Lesson in summer dehydration

[Stosh]

For those who's kids do not listen when it comes to drinking water on a hot day, here's a case in point for you to use.

 

We were doing a Civil War reenactment and the temperature was expected to soar for the day, at least triple digits. At 5:00 am we were up for roll-call and I instructed my first sergeant that everyone in the company was expected to drink a full canteen before they left the line. Every hour they were called back to do the same thing. Each of the canteens were 2.5 quarts. At 9:30 we had a 2.5 hour battle where we ran around and really worked up a sweat. Two more canteens went down during that time. At noon we walked off the field and the temperature was 107 in the shade. About an hour or two after we returned one of my younger members (23 year old veteran Eagle Scout) went down to the heat and we dragged him off to the medical tent. After talking with him the only thing he did different than the rest of the company was he knocked of a 20 oz bottle of Coke. It was enough to put him down and out! The medical staff figured it was about the equivalent of 1.5 canteens negated by that one Coke. The young man remembers coming off the battlefield and then waking up in the medical tent. He was up, talking, for at least an hour after the battle all of which he could not remember. He had changed clothes into modern clothes and laid down in the shade. We dumped 2 canteens of water on him to cool him off but after a half hour his skin was pale and dry. He had stopped sweating and that's when we scooted him off to the medical tent.

 

Next time your boys think it's cool to bend/break the rules, you might want to have a little chat with them about how it works.

 

Stosh

[shortridge]

When it gets that hot, or there's that much exertion, that's exactly how you have to do it. Don't make it an issue of "Everybody who wants a drink, get one." It should be: "Everyone drink. We don't start, or no one moves, until canteens and water bottles are empty." That was my policy teaching programs at summer camp. Everyone drank before we began - no exceptions.

[Eagle732]

Lots of other factors could have caused dehydration in just this one participant. Age, weight, conditioning to hot weather etc.

Wonder how many participants had several cups of coffee before the event?

That being said I don't think soft drinks have a place during camping trips.

[Tampa Turtle]

My 12 year old son went on a camping trip after having the flu earlier in the week. He was feeling much better by Wednesday before after losing fluids out ...well multiple openings let us say. I stupidly let him go. While he did drink he started out dehydrated and our 5 mile hike turned into an 8 miler in a shade-less scrub when the Troop got lost. I gave him some of my water and he seemed OK.

 

After we got back Sunday night he was peeing blood. Found out later he had sustained some (hopefully temporary)kidney damage from cumulative dehydration.

[Stosh]

The lad involved was fit, 23 years old, registered ASM, Eagle Scout. Out of everyone in the group, I would have expected him to go down last. Being the oldest of the group (60 years old), I was nervous I would be the first to go, but I drank more than I expected the others to and supplemented with 20 oz bottles of Gatorade.

 

When I left I weighed 175#, when I got back I weighed 181#. After a day of hourly trips to the bathroom I was back to 175#. I pretty much sloshed around the whole weekend, but on the second day of battle, I took the field in full wool uniform and hung in there pretty good. It really pays to know what you are doing.

 

It's pretty hard to judge as a leader what is expected. At Philmont in modern materials one can get by a bit easier than in super hot heat wearing a heavy wool uniform. The lessons I learned in scouting really pay off over the years.

 

Stosh

[CalicoPenn]

Despite "old wives tales" to the contrary, a 20 ounce cola isn't going to contribute to dehydration (it's actually the hydration equivalent of 13.3 ounces of water), and won't have enough of a diuretic effect to offset what, by my figuring, is the consumption of 3.125 GALLONS of water between 5am and 9:30am inclusive (one 2.5 quart canteen of water at 5, 6, 7, 8 and 9 = 12.5 quarts = 3.125 gallons of water). One 20 ounce cola won't even effect a bodies electrolytes that significantly.

 

Figuring with the additional water (at least 2 canteens) consumed during the battle, everyone consumed more than 3 1/2 gallons of water in one morning. In hot weather, 24 to 32 ounces of water per hour is more than enough for most people (that's one quart per hour or about one and a half gallons from 5-9:30).

 

Based on what is posted, I'd suggest that part of the problem was too much water, without adequate electrolyte replacement/balancing during that time. The gatorade did you more good than all that water did. The water helped dilute your electrolytes. Whoever said that the coke negated 1.5 canteens of water is all wet. I'd also suggest that the biggest part of the problem was doing a battle re-enactment in heavy wool clothes in 90+ heat for two hours. Pre-hydration may help, but frequent hydration breaks, and removing some of the heavier clothing, is a bigger help. My first thought is heat stroke - caught in time, but heat stroke nonetheless. Even people who properly hydrate can get heat stroke.

 

Your also better off drinking throughout an hour, and not all at once (that's how I interpret drinking a full canteen before leaving the line). Though 2.5 quarts is too much to drink in 1 hour, it would have been better to drink it a bit at a time throughout the hour. In hot weather, 8 ounces every 15 to 20 minutes should be plenty.

 

(This message has been edited by calicopenn)

[Papadaddy]

The bigger question is why did they persist in a 2.5 hour "battle" when the temperature approached 107 (presumably in heavy wool period uniforms)? In the military, those are considered "black flag" conditions and all PT, and other unnecessary physical activity ceases, ESPECIALLY for unacclimated individuals in less than optimal physical condition. ESPECIALLY when wearing clothing inappropriate for the climate. Gotta wonder what people are thinking sometimes.

[KC9DDI]

There's another similar thread going on about water vs. sports drinks in the Summer Camp forum. I think CalicoPen is right about that one can of Coke not making a huge impact as long as he was staying well hydrated with plain water as well (not sure where your medical staff came up with their theory...) I wouldn't be so quick to jump to the diluted electrolyte theory, as that can of Coke contained electrolytes as well, and presumably the meals he ate for breakfast and lunch contained enough electrolytes to offset even the 3 gallons of water.

 

What it really sounds like is a moderate case of heat-related illness (probably heat stroke) that may not have been connected to hydration status at all. Remember, dehydration and heat illness are not the same thing, and you could easily have one without the other. It really sounds like he was properly hydrated - but there's only so much good that sweating can do for you when all your skin in wrapped in a wool military uniform.

 

Sounds like a good opportunity for your Scouts to review first aid for both dehydration and heat illnesses, and also a good time for your youth and adult leadership to think about safe activities and safe attire for those really hot days. I think Papadaddy is on to something...

 

To put it in a little perspective, there was a firefighter in the area I used to work that competed in a intense sporting competition on a day with temperatures similar to your situation. He wore his turnout gear the whole time (probably similar to your wool military uniforms) and ended up doing severe damage to his kidneys that required him to be on dialysis for several weeks. Of course, even with the lingering kidney damage, he's lucky to have survived at all.(This message has been edited by KC9DDI)

[Engineer61]

The Gatorade v. Water and Caffeine issues are largely controlled by individual physiology and metabolic processes, according to my kids Dr. who sat on the medical advisory board for Gatorade for a number of years.

 

The underlying issue in some is electrolyte loss, especially sodium. Those that lose a large amount of sodium through sweating are far more susceptible to heat-related illness or injury than those that don't.

 

My son loses are large amount of salt in his sweat. When engaged in physical activity, he has open license to drink nothing but Gatorade. At the end of an extended workout, his dried shirts and hats will have a white salt band, sometimes 1-2 inches wide. Interesting enough, he does not lose that much Magnesium or Potassium.

 

 

[packsaddle]

I agree with Calico regarding the soft drink/electroyte issue. Hyponatremia is also sometimes referred to as water intoxication (it isn't really intoxication but rather loss of sodium). Here's a link from a sports medicine site:

http://sportsmedicine.about.com/od/hydrationandfluid/a/Hyponatremia.htm

 

I have actually had this happen to me on summer backpack trips, too much clean water, not enough replacement electroytes for those lost through sweat. The symptoms are unpleasant but it only takes 20 minutes or so to feel them pass once you've started drinking something that replaces the loss.(This message has been edited by packsaddle)

[Scoutfish]

Okay, I haven't always been what you call responcible when it came to my diet.

 

Well...I'm still not responcible, but a lot better than I ever used to be.

 

From the time I was 16 or so years old, Mountain Dew became my vice. I drank it every day.

 

Matter of fact, whatever the water content of Mt Dew was..was the amount of water intake I had plus what could be absorbed from other foods I ate.

 

All my years of waorking at my company - all through the summer - I drank at least one 2 litre Mt Dew and sometimes two in a day.

 

Nope...didn't drink water to go along with the soda. At night, I'd drink sweat tea with supper, but afterward, I drink at least 2 more glasses of Mt Dew each night.

 

I never passed out or suffered heat stroke.

 

WEll, about a year ago, I decided that I was going to quit drinking Mt Dew. And I did. I might have had four can Mt Dews in all that time.

 

I now drink water and Lipton Diet Green tea ( citrus flavor of course.) during the day, and green tea or sweat tea at night.....and maybe two 24 ounce Cokes over the course of a week.

 

I have had more heat issues since I have switched to water than when I didn't drink water.

 

No, I know that drinkinbg Mt Dew like a fish isn't healthy, but I suppose I had conditioned my body to it for over 30 years and that all the sodium and other preservatives actually helped somehow.

 

But now that I drink mostly water, I have had to stop and eat salty peanuts and bananas during the day due to an electrolyte imbalance. And I can tell a big difference within 5 minutes of eating that stuff.

 

No, I am not gonna start drinking Mt Dew again becuse of this.

 

One thing I did discover is that when I used to drink Mt Deww constantly, I would go through a bottle of Tums in a month and a bottle of Ibuprofen in 2 months.

 

Since I quit drinking Mt Dew about a year ago..I have eaten maybe 6 Tums and taken Ibuprophen once.

 

 

My point:

1) One 20 ounce soda didn't put him down. If it did, then his metabolism is so fragile, that a single candy bar, two bananas or a big glass of tea would also knock him down

 

2) Every individual is different and their bodies are different.

 

My dad used to walk into the house mid day in August after spending hours in the hot sun working in his garden. He'd walk straight to the coffee pot and brew a cup of hi test coffee. As soon as it was done brewing, he'd pour a cup and stick that cup in the microwave to get it hotter.

 

Why? He said it helped cool him off. Whatever.... I never tried it!

 

[KC9DDI]

Before everyone jumps on the electrolyte bandwagon, let's go back to the basics for a second. Let's say that you are presented with the case jblake originally described - an otherwise healthy young man who had spent several hours performing vigorous activity in 100+ degree heat wearing a heavy wool uniform, who passed out, and stopped sweating with pale, dry skin. What's the first thing we need to worry about - heat illness, or blood chemistry? What would we do to prevent something like this from happening in the first place - adjusting activities and attire to match the weather conditions, or try to "balance electrolytes?"

 

Yes, hyponatremia happens, and different people can be more or less susceptible. But it's also very easy to treat - having a bottle of gatorade once in a while, eating healthy meals, or having a handful or trail mix on a break will generally be adequate to keep your electrolytes in check.

 

Sure, in this particular case, with the very intense heat, and the large volume of water consumed, there may have been some hyponatremia going on - but it certainly sounds like the heat stroke was the more immediate, serious issue that needed to be promptly treated.

 

I think you're hearing hoofbeats and thinking zebras. Nothing wrong with being aware of electrolyte imbalances and trying to treat and prevent hyponatremia - but don't do so at the expense of the much more obvious, likely and deadly conditions of heat illnesses.

[Scoutfish]

KC, I don't think anybody is so much saying it wasn't anything but an imbalance...as a wool costume in high heat isn't a good combo any way you look at it, but more pointing out that a single soda isn't what caused him to drop out.

 

Electrolyte imbalance would be more likely than a single soda causing dehydration.

 

Truth be told, I go with a combo of all three:

1) Way too much water taken in

2) Activity to strenuous for the heat

3) Wool in the heat

 

 

[SSScout]

Waaaay back when I coached my daughter's soccer team, I early on noticed how the girls on both teams would start to drag after only 15 or 20 minutes into the game. These are 11, 12, then 13 year olds. Aside from the usual practices and conditioning drills, I then started my team on a regimen of (1) No sugary cereals for breakfast on the day of the game. I told everyone (their parents!) they could have almost anything else for breakfast: oatmeal, bacon & eggs, pancakes, toast and PB&J, but NO SUGARY PACKAGE CEREAL. (2) At the first of the game, before we took the field, everyone drank, in my presence, a cup of water. (3) At the offense/defense team rotation (required by the league! Good idea, I thought), another cup of water required. (4) anytime a sub went in, drink a cup first. Wow! We started running circles around the other teams. Came out that season undefeated.

 

CSDC: Our theme this year was/is "Medieval Adventure". Hey! Let's give a toast to the Queen! Lots of small hands raise their water bottles and jug-a-lug. I was moved to teach my Cubs "Ein Prosit! Gemutlicheit!" My DE took me aside and told me a parent had come to him to complain about the man who was encouraging alcoholism in her Cubs....

[SMT224]

Witnessed a situation at summer camp several years ago -- very hot day, Scout was active and not drinking enough water. He collapsed by the water front, sweating and weak. The medic was summoned, and after a few moments called 911. He and other camp staff worked to cool the kid off and get some water in him. When the ambulance arrived, the EMTs took one look at the kid, then at the lake, picked him up and sat him in the cool lake up to his neck. Once they were satisfied his body temp had lowered to a reasonable level, they transported him to the local hospital where he was re-hydrated via IV for the rest of the day. The next day he stood before the camp at flag raising and talked about the lesson he learned -- stay hydrated and seek a cool place when you feel hot. Turns out he was wearing ankle weights and was working on loosing pounds for wrestling! He let the camp know the IV was no fun and no one should follow in his foot steps.

 

What impressed me was the fact the medic and camp staff were fanning him and giving him water when the cool lake water was just a few feet away -- until the EMTs arrived, no one even thought to put him in it! They didn't hesitate -- he went in clothes, shoes and all! It was clear to them that the number one thing to do was to cool his body off as quickly as possible. Liquids and electrolytes were all secondary to cooling the body.