Re: Hypothermia and Dehydration

Re: Lisa's comments on treatment for hypothermia, we have found that
mild cases respond well to getting in a warm shower or tub, and also
drinking warmed "gatorade" (or other equivalent "sports" drink. This
seems to help the muscles restore the homeostasis by improving
fluid volume and electrolyte balance in the circulatory system; and
by providing an easily absorbed supply of glucose
which is directly metabolized by the muscle tissue.

It is seldom advantageous just to get in a "warm bed" because the body
needs to generate the heat needed to maintain warmth, and the insulation
afforded by a bed does not really contribute much
when heat is not being adequately generated by the body. Although if an
electric blanket or heat pad were used as an external heat source, that
might be of assistance.

We used the warm gatorade* technique at the last National Scout Jamboree
where I worked in a Subcamp Medical Center. Many Scouts had gotten wet and
chilled during the rainstorm, and seemed to "pop right back" after taking
in warm gatorade. (Of course a good night's sleep in a warm sleeping bag
and a healthy dinner didn't do any harm for the "two-legged incinerators"
either!)

(*It is important to dilute the gatorade to "half strength" with water
when using it to treat dehydration.

For more sustained prevention, another factor in nutrition is to consume
foods such as cheese which have a slow release of concentrated energy in
the form of milk fat (or in some cases vegetable fat).
This works especially well before going to bed. If you give Scouts a
"cheese and crackers" snack before going to bed, the slow digestion of
the cheese seems to release energy uniformly throughout the night. A
healthy dinner of carbohydrate foods such as pasta are also beneficial
before going to bed.

Once again, dehydration seems to be one of the chief contributors to
susceptibility to hypothermia because there is not enough fluid volume
in the blood which is readily available
to the muscles to properly metabolize nutrients and dispose of wastes
through the liver and kidneys. As most Scouters know, a great deal of
water is lost through respiration, especially in cold weather when relative
humidity is low. Perspiration also takes a toll, and if water
consumption is not frequent, which it tends not be when cold weather is
present, dehydration can easily occur. Most people do not even feel
thirsty when they are already dehydrated.

Headache and mild chest pain** or other muscle aches and pains are also
directly symptomatic of dehydration, and could be mistaken for "flu" symptoms
which may explain the symptoms mentioned in
the previous post. (**Caution: chest pain can also be associated with
heart attack, so if a crushing pain is present and/or other symptoms such as
shortness of breath, pain radiating into the arms or neck are present,
immediate evaluation by a physician and/or paramedics is essential!)

One very reliable measure to determine the presence of dehydration is
to observe the color of urine. If urine is dark amber, it means that
waste products are being concentrated by the kidneys due to insufficient
intake of water. Infrequent urination is also indicative of the same
problem. Most people think dehyrdation is mainly a problem in hot
weather, but in fact, it occurs probably almost as often in cold weather
because no one considers the imperceptible loss of water through
respiration and perspiration.

At the Jamboree, we were encouraging Scouts to drink about 10 ounces of
water per hour (not pop or sugared drinks because sugar requires a great
deal of water to digest and contributes to further dehydration). It is
recommended that same amount of water be consumed for winter
activities as well. It is far
better to drink water frequently and in smaller quantities to keep up
with the constant loss of water as noted above.

Bob Amick, EMT-B, Exploring Training Chair, Longs Peak Council, Boulder, CO

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