Under black flags we march…. and pass out from heat exhaustion
Why this topic? I’m currently listening to “Under Black Flags we March” by Arch Enemy. Angela Gossow is so hardcore. Speaking of hardcore, show of hands, who tried to prove their hardcoreness in 104F heat before? Just me? There is a reason we are called jarheads. Anyway, I promise this makes sense. Black flag is the marker used on pirate ships. And for weather conditions with a high risk of heat related injuries. That is what I am getting to.
For those of us who live in a place that goes from -50F to 100F we can get frostbite and heat stroke both in one week. So much fun. Sweat is one of our body’s compensatory mechanisms to cool us down. Evaporation of the sweat removes heat from the skin, if everything works well and we drink water and have enough electrolytes, we don’t overheat. Remove the water and salt, then we can’t sweat and we start to heat up like a car with a busted radiator
Loosing fluid via sweat and no intake means that the body has to ration out what’s left between temperature regulation and little things like, THE BRAIN AND KIDNEYS. It’s like would you rather lose a hand or a leg? Both suck.
Let’s start with losing fluid. I know none of my readers have ever been hungover but I hear that it brings headaches, dry mouth, cramps, and other unpleasant things. Why does this happen? Lower blood volume and higher viscosity cause less oxygen to be provided to critical organs, see the above brain and kidney and we also established in a previous episode that oxygen is generally very good for life if you are not an anaerobe.
So what else do we need water for? Without it, no tears, no sweat, less or no perfusion due to hypovolemia, constipation, confusion, fatigue, kidney injury or failure, and myriad other bad things. Death being one of those. The moral of the story? Drink water, get some electrolytes. Especially for those of us who are more mature and/or more active. The thirst mechanism of elderly patients may be blunted leading to fluid deficit. During strenuous exercise or just being in very hot climates can lead to more fluid intake, but also electrolyte imbalances which have a host of other issues. The most prescient for this topic is the inability to hold on to water.
The first step preventative measure is to drink enough water. Depending who you look to, this can be from 48oz to over 128oz/3.7L. Especially in the morning, most of us wake up dehydrated, but particularly those of us who have to urinate frequently at night and may try to limit fluids in the evening. Of course if your provider tells you other wise (kidney failure, etc…) listen to them.
Next balance your fluids. Water is the best but don’t forget to eat also, the body isn’t meant to work with just water or just fat or just protein. We need them all. See MyPlate.gov for a basic overview. Your needs will likely be higher if you’re a marathon runner or live in Arizona. That being said, don’t forget to drink when it’s cold. It can seem less apparent but when it’s cold, we still sweat especially under 645,169 layers of clothing. This topic could go on, but I want to hit on one last thing. For those who are severely dehydrated, or really anyone who gets IV hydration, watch our for fluid overload. Dehydration is more common in the world, however heart failure is pretty common and can lead to fluid overload very easily, among a variety of other conditions. When this overload happens it can raise the blood pressure, cause dyspnea via fluid in the lungs, and throw the electrolytes out of whack. So be mindful of how the patient is breathing, lung sounds, and signs of electrolyte imbalances such as dysrhythmias.
That's my story and I am sticking to it. Hydrate or die. Maybe hydrate and die if you take that too far? Love y'all, please share this and the podcast with anyone you know who may be interested or bored enough to listen. Rate the podcast and stay hydrated.
References
Adult Dehydration fro StatPearls by T. Jones.
Image of tenting skin from dehydration from Dr. P. Marazzi on the Science Photo Library
MyPlate.gov https://www.myplate.gov/
Several water recommendations from: https://www.hsph.harvard.edu/nutritionsource/water/
https://www.cdc.gov/healthyweight/healthy_eating/water-and-healthier-drinks.html
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