Older man holding his head with a soaked cloth while playing tennis.

To Drink or Not to Drink – That Is the Question

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Older man holding his head with a soaked cloth while playing tennis.A recent newspaper article highlighted the bravery of a 5-year-old boy who saved his grandfather’s life. The old man had worked all day in the Florida sun without taking the time to drink anything. Over dinner his grandson noted that he looked pale and tired. By supper time, the old man was sitting on the couch, staring straight ahead, non-responsive. According to paramedics, the boy’s 9-1-1 call got help for his grandfather’s heat exhaustion and dehydration, probably saving him from a stroke or something even worse.

The moral of the story? Not just to call 9-1-1 in an emergency. The more important lesson is to drink adequate water or other fluids when working in high heat and humidity.

The Basics – Heat-related illnesses come in three varieties:

  1. Heat stroke or sun stroke is caused when the heat of the sun disrupts the brain’s ability to regulate body temperature. The best treatment is to get out of the sun (or away from the source of heat) and then cool the body down (by ice water baths, alcohol baths, cool drinks, cool air blowing on the skin, etc). Overheating can be fatal if the body’s temperature goes above 106° F (40° C) and stays there for any extended period of time.

    Heat cramps and heat exhaustion are caused by extreme loss of water and salts when the body sweats excessively without replacement. The body cannot continue to replace these losses from its own limited and rapidly depleted supplies.

  2. Heat cramps result from losing and/or unbalancing the body’s salts – primarily sodium, potassium and magnesium. While this problem is less devastating, the cramps are painful. The best treatment is to quickly replace the lost salts and water – oral athletic drinks or their equivalent can achieve this quickly.
  3. Heat exhaustion results from a decrease in the amount of blood flowing around in the body. This gets worse when the sun’s heat brings more blood to the skin’s surface, making less blood available for circulation in the blood vessels. The result is decreased blood flow to vital organs – like the heart, lungs, kidneys and brain. This can happen quickly, especially for someone who already has decreased body fluids (alcoholics, heart/kidney patients on water pills, patients with vomiting or diarrhea, patients taking cocaine) or who are on medicines that lower blood pressure (diuretics, antihistamines, antipsychotic medications.)

    When the water in the blood is decreased, the number of blood cells still stay the same, making the blood thicker. This can lead to a stroke or a heart attack – and makes the heart work harder, which can cause congestive heart failure.

    Treatment for heat exhaustion can be as simple as replacing fluids and salts in mild cases, or for emergencies like those who are lethargic (don’t force them to drink – they might aspirate), in shock, or comatose – IV therapy may be necessary.

Bottom line:

  1. When working in extreme heat, drink. Whether you feel like it or not.
  2. Before symptoms appear, replace sweat losses – both salt and water – with drinks that contain both water and salt.
  3. Don’t wait until symptoms appear. By then, you may be unable to think clearly enough to drink appropriately.

During summer, in enclosed spaces, or in the presence of extreme heat, dangerous situations can develop rapidly. Victims can be quickly overcome, and without intervention can be rapidly fatal.

Author

Max Wayne Hammonds was born Aug 3, 1943, in northeastern Indiana, in the county hospital in Wabash. He attended high school and college in his home town of North Manchester and attended Indiana University Medical School in Indianapolis. Following an internship in South Bend, IN and a year of flight medicine in the Air Force, he took a residency in anesthesiology at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio, TX.