CATES: One change at time: Staying hydrated

By Carol A. Cates, MSN, MBA, RN

Chief Nursing Officer

Odessa Regional Medical Center

Years ago, I had a friend visit from St. Louis. My friend is an avid runner, and at the time was in training for a marathon. She decided to go for a run, and I warned her to pay attention to her water intake during her run. The reason is simple, our air here in the West Texas desert is so dry, sweat evaporates very quickly, making people not notice how much they are sweating. That can lead to dehydration faster than most people realize. She said she understood, but I don’t think she really got it because she ended up very dehydrated and was ill for a couple of days.

We see quite a bit of dehydration in our Emergency Department (ED) every summer for the same reason, people just don’t realize how fast they can dehydrate in the West Texas heat and that dehydration can lead to some serious problems including acute renal failure and rhabdomyolysis, a condition that causes muscles to break down at the cellular level.

Dehydration is not just a summer issue, dry climate issue, or exercise/sweating issue. Studies suggest that most of us walk around with mild dehydration every single day. Making sure you are well hydrated has major health benefits, and it is one change you can make to improve your overall health.

I think we have all heard the “drink 8 glasses of water a day” to stay hydrated. Unfortunately, good hydration is not that simple. The amount of water each of us need depends on a several variables.

Weight, gender, exercise, kidney function, heart function, and climate all pay a significant part in our daily water needs. We lose water with every breath we exhale, and through urine, bowel movements, and sweat.

The U.S. National Academies of Sciences, Engineering, and Medicine determined that on average men need about 15.5 cups of water per day and women need about 11.5 cups of water per day to replace those normal fluid losses. Those amounts aren’t just water, they include all forms of water intake from other beverages to food. The scientists in those studies determined that about 20% of the water we take in each day comes from food, and the rest is from beverages.

Things that may increase your water needs are exercise or any activity that makes you sweat, hot or humid weather, high altitudes, health conditions like vomiting, diarrhea, bladder infections and urinary tract stones, or pregnancy and breast feeding. If you have chronic health conditions like heart failure or renal failure, you need to talk to your doctor about fluid intake because too little water can cause dehydration, but too much water can make your chronic health conditions worse.

If you are in good health, it’s very rare that you can drink too much water. But it is possible and can be life threatening. Please make sure if you are considering adding large volumes of water to your intake that you discuss it with a health care professional or nutrition expert. And make sure if you are sweating excessively that you are replacing electrolytes as well as water.

Symptoms of dehydration are subtle in the early stages, and thirst isn’t always a reliable indicator, especially in older adults. For most people thirst happens when they are already dehydrated. Some of the early symptoms of dehydration include fatigue and lest restful sleep.

In a study of 26,000 adults, shorter sleep duration was associated with inadequate hydration. Another study found that athletes who were dehydrated had an increased feeling of fatigue and less endurance.

Dark colored urine and less frequent urination is also associated with inadequate hydration. Urine color is a practical way to know if you are well hydrated. Ideal urine should be a very pale yellow—the color of straw. Do remember that some medications can affect urine color, B vitamins for example, and you need to take that into account as you judge your urine color.

Dry skin, cracked lips and decreased skin elasticity are also indicators of poor hydration. Headaches, mood changes, inability to concentrate, confusion, lightheadedness and dizziness are also signs you may be dehydrated. Heart palpitations, that feeling where your heart feels like its beating out of your chest, or an irregular heart rate can be a late symptom of dehydration. Low blood pressure is another late sign.

Good hydration has many benefits. One of the best is a link to healthy aging. A recent study of 11,256 adults over 30 years by the National Institutes of Health (NIH) found people who stay well hydrated are less likely to develop chronic health conditions like heart and lung disease and have longer life spans.

People who are well hydrated have improved brain performance, fewer digestive tract issues, more energy, are able to maintain an ideal body weight better, have decreased joint pain, have better temperature regulation, have fewer kidney stones, have fewer headaches, and have fewer heart and immune system issues.

Water is always the best option for good hydration, but it’s not the only option. Flavored unsweetened water, skim or nut milks, juices (in moderation because of the sugar), sparkling waters (if sweetened in moderation), coconut water, herbal teas, tea, and coffee (in moderation because of the caffeine) are all good options. Sports drinks are good for hydration as well, but again drink in moderation if sweetened.

Sugary beverages can hydrate, but they can drive other health issues, so they are best used sparingly. Foods like watermelon and spinach are by weight almost entirely water, so they have a good ability to contribute to your hydration as well.

Consider adding a hydration plan to your daily routine as part of your one change at a time for better health.