Dehydration, a Killer, by K.B., M.D.

About a century ago, the top five causes of death in the United States were the following:

1. Pneumonia
2. Tuberculosis
3. Diarrhea
4. and 5. Heart attack and stroke.

Diarrhea (dysentery) has always been a problem in the military with 995 out of 1,000 soldiers in the Civil War being affected by it. Diarrhea alone accounted for two-thirds of all deaths on both sides during that war. A reader, B.K., recently expressed interest in learning more about rehydration after reading my medical cabinet article. This article is for her and for anyone else interested in this topic.

I would also like to ask anyone with experience in effective old-time remedies to please write in and share. My mother mentioned long ago that women used to give blackberry juice to babies with diarrhea (an old-time Ozark remedy), and I have since read that blackberry root can be employed as treatment for diarrhea. Has anyone had success with this? It will be important to have alternatives to modern medications due to limited shelf-life and possible limited future availability of loperimide, ondansetron, intervenous (I.v.) fluids, and other currently used treatments. Below, the prevention and treatment of dehydration will be covered including recent personal experience by yours truly who ended up in the emergency department!

Disclaimer: I am neither prescribing nor diagnosing, and recommend that you always consult with your own medical provider when making decisions about past, current, or future care. Whatever you do is at your own risk. Also please know that I do not receive any kickbacks for the mention of any products or websites.

Prevention

In hard times, we will be more at risk. All of us are well acquainted with the drill of using safe water, washing hands frequently, keeping hot foods hot and cold foods cold…. Everything will be more difficult if/when Schumer hits the fan. Learn now to avoid pain later.

Insects have always been one of the biggest vectors of disease. With no air conditioning, more flies will be indoors. I remember my mother telling me about setting the table with the silverware underneath each plate which was flipped upside down to prevent contamination by flies. Outhouses + barnyards + flies= contamination in the kitchen. Keep foods sealed, and practice kitchen cleanliness to avoid pests like roaches.
Stock up on pest control supplies. Make sure to have a good supply of fly swatters available, lids and clean towels to cover food, and intact screens on windows and doors. You may also consider getting a supply of cheap, hangable fly strips to catch the ones that won’t sit still to be swatted. They last forever, and at the time of this writing a 10-pack (good enough for the season) costs less than a couple of rolls of paper towels. Roach baits and other similar items are still commonly available without shortage. Buy cheap, and stack deep.

A Case to Learn From (Errors and All)

There is an old adage, “A doctor that treats himself has a fool for a doctor and a fool for a patient.”
Why so? For starters, one does not always reason clearly when ill plus there is often emotional interference (Denial-I’m not that sick. I’ll be fine. Exaggeration-I’m dying!) or lack of experience in a particular area of medicine. After all, no one is perfect.

Well, last summer during peak Covid in our area, I became ill first with vertigo (benign paroxysmal positional vertigo, again) and then a couple of days later with diarrhea. I lost 7 lbs in 5 days despite half-hearted attempts at oral rehydration and just trying to tough it out. I didn’t think I was that ill. Wrong. Wrong. Wrong. At my age, I should have jumped on it hard and fast. After struggling for 10 days and shaking constantly the last few days, I ended up in the emergency department for iv rehydration, blood tests to assess my electrolytes, etc after “dragging my feet” and consulting over the phone with medical professionals since my doctor was out of town. My emergency room physician was great! She gently and graciously reminded me that at “our” age we have to treat more aggressively. (In general, the old, the very young, and the chronically ill require prompt complete management.) After initial treatment, I was sent home to slowly recover over the next couple of weeks in the following order: first, to rehydrate with 3 liters of oral rehydration fluid a day for 3 or 4 days and second, to expect strength to start to return approximately one week after recommencing a normal diet. Friends, it frankly took me a month to fully recover. So much for trying to tough it out. (Yes, doctors intensely dislike being patients.) I’m certain that younger, stronger, and smarter individuals would have recovered more quickly.

Treatment of Vomiting

At the first suspicion of nausea or diarrhea, start treatment. Frankly, if you are losing fluids at both ends, you’ll quickly be in trouble. The management discussed below is for adults who aren’t pregnant.
For nausea, take oral medication at the earliest suspicion as it can deteriorate rapidly to vomiting.
Have on hand, whatever treatment works best for you or your household. Some people swear by pepto bismol or other over the counter remedies. I grab ondansetron which is a reasonably priced generic prescription that your medical care provider could order for you. Oral ondansetron comes in two forms.
The first is a typical pill that one swallows. The other is “ODT” which stands for oral dissolving tablet. After placing one under the tongue, it rapidly disintegrates. Follow it with a gentle swallow. No liquid is required. This medication works by blocking the release of serotonin in the intestinal tract and central nervous system thereby decreasing nausea and vomiting. You can read more about it here.

If it is too late for oral medications, there are rectal suppositories of Phenergan or an injectionable form which can be administered at a clinic or other medical office.

What are the drawbacks? Well, there is always the possibility of a side effect or interaction with another medication or supplement. Shelf life? Ahhhhh, there is my particular concern. It lasts approximately two years. That isn’t very long and can be upsetting when getting no relief from expired pills. If no advanced medications are available, we’ll still have home remedies of ginger, mint, etc and acupressure. Please consider reading this article and watching the video to learn how to perform acupressure for the treatment of nausea.

Remember to use common sense when ill with nausea. Stick to oral fluids until vomiting has ceased for about six hours. Take slow, frequent sips. Wait 10 to 15 minutes to begin again if vomiting occurs.
What types of fluids? Water and oral rehydration mixes (for example Pedialyte) are helpful for vomiting and/or diarrhea. When you have improved enough to advance your diet, consider saltine crackers, rice, applesauce, toast, and other bland foods. Avoid fatty foods, dairy, and spices until much later. The longer and more serious the bout of vomiting and diarrhea, the more crucial that oral rehydration therapy is. More information on this later.

What if the patient does not have diarrhea but vomiting is uncontrollable and no help is available?
What if the patient is unconscious? Consider rectal rehydration aka proctoclysis.  I encourage you to read this article and put the information in your medical supplies along with an enema bucket or other equipment of your choice. Of course, it is best to utilize clean oral rehydration solution, but I read about a nurse adrift on a raft in the ocean who kept herself and her family alive by performing rectal rehydration with the contaminated rainwater in the bottom of their raft. Remember to have the patient lying on his left side for this procedure and limit the amount of liquid to 500 cc per hour. The fluid will be better absorbed and of greater help to the patient, in general, if it contains sugar and salt in addition to clean, warm, body temperature water.

Forms of rehydration that require prior training and sterile supplies include intravenous (i.v. — into the vein), intraosseous (into the bone), and subcutaneous (beneath the skin) introduction of sterile fluids.
The last is usually reserved for children when other forms of administration are not possible.

Treatment of Diarrhea

To slow the passage of stools or not? That is the question. It depends on the illness, and some physicians prefer not to slow the transit no matter the cause. With some bacterial and parasitic diseases, it is beneficial to let the contaminated contents exit the intestinal tract. In other instances, treatment with loperimide or other anti-diarrheal may be indicated. Again, loperimide has a shelflife of only about two years. Bismuth subsalicylate, aka Pepto Bismol, is another option. Narcotics such as lomotil also slow intestinal motility. Start treatment with oral rehydration fluids promptly unless otherwise directed. Women around the world have been taught to add a fist full of sugar and a pinch of salt to a liter of cool water in order to prevent death by dehydration. Do not restrict fluids! Try to replace as much as the patient is losing. In my situation, I was instructed to drink 3 liters of Pedialyte a day by slowly sipping it throughout my waking hours. A different formula for oral rehydration mix is:

  • 1/4 teaspoon each of table salt, baking soda, and salt substitute
  • 2 1/2 tablespoons sugar or Tang or other flavored sugar drink mix
    such as lemonade
  • 4 1/4 cups cool water

Stir well and refrigerate.
Salt substitute contains potassium and can be found in the grocery aisle. Buy it and place it with your gastrointestinal treatment supplies.

Conclusion

Well, fellow readers, I hope that there were some new and interesting tidbits for you in this article.
Perhaps there is someone reading who has experience with effective remedies that we can produce ourselves in a wide variety of growing zones? Please write in and share with SurvivalBlog readers, via e-mail to JWR, for posting in the weekly Snippets column. In the meantime, knowing that we are likely to face the threat of dehydration syndrome, let us all check our medical supplies and make sure that we are ready!

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