Dehydration in Adults Overview

Dehydration is a condition that occurs when the loss of body fluids, mostly water, exceeds the amount that is taken in. With dehydration, more water is moving out of our cells and then out of our bodies than the amount of water we take in through drinking.

We lose water every day in the form of water vapor in the breath we exhale and as water in our sweat, urine, and stool. Along with the water, small amounts of salts are also lost.

When we lose too much water, our bodies may become out of balance or dehydrated. Severe dehydration can lead to death.

Causes of Dehydration in Adults

Many conditions may cause rapid and continued fluid losses and lead to dehydration:

• Fever, heat exposure, and too much exercise
  
  
• Vomiting, diarrhea, and increased urination due to infection
  
  
• Diseases such as diabetes
  
  
• The inability to seek appropriate water and food (an infant or disabled person, for example)
  
  
• An impaired ability to drink (someone in a coma or on a respirator or a sick infant who cannot suck on a bottle are common examples)
  
  
• No access to safe drinking water
  
  
• Significant injuries to skin, such as burns or mouth sores, or severe skin diseases or infections (water is lost through the damaged skin)

Symptoms of Dehydration in Adults

The signs and symptoms of dehydration range from minor to severe.

• Increased thirst
  
  
• Dry mouth and swollen tongue
  
  
• Weakness
  
  
• Dizziness
  
  
• Palpitations (feeling that the heart is jumping or pounding)
  
  
• Confusion
  
  
• Sluggishness, even fainting
  
  
• Inability to sweat
  
  
• Decreased urine output: Urine color may indicate dehydration. If urine is concentrated and deeply yellow or amber, you may be dehydrated.

When to Seek Medical Care

Call your doctor if the dehydrated person experiences any of the following:

• Increased or constant vomiting for more than a day
  
  
• Fever over 101°F
  
  
• Diarrhea for more than 2 days
  
  
• Weight loss
  
  
• Decreased urine production
  
  
• Confusion
  
  
• Weakness

Take the person to the hospital's emergency department if these situations occur:

• Fever higher than 103°F
  
  
• Confusion
  
  
• Lethargy
  
  
• Headache
  
  
• Seizures
  
  
• Difficulty breathing
  
  
• Chest or abdominal pains
  
  
• Fainting
  
  
• No urine in the last 12 hours

Exams and Tests

The doctor may perform a variety of simple tests at the examination or send blood or urine samples to the laboratory. Through tests and examination, the doctor will try to identify the underlying cause or causes that led to the dehydration.

• Vital signs
  
  
  • Fever, increased heart rate, decreased blood pressure, and faster breathing are signs of potential dehydration and other illnesses.
    
    
  • Taking the pulse and blood pressure while the person is lying down and then after standing up for 1 minute can help determine the degree of dehydration. Normally, when you have been lying down and then stand up, there is a small drop in blood pressure for a few seconds. The heart rate speeds up, and blood pressure goes back to normal. However, when there is not enough fluid in the blood because of dehydration and the heart rate speeds up, not enough blood is getting to the brain. The brain senses this condition. The heart beats faster, and if you are dehydrated, you feel dizzy and faint after standing up.
• 
  
• Urinalysis
  
  
  • The color and clarity of urine, the urine specific gravity (the mass of urine is compared with that of equal amounts of distilled water), and the presence of ketones (carbon compounds-a sign the body is dehydrated) in the urine may all help to indicate the degree of dehydration.
    
    
  • Increased glucose in the urine may lead to a diagnosis of diabetes or indicate loss of diabetic control and a cause for the dehydration.
    
    
  • Excessive protein may signal kidney problems.
    
    
  • Signs of infections or other diseases, such as liver disease, may be found.
• 
  
• Blood chemistries
  
  
  • The amount of salts (sodium and potassium) and sugar as well as indicators of kidney function (BUN and creatinine) may be important to evaluate the degree of dehydration and possible causes.
    
    
  • A complete blood count (CBC) may be ordered if the doctor thinks an underlying infection is causing the dehydration. Other blood tests, such as liver function tests, may be indicated to find causes of the symptoms.

Dehydration in Adults Treatment - Self-Care at Home

Try to get people who are dehydrated (even those who have been vomiting) to take in fluids in the following ways:

• Sip small amounts of water.
  
  
• Drink carbohydrate/electrolyte-containing drinks. Good choices are sports drinks such as Gatorade or prepared replacement solutions (Pedialyte is one example).
  
  
• Suck on popsicles made from juices and sports drinks.
  
  
• Suck on ice chips.
  
  
• Sip through a straw (works well for someone who has had jaw surgery or mouth sores).
• Try to cool the person, if there has been heat exposure or if the person has an elevated temperature, in the following ways:

• Remove any excess clothing and loosen other clothing.
  
  
• Air-conditioned areas are best for helping return body temperatures to normal and break the heat exposure cycle.
  
  
• If air conditioning is not available, increase cooling by evaporation by placing the person near fans or in the shade, if outside. Place a wet towel around the person.
  
  
• If available, use a spray bottle or misters to spray luke-warm water on exposed skin surfaces to help with cooling by evaporation.
  
  
• Avoid exposing skin to excessive cold, such as ice packs or ice water. This can cause the blood vessels in the skin to constrict and will decrease rather than increase heat loss. Exposure to excessive cold can also cause shivering, which will increase body temperature-the opposite effect you're trying to achieve.

Medical Treatment

Treatment in the Emergency Department centers first on restoring blood volume and then body fluids, while determining the cause of the dehydration.

If your core body temperature is greater than 104 °F, doctors will cool the entire body. They may promote cooling by evaporation with mists and fans or cooling blankets and baths.

• Fluid replacement
  
  
  • If there is no nausea and vomiting, fluid replacement is begun. You are asked to drink electrolyte/carbohydrate-containing fluids along with water.
    
    
  • If there are signs of significant dehydration (elevated resting heart rate, low blood pressure), fluids are generally given through an IV.
  
  
• Disposition
  
  
  • If your condition improves in the Emergency Department, you may be sent home, preferably in the care of friends or family.
    
    
  • If you remain dehydrated, confused, feverish, have persistently abnormal vital signs, or signs of infection, you may need to stay in the hospital for additional treatment.

Medications

If fever is a cause of dehydration, the use of acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil) may be used. This can be given by mouth if you are not vomiting or as a rectal suppository if you cannot take anything by mouth.

Next Steps

Call or return to your doctor or the hospital as instructed.

Follow-up

• Take prescribed medications as directed.
  
  
• Continue to keep yourself well hydrated with plenty of water or sports drinks.
  
  
• Watch for signs of dehydration in yourself and others.

Prevention

The foremost treatment for dehydration is prevention. Anticipate the need for increased fluid intake.

• Plan ahead and take extra water to all outdoor events and work where increased sweating, activity, and heat stress will increase fluid losses. Encourage athletes and outdoor workers to replace fluids at a rate that equals the loss.
  
  
• Avoid exercise and exposure during high heat index days. Listen to weather forecasts for high heat stress days, and plan events that must occur outside during times when temperatures are cooler.
  
  
• Ensure that older people and infants and children have adequate drinking water or fluids available and assist them as necessary. Make sure that any incapacitated or impaired person is encouraged to drink and provided with adequate fluids.
  
  
• Avoid alcohol consumption, especially when it is very hot, because alcohol increases water loss and impairs your ability to sense early signs associated with dehydration.
  
  
• Wear light-colored and loose-fitting clothing if you must be outdoors when it is hot outside. Carry a personal fan or mister to cool yourself.
  
  
• Break up your exposure to hot temperatures. Find air-conditioned or shady areas and allow yourself to cool between exposures. Taking someone into a cooled area for even a couple of hours each day will help prevent the cumulative effects of high heat exposure.

Outlook

When dehydration is treated and the underlying cause identified, you will recover normally.

Dehydration caused by heat exposure, too much exercise, or decreased water intake is generally easy to manage, and outcome is excellent.

What U need to know about Constipation

What is constipation?

Constipation means different things to different people. You may have constipation if you have three or fewer bowel movements in a week or if stool is hard, dry, painful, or difficult to pass. Some people with constipation lack energy and feel full or bloated.

Some people think they have constipation if they don’t have a bowel movement every day. However, bowel habits are different for everyone. The foods you eat, how much you exercise, and other factors can affect your bowel habits.

At one time or another, almost everyone gets constipated. In most cases, it lasts for only a short time and is not serious. When you understand what causes constipation, you can take steps to prevent it.

What causes constipation?

To understand what causes constipation, it helps to know how the large intestine works. The large intestine removes most of the water from stool and changes it to a solid waste. The large intestine then moves the stool through the rectum and anus as a bowel movement.

Constipation occurs when stool passes through the large intestine too slowly. When stool stays in the large intestine too long, the intestine removes too much water, and the stool becomes hard and dry.

Some lifestyle habits that may cause constipation include

• changing your normal diet, exercise, or travel habits
• ignoring the urge to have a bowel movement
• feeling a lot of stress
• eating a low-fiber diet
• not drinking enough liquids
• taking calcium or iron supplements
• taking medicines such as painkillers with codeine; diuretics, also known as water pills; medicine for depression; and some antacids

Some medical conditions that may cause constipation include

• pregnancy or having given birth
• problems with the muscles and nerves in the intestine, rectum, or anus
• irritable bowel syndrome, a condition in which the nerves that control the muscles in the intestine don’t function correctly; the intestine becomes sensitive to food, stool, gas, and stress
• diabetes, a condition in which a person has high blood sugar, also called hyperglycemia, because the body cannot use blood glucose, or blood sugar, for energy
• hypothyroidism, a condition in which the thyroid gland does not produce enough hormone to meet the body’s needs and many of the body’s functions slow down

What tests are done to find the causes of constipation?

To find out why you have constipation, your doctor will perform a complete physical examination. The doctor may also order one or more tests if a serious problem is suspected as the cause of constipation.

• Sigmoidoscopy. The doctor puts a thin, flexible tube called a sigmoidoscope into the rectum. This scope can show the last third of your large intestine.
• Colonoscopy. The doctor looks at the entire large intestine with a long, flexible tube with a camera that shows images on a TV screen. The tube is like a sigmoidoscope but longer. You receive medicine to help you sleep during a colonoscopy.
• Colorectal transit study. For this test, you swallow small capsules that can be seen on an x ray as they move through the large intestine and anus.
• Anorectal function test. The doctor inserts a small balloon into the anus to see if you are able to push it out.
• Defecography test. The doctor inserts a soft paste into the rectum. The doctor asks you to push out the paste while an x-ray machine takes pictures of the rectum and anus.

What can I do about constipation?

You can take several steps to prevent and relieve constipation.

1. Eat more fiber.

Fiber helps form soft, bulky stools and is found in many vegetables, fruits, and grains. Be sure to add fiber to your diet a little at a time so your body gets used to it. Limit foods that have little or no fiber such as pizza, ice cream, cheese, meat, snacks like chips, and processed foods such as instant mashed potatoes or frozen dinners.

High-fiber Foods

Fruits	Vegetables	Breads, Cereals, and Beans
apples peaches raspberries tangerines oranges pears prunes	acorn squash broccoli brussels sprouts cabbage carrots cauliflower spinach zucchini	black-eyed peas kidney beans lima beans cold whole-grain cereal (All-Bran, Total, Bran Flakes) hot whole-grain cereal (oatmeal, Wheatena) wheat or 7-grain bread

Your doctor may suggest you take fiber pills or powder to help soften and bulk up the stool. You can buy fiber products in a pharmacy or grocery store without a prescription. Some fiber products are flavored while others are not. Be sure and take the fiber with plenty of water as directed.

Some people have gas and bloating at first when taking extra fiber. Let your doctor know if you are having problems that do not go away after a few days.

2. Drink plenty of water and other liquids such as fruit and vegetable juices and clear soups.

Liquids have little effect on stool form; however, drinking enough fluids is important because dehydration can cause constipation. Try not to drink liquids that contain caffeine or alcohol if you feel thirsty or dehydrated.

3. Get enough exercise.

Regular exercise helps your digestive system stay active and healthy. Exercising 20 to 30 minutes every day may help.

4. Visit the restroom when you feel the urge to have a bowel movement. Allow yourself enough time to relax.

Sometimes people feel so hurried that they don’t pay attention to their body’s needs. Make sure you visit the restroom when you feel the urge to have a bowel movement. If you usually have a bowel movement at a certain time of day, visit the restroom around that time. Reading a book or magazine in the restroom can help you relax. If you cannot have a bowel movement within 10 minutes, get up and return the next time you get the urge.

5. Use laxatives only if a doctor says you should.

Laxatives are medicines that help you pass stool. Most people who are mildly constipated do not need laxatives. However, if you are doing all the right things and you are still constipated, your doctor may recommend a laxative for a limited time. Your doctor will tell you what type is best for you. Laxatives come in many forms including liquid, chewing gum, and pills.

6. Check with your doctor about any medicines you take.

Some medicines can cause constipation. Be sure to ask your doctor if any medicines you are taking could cause constipation.

7. Follow any special treatments your doctor recommends.

If you have problems with the muscles and nerves that control bowel movements, your doctor may suggest biofeedback. Biofeedback is a painless process that uses sensors in the rectal area to help you feel the stool and move it out of the rectum. Doing biofeedback with a trained therapist has been shown to help some people with constipation.

Top Tips for Clear Skin

Clear Skin: Step by Step

Blemishes or pimples often appear on your face, neck, chest, back, and shoulders -- where skin has the greatest amount of oil glands. Few of us are immune to breakouts, but you can prevent or get rid of most acne. For a clear complexion, view the slides ahead to see some surprising dos and don'ts.

Don't Dry Out Your Skin

Avoid rubbing alcohol or alcohol-based astringents and toners, even if you have oily skin. These products can strip your skin of its natural, protective moisture. This can irritate skin and make acne worse. These products may also make it more difficult to tolerate prescription acne medications.

Do Use Oil-Free Moisturizer

Healthy skin is moist. Choose an oil-free moisturizer that says "noncomedogenic" on the label. This means it won’t clog your pores or cause whiteheads or blackheads. You may hesitate to apply moisturizer to acne-prone skin, but a good moisturizer can actually help calm your skin and keep acne at bay.

Don't Avoid Favorite Foods

It's a myth that oily foods or chocolate cause pimples. Acne is caused by overactive oil glands in the skin. If certain foods seem to cause you to break out, try to avoid them. But you don't need to shun pizza or chocolate for clear skin.

Do Drink Plenty of Water

Drink water throughout the day to keep your skin well hydrated. Also, eat a healthy diet with plenty of fresh fruits and vegetables rich in vitamin A and vitamin E, two vitamins known to benefit your skin. Green, leafy vegetables such as spinach and broccoli are rich in vitamin E. Vitamin A is found in colorful fruits and vegetables such as carrots, cantaloupe, peaches, and peppers.

Don't Use Heavy Cosmetics

Avoid oil-based cosmetics. How can you tell? Follow this simple guideline: Creamy foundation or blush generally can clog pores. Bare mineral cosmetics, which are light and powdery, are less likely to do so.

Do Use an Oil-Free Foundation

Do use oil-free foundation if you wear makeup. Splash your face with cold water before applying your foundation. Cold water helps close your pores. No matter how tired you are, wash your makeup off before bed.

Don't Sunbathe or Tan

It's a myth that tanning clears up your skin. It's a fact that UV rays put you at risk for skin cancer, premature aging, and wrinkles. Don't lie in the sun or use a tanning booth. Also, some commonly prescribed acne medications, including topical retinoids, can make you more sensitive to damage from the UV rays.

Do Use Oil-Free Sunscreen

Wear an oil-free sunscreen or moisturizer with a sun protection factor (SPF) of 15 or higher that provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Look for products labeled noncomedogenic that won't clog your pores. Reapply every two hours.

Don't Use Greasy Hair Products

Products such as pomades or gels can clog your pores when your hair brushes against your face. Keep your hair clean using an oil-free, acnegenic or noncomedogenic shampoo. If you have oily hair, shampoo daily. Shield your face when applying any sprays and gels on your hair.

Do Keep Hair Off Your Face

Pull long hair back when you sleep so it doesn't aggravate your skin. Try to keep your hair away from your face during the day as well. Remember, hair contains oils that can cause breakouts -- even if you don't use hair products .

Don't Touch Your Face

Touching or rubbing your face worsens acne. Also, don't lean your face on your hands. And try to keep your cell phone away from your face. Our hands and phones may carry oils and germs that can irritate blemishes. Tight-fitting hats can also cause or worsen acne, especially if you sweat.

Do Apply Cream With Applicators

Use cotton balls, Q-tips, or applicators when applying creams or makeup to your skin. If you use your hands, apply these products only with your fingertips. Our hands carry oils and germs that can worsen acne and blemishes.

Don't Overwash Your Face

Dirty skin does not lead to acne or blemishes. Frequent and vigorous washing can irritate your skin and make acne worse. So can scrubs and soaps with harsh chemicals. Instead, wash acne-prone areas twice daily with a mild soap and warm water.

Do Choose Oil-Free Soap

Oil-free soaps won't clog your pores or cause blackheads, acne, and whiteheads. Choose products that are labeled "oil free," "nonacnegenic," or "noncomedogenic." Apply the soap and wash with your fingertips. Washcloths, mesh sponges, or other products can irritate the skin and cause breakouts.

Don't Pop Your Pimples

Squeezing pimples or blemishes just creates more problems. Resist the temptation. It will only delay healing and increase the risk of scarring. Squeezing pimples may also push infected material into the skin, where it can cause additional inflammation and scarring

Do Use Acne Medicine as Directed

Acne medication doesn't work overnight. Most treatments take up to eight weeks of daily use before you see an improvement. It may take as long as six months for your skin to totally clear up. Sometimes your doctor will recommend using the acne medicine even when your skin clears. Be sure to follow your doctor's directions. Overuse of medicine such as Retin-A can irritate skin, while underuse is not effective.

Look Into All Acne Treatments

Don't just live with acne, blackheads, and blemishes. If the first cream you try doesn't work, see your doctor or dermatologist to discuss other treatments. There are many types of medicines to help clear your skin. Some are available only from a doctor.

7 Words & 7 Rules for Eating

Pollan says everything he's learned about food and health can be summed up in seven words: "Eat food, not too much, mostly plants."

Probably the first two words are most important. "Eat food" means to eat real food -- vegetables, fruits, whole grains, and, yes, fish and meat -- and to avoid what Pollan calls "edible food-like substances."

Here's how:

1. Don't eat anything your great grandmother wouldn't recognize as food. "When you pick up that box of portable yogurt tubes, or eat something with 15 ingredients you can't pronounce, ask yourself, "What are those things doing there?" Pollan says.
2. Don’t eat anything with more than five ingredients, or ingredients you can't pronounce.
3. Stay out of the middle of the supermarket; shop on the perimeter of the store. Real food tends to be on the outer edge of the store near the loading docks, where it can be replaced with fresh foods when it goes bad.
4. Don't eat anything that won't eventually rot. "There are exceptions -- honey -- but as a rule, things like Twinkies that never go bad aren't food," Pollan says.
5. It is not just what you eat but how you eat. "Always leave the table a little hungry," Pollan says. "Many cultures have rules that you stop eating before you are full. In Japan, they say eat until you are four-fifths full. Islamic culture has a similar rule, and in German culture they say, 'Tie off the sack before it's full.'"
6. Families traditionally ate together, around a table and not a TV, at regular meal times. It's a good tradition. Enjoy meals with the people you love. "Remember when eating between meals felt wrong?" Pollan asks.
7. Don't buy food where you buy your gasoline. In the U.S., 20% of food is eaten in the car.

12 Tips for Better Sleep in Bad Times

Here are a dozen tips to help you get a better night's sleep:

1. Caffeine is a stimulant and should be stopped four to six hours before bedtime. Caffeine is in coffee, soda, iced tea, chocolate, and various over-the-counter medications. Remember, caffeine builds up throughout the day, so two cups of coffee at dinner and some chocolate ice cream can be close to 500 milligrams of caffeine, a large dose. It is also a little-known fact that caffeine can stay in the system for up to 12 hours. So try not to have any past lunchtime and have decaffeinated coffee after dinner. One note of caution: Be careful if you are a big caffeine person and you cut yourself off too quickly, because you will get headaches, which of course will keep you awake.
2. Nicotine is also a stimulant and should be avoided near bedtime and if you wake up during the night. Thus, having a smoke before bed, although it feels relaxing, is actually putting a stimulant into your bloodstream. Recent research has shown that if you must smoke, take long, slow drags and pause between puffs, as this method produces the least stimulating effects, as opposed to short, quick puffs. (We are not condoning smoking, but if you must, at least follow these suggestions for more restful sleep). Also, cut back before bed -- have fewer cigarettes during the four hours before bed, and don't have any 30-45 minutes before bed.
3. Alcohol is a depressant; although it may make it easier to fall asleep, it causes you to wake up during the night. As alcohol is digested your body goes into withdrawal from the alcohol, causing nighttime awakenings and often nightmares. Excessive alcohol use can lead to dependence, and the withdrawal from alcohol dependence can also affect your sleep.
4. A light snack may be sleep inducing, but a heavy meal too close to bedtime interferes with sleep. Stay away from protein and stick to carbohydrates. Research has shown that small snacks rich in carbohydrates may help improve sleep. In addition, milk or dairy products have been shown to be sleep inducing. Milk has L-tryptophan, which has been shown to help people go to sleep. So skim milk and a low-fat snack may be a good nighttime treat.
5. You may not want to exercise vigorously just before bed. It may be best to exercise late in the afternoon. Still, some studies have shown that exercise right before bed is not as bad as was once thought, unless you are the type of person who becomes more alert with exercise.
6. Minimize noise, light, and excessive cold or hot temperature during sleep by using ear plugs, window blinds, or an electric blanket or air conditioner appropriately. If your room is too hot (above 75 degrees) or too cold (below 54 degrees), it can affect your sleep.
7. Try not to drink anything after 8 p.m. Often people wake up to go to the bathroom (once or twice a night as you get older is normal).

   Some general insomnia guidelines:

8. Restrict the amount of time you spend in bed to the actual amount of time you sleep. You are not sleeping anyway, so do something worthwhile.
9. Go to bed only when you are sleepy. This avoids that time you often spend trying to sleep but failing to do so. Get out of bed if you can't fall asleep or go back to sleep within 10-15 minutes; return to bed only when you feel sleepy. Repeat this step as often as necessary during the night. You can read, listen to soft music, or watch a movie. Don't fall asleep on the couch.
10. Use the bedroom for sleep and sex only; do not watch TV, listen to the radio, eat, or read in bed.
11. Get up at the same time each morning. Keep your biological clock going in the right direction, otherwise you will be fighting against it. Do not nap during the day. The time it takes you to fall asleep is decreased by the longer you have been awake.
12. Allow yourself one hour to unwind before bed. Brush your teeth one hour before getting into bed and wash your face slowly with warm water. Set the mood for relaxation before bed. This is not a time to be rushing about or planning the following days events. Do this earlier in the evening.