June 08th 2005 - The Importance of Fluids and Electrolyte Balance
copyright by Karen S. Vaughan, Lic. Ac., MSTOM
While we know that diarrhea can be dangerous- it kills around 3100 people a year in the US and 2.2 million anually worldwide- we associate dangers with the Third World, the elderly and the very young, especially those who are frail. But a bout with food poisoning last week brought home in a very personal way how sudden fluid loss can down any of us.
After getting some bad food over Memorial Day I awoke with a churning feeling in my stomach. I got up in the middle of the night and took some medicine which I promptly threw up. That opened the floodgates, and for several hours I lost fluids from both ends. I didn't want to surpress it- if I had bad food I wanted to get it out of my body, I figured I'd drink later when my stomach had settled down. I finally made it to sleep until a phone call pulled me out of bed. As I stood up I realized that the world was spinning. I knew I needed fluids and electrolytes and staggered down to the kitchen where only milk and soymilk looked out from the refrigerator. (We had nothing so unhealthy as gingerale.) There was no time to make up the electrolyte solution in the medicine cabinet or to reconstitute a powdered sports drink. I was spinning. I grabbed a spoonful of an herbal jam (chaywanprash*) as I crashed to the floor and passed out. When I came to some time later abraded and lying in a pool of something I broke on the way down, I realized that only the sugar and minerals had revived me. I grabbed a bottle of seltzer from the floor and sipped as I took some more jam until full consciousness set in.
A mere 2% drop in body water can trigger fuzzy short term memory, poor judgement, trouble with logical thinking and difficulty focusing. As I lost fluids, my judgement dropped and I let the discomfort of throwing up keep me from drinking. Slowly sipping water or an electrolyte replacement might have prevented this. When too much is lost through diarrhea and vomiting, blood sugar can dramatically drop and there may be insufficient glucose for the brain.
What are electrolytes? The salts and sugars that circulate in your blood and allow cell transport and nourish the brain. When you sweat, you can taste the sodium and potassium salts on your skin. The sugars are burned as energy. Whether these electrolytes are too high or too low, they can cause life-threatening problems.
Why are electrolytes needed? The body uses electrolytes to help regulate nerve and muscle function, to help maintain acid-base
balance necessary for normal cell functions and to maintain normal fluid levels in cells, tissues, and organs and to move fluids around from cell to cell, tissue to tissue, and organ to organ as needed. They are found in the intracellular fluid (more sodium), extracellular fluid (more potassium) and in the blood. The good (probiotic) bacteria in your intestines help synthesize electrolytes in the colon.
Symptoms of electrolyte imbalance and dehydration include: dizziness, fuzzy thinking, nausea, concentrated and scant urine and possibly dry mouth or mucous tissues. Confusion and disorientation mean that a person who is having severe vomiting or diarrhea should not be left alone to care for himself. When a person suffers from dehydration, it is difficult to judge how well he is doing and whether or not he needs help because of this confusion, Electrolyte imbalance can be caused by infection that causes vomiting or diarrhea, food poisoning, bulimia or laxative abuse, side effects from chemotherapy, excessive sweating during exercise or hot weather and insufficient intake. Rapid depletion of fluids and electrolytes is the most dangerous condition,
Diabetics have special problems. If fluids are depleted while blood sugar is being used up during exercise or after taking insulin, blood sugar may plummet. If the fluids are depleted from other causes, blood sugar can become concentrated. Both can cause diabetic coma. (If you can't check their blood sugar, give glucose. Too much sugar causes damage over a long period of time, but too little sugar can kill rapidly. Then call 911.)
Water can replace fluids so that the electrolytes remaining in the body can be used. But it eventually dilutes the salts in the blood and a condition called hyponatremia can cause swelling in the brain. That is what killed the Boston Marathon runner in 2002. Note that the symptoms look like those of heat prostration and the runner took extra water to cure her heat prostration.
Too many fluids are at least as dangerous as too few, according to an editorial in the July 19 issue of the British Medical Journal. Most people still think you're supposed to drink as much as you can, exceeding thirst . But that advice is dead wrong, says Timothy Noakes, MD, author of the editorial and chair of exercise and sports science at the University of Cape Town and the Sports Science Institute of South Africa. A woman runner who drinks enough water to add 2.5 kilograms (about 5 quarts) of water weight can kill herself. Usually sweat and urine will cause the loss of 2 liters an hour, but during exercise the body conserves sweat and people urinate less. Water loss may fall to under 1/3 liter during exercise.
The guidelines are 20 ounces of fluid before exercise, and over the course of every hour of exercise drink between 28 to 40 ounces of fluid. That is not a great amount. Salt loss varries considerably between individuals. In general if your sweat stings your eyes and you typically get a salt crust on your skin from sweating during exercise you should not count on electrolyte solutions like Gatorade being sufficient for you. You need salt from food and should add extra before exercises like a long race and make certain not to overdo fluids.
Take home lessons:
1. Keep a ready source of electrolytes around. This can be as prosaic as gingerale or Gatorade, or can be a specially designed electrolyte solution like Pedialite. You may also keep salts to be made up, but sometimes you need electrolytes NOW. Keep a bottle near the bed or the bathroom.
2. Homemade solution, say for a patient with diarrhea, can be made and refrigerated from:
2 quarts water
1 teaspoon baking soda
1 teaspoon salt
7 Tablespoons sugar
1/2 teaspoon salt substitute (potassium)
1/4 teaspoon ginger
3. During hot weather, drink a sports solution or drink fluids and get food sources of sugar and salts Even watermelon can be used as a summer electrolyte solution- there were summer riots in Bejing when watermelon could not get into the city as recently as 25 years ago.
4. If a family member has severe diarrhea and vomiting do not leave them alone. If you are alone and cannot get help, get an electrolyte solution and put it by your bed or toilet. Sip it, even if you are also vomiting. Gingerale or nonalcoholic ginger beer may be more useful initially than other electrolyte solutions because ginger settles the stomach.. But use other solutions with the salts and potassium when your stomach settles down.
5. If diabetic, watch your fluid intake AND your blood sugar carefully. If a diabetic is in a coma and blood sugar levels cannot be taken give something sweet and call 911. (If blood sugar can be checked, do so while you are waiting because the EMTs generally are not allowed to test themselves but can use your information.)
5. Drink just to thirst while exercising. For short sessions, water is fine if you are not a salt excreeter (see below) and have good mineral sources in your food. For long sessions an electrolyte solution is useful. Weigh yourself before and after exercise session. If you lose weight, drink more. If you have gained weight, drink less.
6. If you have sweat that crusts and stings your eyes, drink electrolyte solutions when you exercise and take extra salt and potassium rich foods like bananas before long hot races.
*Chaywanprash is an Ayurvedic tonic jam which is extremely high in Vitamin C. It has salty, sweet and sour tastes. Chaywanprash's basic ingredient amla has 30 times more vitamin C than orange and helps in strengthening the immune system and expediting the healing process. Regular intake of chyawanprash strengthens digestion, absorption and assimilation of food and balances stomach acids.
Acupuncture and Herbs by Karen Vaughan, L.Ac in Park Slope and Manhattan.
118 East 37th Street, New York, NY 10016
Brooklyn, NY 11215
Hyponatremia in Distance Athletes-Pulling the IV on the 'Dehydration Myth' by Timothy D. Noakes, MB ChB, MD. THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 9 - SEPTEMBER 2000 noakes.htm http://www.physsportsmed.com/issues/2000/09_00/