Wilderness Doc: Hydration and Rehydration

While hydration may seem more like a summer topic, cold, dry weather can cause a decrease in thirst, making it easier to become dehydrated. Here’s an article from Wilderness Doc on Hydration and Rehydration, including using a nasogastric tube for severely dehydrated patients. While Doc doesn’t discuss it in this article, there is also the option of emergency rectal hydration for patients who are unconscious, suffering nausea, or in shock.

Hydration aka water…essential for life. We take for granted this vital substance which we cannot live without. In much of the world, however, clean drinking water is a luxury. In a previous post, I have discussed how to make this water safe to drink. In this post, I want to examine what you might be able to do for yourself or a companion should you become dehydrated.

Oral rehydration is the standard way to rehydrate. This can be accomplished with small sips of water, Gatorade or, in dire circumstances, whatever you have at hand. If you have more resources, making an oral rehydration solution is even better. There are several options to make this. The two most common start with a quart of clean water to which the following is added:

Option 1: One teaspoon of salt, 8 teaspoons of sugar. Mix, then add 0.5 cup orange juice or half a banana (mashed).

Option 2: One-fourth teaspoon of baking soda, 1/4 teaspoon salt. Mix. Add 2 tablespoons of sugar or honey. Mix again. Add 0.5 cup orange juice or half a banana (mashed).

Ideally, the dehydrated patient will drink at least 3 quarts of this solution daily until the diarrhea or other source of dehydration ceases.

Unfortunately, the severely dehydrated patient may refuse or be physically unable to drink the solution. In those cases, consider a nasogastric tube feeding for these patients. Most people are able to easily place such a tube with some lubrication either through KY or other water soluble lubricants applied either to a standard NG tube or to IV tubing or any relatively clean piece of small caliber, flexible tubing. Be sure to test placement by listening over the stomach while blowing into the mouth end (proximal end) of the tube and hearing bubbles in the stomach. You should also start out with a very small (less than 5 ml) test infusion. If coughing occurs, check placement again as you do not want to introduce the solution into the lungs and potentially produce a pneumonitis. The amount of fluid to administer for adults is calculated by adding the patient’s weight in kg’s to 40. An 80 kg patient would need 80+40=120 ml/hr of the oral rehydration fluid. This would be continued until the patient is able to drink the solution on their own, without aid of the tubing.

While there are examples of WWII POW’s utilizing sharpened bamboo sticks and rubber tubing to fashion IV’s, the risk of infection from this would be very high. Further, the art of finding a vein in such a severely dehydrated patient is one most, even with modern and sterile equipment do not possess. If things are so bad as to even consider such a situation, it is likely natural processes will not be stopped. So, while an interesting thought experiment, I would recommend you think more about and ensure adequate knowledge of the above skills instead…