Spotting dehydration early

Reducing the level of sodium in the body’s cells below what the body needs to work effectively can lead to clinical dehydration. The stakes are worth being clear about: if symptoms are not recognised and the lost fluid is not replaced effectively, in extreme cases this can lead to being hospitalised.

Early symptoms

• thirst
• a decrease in urine output
• darker coloured urine
• lethargy
• nausea
• cramps
• dizziness
• dark rings under the eyes
• low blood pressure
• ringing in the ears

A second list adds dry mouth or a swollen tongue, weakness or sluggishness, a heart that feels like it is jumping or pounding, confusion, fainting, and an inability to sweat.

Where the advice stops

There is a line here worth knowing before you need it. Dizziness on standing, blood pressure dropping on standing, muscle cramps, spasms and weakness, nausea or vomiting, severe abdominal pain, drowsiness or confusion, new fluid around the ankles or calves, new breathlessness, a fast heartbeat or palpitations, rapid weight loss — any of these and the guidance is to attend the Emergency Department, and to expect to be admitted.

And a warning that runs against the instinct everything above builds: general advice is not to take rehydration solutions if you suspect you are at that stage, unless under medical supervision, as they may worsen an electrolyte imbalance.

The middle ground

Between "fine" and "go to hospital" there is a band called amber, and it is the one worth learning because it is the one you can act on. The signs are: passing a reduced amount of urine, urine looking more concentrated and darker, feeling thirsty, a dry mouth and dry skin, and slight weight loss.

The action at amber is to keep doing everything in the green pathway and contact your stoma nurse or healthcare professional for advice. You may need your bloods checked to assess kidney function. If you do not improve, attend the Emergency Department.

Why the early end matters

Acute kidney injury is a sudden deterioration in kidney function over hours or days, and it is thought to occur in 20% of all emergency admissions to hospital — many of which could be avoided with the right care and early treatment. In most cases function fully recovers once AKI is treated, but for some it can lead to chronic kidney disease.

The consequences of running dry are broader than kidney function alone: medications not being absorbed adequately because of fast transit through the gut, undernourishment and weight loss, salt imbalances that can cause heart rhythm problems or muscle weakness, cramps and spasms, more frequent emptying and a greater risk of leaks and sore skin — and, named as plainly as the rest, the psychological consequences: anxiety, depression, and loss of confidence.