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You would not imagine that dehydration can lead to complications. But take the case of this 75-year-old man, who keeps to his morning routine of a walk and buying the day’s essentials from the neighbourhood bazaar. He insisted on his outdoor routine despite the extreme heat wave that gives the “real feel” of 50 degrees Celsius. He didn’t feel thirsty or realise he was suffering from dehydration. The day it became severe, he landed at our emergency room with kidney damage and was put on IV fluids.
Our patient had not been hydrating himself well despite the exposure to the sun, losing more fluids than he could replenish. So what he suffered was heat exhaustion, a step away from heat stroke. He was a patient of hypertension and was on diuretics to manage his blood pressure. So his body lost extra water, disturbing the balance of electrolytes like sodium and potassium, which are responsible for key body functions. His kidney function was impaired. A severe drop in blood volume due to dehydration had pushed his body into a state of shock, a life-threatening condition characterized by low blood pressure and oxygen levels.
WHY DEHYDRATION AFFECTS KIDNEYS
Dehydration decreases blood volume, which can reduce the amount of blood flowing to the kidneys. This can hinder their ability to filter toxins from the blood. This results in a higher concentration of minerals and waste products in the urine, increasing the risk of kidney stones. These in turn can cause pain and blockages in the urinary tract, potentially damaging the kidneys. In severe cases, dehydration can lead to AKI (acute kidney injury), a sudden loss of kidney function.
WHAT DEHYDRATION IN THE ELDERLY LOOKS LIKE
Our patient had dry mouth and kidney injury. He could not urinate, had dizziness, confusion and experienced a sudden drop in blood pressure.
Some may report urinary tract infections (UTIs) because of concentrated urine, cardiac issues like irregular heartbeats or arrhythmias and angina as the heart is under stress with a lower blood volume circulating in the body.
WHY THE ELDERLY CANNOT FEEL DEHYDRATION
That’s because our sensation of and response to thirst can be blunted with age. We tend to miss or fail to interpret the brain’s cues to drink. Those suffering dementia are more at risk of missing these signals.
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As we age, our kidneys’ ability to hold on to water diminishes, leading to increased fluid loss through urination. Swallowing difficulties (dysphagia) can make it challenging for the elderly to drink enough fluids. Self-restriction of fluid intake to avoid frequent urination can also lead to dehydration.
Most elderly people love their outdoor experience and may sit in a verandah for long spells without rehydrating themselves. So when they get up, they feel light-headed and are at risk of falls.
Sometimes medication like beta blockers reduce the heart’s ability to sense the heat stress in the body while certain drugs prevent sweating.
WHAT ABOUT PREVENTION?
Avoid high activity between 11 am to 4 pm, stay indoors. Wear cotton clothes and keep sipping three litres of water through the day. Make sure you urinate between four and 10 times every day.
(Dr Tickoo is Director, Internal Medicine, Max Healthcare)
© The Indian Express Pvt Ltd
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