Staying Hydrated

The weather is heating up and with the humidity, we are all perspiring for no good reason and certainly without any physical effort. Our focus must shift to helping people who are ill to stay hydrated enough to get through the hot and sweaty spells.

The easiest prevention to getting dehydrated is to conserve energy, try not to sweat, stay indoors in an air conditioned room and drink plenty of fluids, advice that we all throw around randomly! Not everyone likes water though and the old saying, drink 8 glasses of water a day does not really apply to those who are chronically ill.

For those of us who are healthy, it's easy to drink 8 glasses of water or fluids of some kind to make sure we stay hydrated. However, for the sick and elderly, their bodies may not be signalling them that they need to drink, they may not easily have access to drinks or have the inclination to increase the amount of fluid they are drinking.

When I worked as a homecare nurse in the hot summers in New York City, I would visit my patient's in their small apartments with no air conditioning and marvel at their tolerance. While I huffed and puffed and sweated, my astute patients moved slowly with precision, sat with cold compresses on their heads and necks and gorged on watermelon. I had an initial aversion to watermelon, it being foreign to my Irish sensibilities. Little did I know that this fruit saves little old dehydrated lives, toddlers and the like. I have yet to find anyone who does not partake of watermelon joyfully on a hot summers day.

Why do we need to drink fluids?

Fluids in our body transport nutrients, glucose, oxygen around our body and remove waste products. The bloodstream that has adequate volume can get the nutrients to their destination quickly and efficiently and blood pressure is maintained at a decent level. Without fluids, these processes work less efficiently and waste is stored for longer. Fluids help to regulate body temperature. When it's hot outside, our body heats up and when we exercise, our muscles heat up. As a result, we sweat and release heat into the fluid which sits on our skin and evaporates causing our body to cool down. Liquid is needed to create this process.

Liquids also help with digestion, to make the gastric juices that digest food and to help the juices to mix and break down food. In order for food to break down, the food must be reduced to a liquid so it can be absorbed. Additionally, liquids are needed to create the fluids in our joints so our movements are painless. These and many more body functions describe how essential fluids are in our bodies.

How do you know if you are drinking enough?

Most of us know when we need to drink:

1. Our mouths & lips become dry.
2. We feel thirsty.
3. We notice that we are sweating.
4. We have not pee'ed for a while.
5. When we pee, the fluid appears dark.
6. Some of us feel weak and dizzy (because our blood pressure drops).
7. Some of us feel nauseous.
8. Some of us get a headache.

What about the elderly or sick? Some of these mechanisms do not signal the sick and elderly to drink so they do not feel thirsty, don't sweat and don't notice that they are not peeing. Tell tale signs of dehydration in someone who is sick include the following:

1. Dry mucus membranes. If you stick out your tongue, it should be glistening and moist and so should the inside of the mouth. If you notice that the saliva is thick and stringy, this is also an indicator that more fluids are needed.
2. Skin tenting occurs when there is significant dehydration. If you pinch a little skin on the top of the hand, it should return to it's normal position right away. This shows adequate hydration of the tissues. With dehydration, the skin stays up, like a tent, and returns to normal slowly.
3. Low blood pressure occurs because of low volume of blood in the blood vessels.
4. Scant and dark urine is one of the most obvious signs of hydration problems. We often view the color as a guage of our level of hydration and the darker it is, the more liquid we are encouraged to drink.

If you don't like to drink water, there are a number of fluids that you can drink that are just as effective as water. In fact, we get 20% of our daily fluid requirements from food, not fluids.

For those who don't like drinking fluids, be it water or other drinks, there are a number of ways to make sure they have enough fluid on board. Good alternatives to drinking can be found in many places:

1. Fruit is full of liquid, so as long as you are not a diabetic, eating your favorite fruit can help to give you lots of fluids that you may not realize. The best fruits, loaded with liquid are watermelon, citrus fruits, strawberries (don't forget the  ice cream!), apricots, peaches, nectarines, cherries, apples and grapes.
2. Vegetables are not our first thought when we think of fluid laden foods but these are especially fluid filled: carrots, bell peppers, lettuce, tomato, cucumber, celery, squash and broccoli
3. Ices are a great way to cool people down, give them fluids that are tasty and to find a good way to offer nutritious fluids in the form of a frozen pop. Try making a smoothie with some fruit, dairy or soy and water and freeze it in an ice pop mold.
4. Ice Cream can be a last ditch effort to get some protein and fluid into your non-conforming loved one. There are low calorie options, but if they are particularly ill, as long as they are not diabetic and their blood sugar is within range, ice cream can be a great solution to a drinking problem.
5. Jello & Puddings similar to ice cream can also alleviate a drinking problem especially if liquid itself is too thin to be swallowed without choking. At some point when people are very sick and for some elderly with dementia, swallowing becomes a challenge making it difficult to maintain an adequate food intake on a daily basis. Jello can often be swallowed without choking and is made primarily of fluid.
6. Yogurt offers an opportunity to indulge in a little protein and some healthy  probiotics that may sooth an upset stomach and alleviate some bad breath!
7. Soup, always the cure all, especially if it's chicken offers a tasty nutritious meal. It may not be the meal of choice in hot weather, but some, like gazpacho and various fruit based soups are tasty served cold.
8. Cereals served cold with milk, soy or yogurt are often forgotten when trying to tally the fluid intake. If in doubt, cereal offers a nutritious palatable meal. Served hot, oatmeal and other hot cereals can be boosted with protein when made with milk rather than water.

9. Water with a dash of some flavor you like. When the taste is important adding a dash of your favorite flavor; a twist of lemon, a little mint, a dash of mango juice or a hint of pineapple may be the solution.

When to be cautious about Fluids

On occasion, we need to be mindful of not drinking too much or making a sick person drink against their will. Often, people who are chronically ill are not able to tolerate too much fluid, so it's best to give drinks and alternatives in small amounts. Sometimes, when too much fluid is given, it sits in their stomach and causes nausea, sometimes vomiting.

People who have heart failure and swelling in their ankles must watch the amount of fluids that they are drinking. Because the heart is not pumping effectively, fluids back up into the tissues, and gravity usually sends the fluid to the feet, ankles, hands and base of the spine if the person is sitting mostly or confined to bed. With heart failure, the fluid intake may be limited to a liter a day and if there is an overload, congestion and shortness of breath may ensue. People with heart disease should consult their physician about the amount of fluid and salt that they should have each day.

People with kidney disease must also be mindful of the amount of fluids they consume. If their kidneys are no longer functional, or produce only minimal amounts, the person may be on dialysis. In these circumstances there is often a fluid restriction each day and the person may also need to avoid high protein drinks.

People with diarrhea or vomiting will become dehydrated more quickly. Some fluids will make the diarrhea worse. Juices, especially prune juice are notorious. With diarrhea, a BRAT diet is recommended. Bananas, rice, applesauce and toast. These foods replace fluids, are binding and bland and are an easy solution to help alleviate dehydration and diarrhea. People with diarrhea should consult their physician within 1 day, especially if elderly or ill.

People with difficulty swallowing are at risk of aspirating and getting a chest infection. If you notice that your loved one often chokes or coughs when they are drinking, they may need to have further testing. A good way to help the situation is to have the person sit straight up, lean slighty forward and bow their head when they are swallowing. This prevents the fluid from going down the wrong tube when swallowing. If swallowing is a significant problem, all fluids must be thickened before giving them to the person to swallow.

How do you avoid conflict about drinking and fluids with your sick loved one:

1. Give drinks and fluids that they like as long as they don't overdo the calorie content if they need to watch calories and sugar content if they are diabetics.
2. Give small amounts, a variety of options and more frequently.
3. If they eat some fruit, ice creams, ices, puddings, cereal etc. chances are, they are getting enough fluids, so don't sweat it....excuse the pun!
4. Water down drinks such as juices and high sugar drinks if needs be. This can be helpful when your loved one only wants to drink one or two types of drinks.
5. Offer protein drinks as a meal if they do not have an appetite but prefer to drink fluids.

Fluids that cause dehydration

Sometimes we think we are drinking plenty of fluids, but we are peeing more than we are drinking. There are a number of drinks that have a diuretic effect thus causing dehydration. Do you drink coffee? You can expect to pee alot after drinking coffee. Alcohol is a notorious offender and surprisingly, some soft drinks that contain caffeine. Energy drinks are not only full of sugar but give a hefty dose of caffeine that causes dehydration, so make sure to read the ingredients before filling up on these drinks.

Sports drinks often contain sugar and colors that are not needed for hydration, however, if you are in need of calories, there is no harm as long as the sugar and calorie content are not too high. If you plan to use a sports drink for hydration, pick one that contains electrolytes too especially if you have been sweating alot and you need to replace lost salt.

Sports drinks are not the drink of choice for the sick and elderly since there are so many other choices in fluids that offer calories and protein too. Depending on the illnesses and restrictions that apply to the ill and elderly, the choices in drinks should revolve around the types of fluids that would offer the most benefit. For people who are not eating very much food, calories and protein are helpful in fluids: yogurt, ice cream, protein drinks, milk and soy products.

When all else fails, and dehydration is not manageable with conservative means, a trip to the doctors office or the emergency room may be warranted. In general, a few liters if intravenous fluid takes care of the hydration problem in the short term, however, a look at the cause and finding a long term solution may be more challenging.