’s happening in our hotter months, be careful, you’re going to dehydrate more easily. Individuals taking medication that increase fluid loss. People don’t realize as we age, older adults may already be dehydrated before they even feel thirsty. A lot of older people that I haven’t taken care of over the years, they don’t want to eat or drink. Their appetite decreases, and they don’t get thirsty.”
There are parts of the day to avoid.
Sommer said, “Many people underestimate how much fluid they’re losing because of the heat and humidity. The hottest part of the day typically is between 10am and 4pm with peak heat often occurring between two and four, and when we talk about sunscreen and protect your skin, and when to stay out of the sun, for sunburns, this is also for dehydration. This can cause dehydration and heat-related illnesses, so you need to be wary if you’re going to be out in those hours, and it’s something you can’t avoid. Make sure you bring water, stay hydrated.”
What medications can increase dehydration risk?
Sommer said, “A lot of people that have high blood pressure, they are usually started on a diuretic, or it is used in conjunction with another high blood pressure medicine. So, diuretics are the water pills, that’s when you retain water, you have swelling, or if you have a condition called heart failure, you most likely will be prescribed a diuretic. So, examples can include like hydrochlorothiazide or HCTC, is the other name.That’s what’s on the medication bottle, because the name is too long to fit on the medication bottle. Furosemide or Lasix or Spironolactone, these medications increase urine output, and they can cause fluid level loss. So, if you’re on that and you’re out in the heat during the times that we mentioned, just make sure you replenish your water. A lot of times, because patients are on water pills, they think that they shouldn’t drink water. That’s not always the case. Certain diabetes medications, and these are newer, in the last couple of years, those are called Jardiance, Farxiga, and Invokana. They can increase your urination, so meaning that you’re urinating more, so your intake needs to match your output.”
Mental health medications can also contribute to dehydration.
Sommer said, “Certain antidepressants and antipsychotics can interfere with temperature regulation and sweating, as well as laxatives, people overuse laxatives, and that also pulls all the fluid out of your body. Some mental health medications and antihistamines can contribute to dry mouth and reduce fluid intake. So I often tell patients, dehydration is not usually caused by one thing. It is often a combination of heat, humidity, sweating, our good old friend alcohol, not drinking enough fluids and certain medications, so put all those together and dehydration can happen pretty fast. So just be aware.”
What are the signs and symptoms of dehydration?
Sommer said, “Thirst, dry mouth, fatigue, headache, weakness, muscle cramps. The color of your urine, if your urine is dark yellow, or you have a decrease in urination, this could be a sign that you’re dehydrated. So, if your urine is clear, then we tend to say that if it looks close to water, you’re pretty hydrated. So, simple rule is, your urine should look more like lemonade than apple juice. So, if it’s light yellow, it’s better than looking dark yellow or orange. Dizziness, lightheadedness, rapid heartbeat, difficulty concentrating, irritability, increased fatigue, severe dehydration may cause confusion, very low blood pressure, fainting, loss of consciousness, and even shock. Those are medical emergencies. And keep in mind, older patients or older family members, if you have seen any of these symptoms in them, it could be a sign of dehydration. Confusion is a big one, and it’s usually the first two things you think about is dehydration or UTI in the elderly.”
When does dehydration become dangerous?
Sommer said, “So what happens inside the body when somebody becomes dehydrated? The body immediately starts trying to conserve water, so your kidneys reduce urine production. Your heart works harder to circulate the blood, and hormones are released to help maintain blood pressure. But if it continues, obviously you can have complications. So kidneys take a hit. The dehydration can lead to acute kidney injury, kidney stones, or worsening of kidney disease, so if you already have a kidney problem, this becomes very difficult during this time, because you can actually worsen your kidney disease if you become dehydrated.”
Heart problems can also arise.
Sommer said, “It can spike your heart rate up. Your heart can beat very fast. It drops your blood pressure. That’s where you find that dizziness associated with dehydration. Electrolyte imbalances can also cause your heart rate to go up, but it can also cause abnormal heart rate or arrhythmias. So you need to be careful with that. When you sweat, you lose potassium and sodium, and those are two important electrolytes that your heart needs to maintain your heart rate, and it prevents your heart from going into a bad rhythm.”
It can also affect the brain.
Sommer said, “The brain is very sensitive to dehydration, again, of course, in the elderly, confusion, delirium, difficulty concentrating, and increased fall risk in older adults, so it all kind of comes together. The body will work together, so it’s not just one thing. Usually, multiple things are going on at the same time. When you’re dehydrated, you can also get terrible muscle cramps, weakness and fatigue. You’ll be sluggish, you don’t feel like doing anything or getting out of bed, that could be due to dehydration. If you wake up in the middle of the night and you have those terrible Charlie horse cramps in your leg, that could be from dehydration, it could also could be from electrolyte imbalance, like your potassium or your magnesium is low, so but again, that could be factors from being dehydrated.”
Is water the answer?
Sommer said, “If you’re mildly dehydrated, yes, water is the answer. However, if you’re losing significant fluids through excessive sweating, vomiting, diarrhea, prolonged outdoor activity, you’re also losing electrolytes, like I just mentioned, so sodium and potassium, these are really important. So, in those situations, they have now liquid IV, and different types of oral rehydration solutions, or electrolyte replacement beverages, may be helpful. I know Gatorade is big, but sometimes we worry about the sugar content, although they do have sugar-free Gatorade and Powerade, but now you see packets of all these oral rehydration solutions you can put in your water, and actually I have these at home because my younger daughter is a very big runner, and she will run at all hours of the day, so it’s important that she stays hydrated, so my one cabinet has it’s like an different flavors.”
When should someone seek medical care if they’re concerned about dehydration?
Sommer said, “If you have persistent vomiting, severe diarrhea, inability to keep fluids down. If you can’t keep any type of water or oral hydration down, you need to seek medical attention. If you have significant dizziness, if you’re not urinating enough, if your urine is dark, like we talked about, if it looks more like apple juice or even darker, you need to go seek medical attention, and then symptoms that continue, even if you’re hydrating and you’re not feeling any better, go seek medical care. Obviously, it’s an emergency if somebody is confused, if they fainted, if they lose consciousness, if they have severe weakness or they have signs of shock, that indicates severe dehydration, and that requires urgent treatment.”
Hydrate before you’re thirsty.
Sommer said, “Thirst is often a late sign. So, carry water everywhere. Make sure you have access to water. If you forget your water bottle at home, don’t wait until you’re already dehydrated. Avoid excessive activity during the peak heat. Try to avoid strenuous outdoor activities between 10am and 4pm and then if you’re going to go outside and exercise, make sure you increase your food intake, as well as working outdoors, and the outdoor workers are the big one, they usually have a lot of problems during this time of year. They’re sweating excessively, so they’re losing fluid faster than they can put in. So, it’s important that you drink during the day, but also hydrate when you’re home. Any type of illness, fever, or just during hot weather, try and increase your fluid intake.”
Alcohol is not a way to hydrate.
Sommer said, “It definitely can worsen dehydration, so can caffeine. Those things also actually increase urination, so you need to be careful. Dehydration is much more than feeling thirsty, and remember, it can affect your kidneys, your heart, your brain, and your overall health. So, here in the Florida Keys, our heat, humidity, outdoor lifestyle, and certain medication can increase your risk, so just be aware. Hydrate before you’re thirsty, avoid excess activity during the hottest part of the day, and make sure you know your medications, or your family’s, your loved ones’ medications, and pay attention to those early warning signs. A little prevention can keep you healthy, and out of the emergency room.”
For more information on how Key West Surgical Group can help, click here: https://www.keywestsurgicalgroup.com/