Dei'ah veDibur - Information & Insight

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9 Tammuz 5766 - July 5, 2006 | Mordecai Plaut, director Published Weekly










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Home and Family

Dehydration and Heat Stroke
by L. Raffles

There's an old expression that 'mad dogs and Englishmen go out in the midday sun.' And I guess this is because they are so unused to seeing any sun at all. Certainly the English flood out into the streets and onto the beaches when the temperature inches over 70 degrees Fahrenheit (24 C), whereas seasoned Israelis would call that a mild day. The fact is, though, that lack of experience with high temperatures have made the English far too disrespectful of the dangers of prolonged exposure to the sun, and they are less likely to recognize the symptoms of dehydration or heat stroke.

Those who live in hot climates and visitors who are unused to hotter temperatures should be well informed of the correct behavior in the sun and heat, and learn to recognize the early signs of dehydration or heat stroke, both of which kill many people every summer.

If you can remember getting out of a swimming pool on a hot day, even though the air was warm, you felt cool. This is because when the warm air evaporates the water on your skin it also takes some of the heat away from the body, causing the body to cool down. This is how the body keeps cool, as the sweat hits the skin, the warm air evaporates it, and this cools the skin.

On a hot day an amazing amount of body fluid is lost through sweat. The skin may not actually feel at all sweaty, because the air can evaporate it as fast as it is produced, but under the arms it should feel a little sticky because the air cannot circulate very well there. As the body dehydrates, it tries to conserve water and one of the signs of dehydration is the cessation of sweating.

If you gently pull up the skin of the hand, it should fall back into place as soon as you let go (unless you are in the older bracket, and have lost some elasticity from aging). Try it on yourself or on a child's hand . . . it shouldn't hurt, and watch how the skin falls nicely into place. This is because the skin is somewhat elastic, and this is due to the water in the skin. When a person dehydrates, the skin loses its elasticity and will not fall back as quickly, but will stay pinched up.

Other signs of dehydration are a sunken 'soft spot' (fontanel) on a baby's head, reduced wet nappies or lack of going to the toilet, or very concentrated (yellow) urine. The eyes may have no tears and become dry, the skin may look grey, and of course, the mouth and tongue will be dry. However a dehydrating person will often not complain of thirst.

Summary of symptoms of dehydration:

  • Skin under arms NOT sticky/sweaty

  • Skin loses elasticity

  • Reduced urination or very concentrated urine

  • No tears

  • Grey skin

  • Mouth and tongue dry

  • Sunken 'soft spot'


Rule Number One has to be stay out of the sun, especially during the hottest part of the day. Try to find things to do inside or at least stay in shady places.

Rule Number Two is to drink plenty of fluids. If you are giving out popsicles, that's very nice, but make it a rule that the kids have to drink one or two cups of something else before they can have their popsicle. This is particularly important when they run in hot from school or from playing outside, and they may not have had a drink for a while. Keep reminding them to take more drinks.

Water is definitely the best fluid to give, and it tastes nicer cold from the fridge, but I know that many children won't touch it, so don't choose the summer time to wean them from being spoiled in this regard, and let them drink whatever fluids go down. If nursing babies need extra fluids, boiled water can be given by spoon. And don't you forget to drink, especially if you are nursing; being too busy is not an excuse.

Rule Number Three is that during hot weather, when a child complains of headaches, sore throat, or feeling unwell, then the first thing to do is give more drinks, even if they say they are not thirsty, and get them to sit out of the sun.

If you suspect someone is dehydrated, you must seek medical advice, especially for young children for whom this condition can be fatal quite quickly. Dehydration can be prevented by giving fluids, but it should not be treated just by giving water to drink. The person may need the special re-hydration solutions which have the right amounts of salts and sugars that the body needs, or possibly an intravenous infusion of fluids.

Besides dehydration being caused by heat, it can also be caused by vomiting and/or diarrhea. In the latter case, dehydration can be more difficult to treat because any fluids given will be expelled from the body. In this case, fluids should be given in small amounts as often as possible rather than in large amounts less often, and there are advice guidelines of how much to give depending on the age of the child. Also the special oral re-hydration solution, which is more easily absorbed by the body, is particularly good in cases of vomiting and diarrhoea.

Heat stroke differs from dehydration in that dehydration is when the body loses body fluids, and heat stroke is when the body gets overheated. It is very dangerous if the brain is overheated, and if it not dealt with quickly (sometimes a matter of minutes) then it can be fatal. When the air is very humid, evaporation from the skin cannot occur properly and the body doesn't cool down. So although that means that the person is less at risk of dehydration, the risk of heat stroke is much higher. In heat stroke, the problem is in the brain. It can strike with frightening speed.

The symptoms of heat stroke:

  • Slurred speech

  • Dizziness

  • Fainting

  • Hallucinations

  • Seizures

In the case of heat stroke, it is not enough to give fluids. This is a medical emergency and immediate medical attention should be sought. Meanwhile remove clothing, use a damp cloth to wet the body with water and use a fan to cool. If the person is also dehydrated then they won't be able to lose heat by sweating, and this will add to the heating up of the body, so drinking will help.

Please note that the most vulnerable people are those exercising or trekking, old people in hot humid weather who do not use an air conditioner and young children left in a car, even for short periods. Children under two are particularly at risk because they cannot control their body temperature as efficiently. Of course someone can suffer from both these conditions at one time.

Remember that although there are treatments for these conditions, and people survive them, it is much easier to prevent them. A spray bottle and a fan are good tools to keep cool; don't rely on thirst, drink plenty of fluids anyway, and stay out of the sun during the hottest part of the day.


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