Transcription:
Staying Hydrated When Temperatures Heat Up

Melanie Cole (Host): Water is essential to life. It regulates the body’s internal temperature, acts as a building block for cells and helps flush waste. Without water, the consequences can be more than just a dry mouth. My guest today is Dr. Mark Tompkins. He’s an emergency medicine physician at Hendricks Regional Health. Dr. Tompkins, welcome to the show. Tell us how often, as an emergency medical physician, how often should we drink water in hot weather? People think they are supposed to be drinking every ten minutes or something. Give us a little run down on hydration.

Mark Tompkins, MD (Guest): Sure. Hi Melanie, yeah thanks for having me today. Yeah, it’s interesting a lot of our sort of experience with dealing with water intake comes from a couple populations. One is athletes and then the other believe it or not are the populations that migrate over to Mecca over in the Middle East. So, essentially, the way I like to think of it is, when it’s warm out in places like Indiana, Midwest, I sort of think of it in terms of what you’re doing. So, if you’re spending most of your time indoors with air conditioning and really your time outside is based only transitioning from your car to a store and then back to your house; I think your fluid and water intake can be pretty much the same as what you do throughout the year. However, if you are spending longer periods of time outside, either something as simple as waiting in line for tickets at a concert or obviously the more risky situation of actually working outside when it’s very hot or sort of what I call the double or triple threat and that is actually exercising outside. You definitely have to be taking in more quantities of water.

Melanie: So, water, just water or electrolyte beverages, let’s talk about that triple threat. If you are exercising and it’s hot I mean that whole thing; is it better to just drink water Dr. Tompkins or is it better to use one of those electrolyte replacement beverages?

Dr. Tompkins: Yeah, great question. So, I sort of use about a two or three-hour span as my cutoff for when I start to think that electrolyte fluids are a better fit. That being said, I think using electrolyte solutions isn’t a problem or isn’t risky if someone prefers to use one of those products a Gatorade or a Powerade or any of the other number of competitive products that are out there. It isn’t dangerous to use those. I know a lot of people like to have a flavored drink rather than just drinking water. Some people don’t like water. But I think if you are getting to a point where you are doing an activity or sweating a lot, for approximately two to three hours, then at that point, I actually think people need to use an electrolyte solution. I think up until that two or three-hour cutoff, I think just plain water would be fine.

Melanie: So, now what are we looking for, because you know some people say well if you get thirsty then that means you have waited too long, but if you are in the heat, sometimes the thirst isn’t what you would notice first so when you see people come to the emergency room and they are dehydrated; what might have been the steps that got them there?

Dr. Tompkins: Sure. Yeah, that’s another interesting topic. So, in theory, you are exactly right. Thirst should be a driving force that would cause someone to take in fluids and our body definitely has mechanisms to make sure that we are drinking enough. But those mechanisms in some people, aren’t as well adapted as in others and so in a situation where somebody is outside, I think it is important to consume water or an electrolyte solution and I think that the interval that I like to tell people is about every twenty minutes or so it would be worthwhile and very important to take in – and an easy measurement that I give people you know in medicine we do a lot with milliliters and metric system measures; but I think for most people it’s easier to think in terms of ounces and cups. So, I like to use just 8 ounces a regular cup about eight ounces or one cup every twenty minutes during activity usually is sufficient for most people to stay hydrated appropriately. I also like to encourage people, if they are going to working outside or particularly if they are going to be working out exercising outside; I also like a pre-hydration where about two hours before you are going to do that activity that you actually would consume maybe even twenty ounces or so of water and then right before you do the activity, taking in another ten or twenty ounces. Kind of that pre-hydration phase can really help alleviate some of the issues that we see downstream.

Addressing the question, you had about symptoms that people get and why do people get in trouble. Usually it’s because they didn’t consider that they would become dehydrated. A lot of people that aren’t used to working outside, sometimes it’s not a planned activity and they just have an inkling that they want to do some pruning and they end up spending a couple of hours outside and they get dehydrated and overheated and it maybe wasn’t an activity that they were planning. Kind of early symptoms can be just feeling weak and lightheaded. Sometimes people can feel nauseated. Some people are prone to muscle cramps and that actually happens due to electrolyte issues as you are excreting electrolytes in your sweat it actually changes your body and muscle chemistry a little bit to the point where you can have some cramps. And those are I think sort of some of the more common what I consider more mild symptoms that people get when they get overheated and or dehydrated.

Melanie: If you are out in the heat, as the summer has been hot all over the country, people are out in the heat and maybe they are hydrating themselves. Is sun exhaustion, heat exhaustion or heat stroke; is that the same thing as dehydration and can you get one without the other or do they necessarily come together?

Dr. Tompkins: Great question. They can occur in exclusion of each other although it’s common that they occur together. People that are outside – people can get dehydrated absolutely without being overheated, but in general, when I see people coming in; they usually have a component of both. People when they have – heat illness is a spectrum and so it can range from mild symptoms which would be some of the other things we talked about feeling weak, feeling some nausea, the muscle cramps and then over at the other end of the spectrum is heat stroke and that definition usually requires two criteria. The first is an elevated temperature and that would be different than just having a fever for example, it’s an elevation in temperature due to being overheated actually so usually we will see this in the summertime. But the other component of that is that the person is actually having mental status change. And that is a situation where they may be showing confusion and in rare cases can have seizures and that is a much more serious condition. That is one that we definitely would need to see someone come to the hospital for that. If somebody had a situation where they witnessed somebody having those symptoms, I would have them call 9-1-1 to get the paramedics involved. They would have the ability to initiate some cooling measures and also initiate hydration which can actually help in cooling the patient down as well, just simply giving IV fluids.

Melanie: Wrap it up for us Dr. Tompkins with your best advice because this is such an important topic and you see this kind of thing all the time at your job. So, give us your best information about dehydration and why it’s so important that we keep track of the amount of water that we are drinking especially in the heat.

Dr. Tompkins: Yeah, absolutely. So, I think being aware just simply being aware of the need to stay hydrated and also that the amount of hydration one needs to take in is likely going to be above and beyond what your body is going to tell you what you need. So, having an awareness particularly when you have a scheduled or planned activity be it working outside, or exercising outside, making sure that you do that pre-hydration step and then likewise, while you are outside working in the heat, or exercising, making sure that you have a water bottle that has intervals marked in eight ounce or sixteen ounce increments so that you are able to monitor what you are taking in. I think doing that would go a long way to preventing dehydration and certainly likewise, having an awareness of people who you are out working with or exercising with so that if they were to exhibit symptoms such as nausea, feeling weak, feeling like they are having muscle cramps to help them get in a situation where they are in a cooler environment and helping them to hydrate. And then the other end of the spectrum, the more serious symptoms with having confusion otherwise would be a sign where people need to call 9-1-1 in addition to helping the person cool down.

Melanie: Great information. Thank you so much doctor for being with us today and for sharing your expertise as an emergency medicine physician in this really important topic. This is Health Talks with HRH, Hendricks Regional Health. For more information, please visit www.hendricks.org, that’s www.hendricks.org. I’m Melanie Cole. Thanks so much for tuning in.