Every now and again, something splashes across my deflector shields, pulls me away from mulling over the comic nature of life, human nature, and maintaining sanity in an increasingly oddball world, and makes me reach for the keyboard.
And since we are clearly into legit summer weather, with likely highs in the 100s to come for several months, it’s a timely topic.
Short version: I drink to thirst, but not more than 32 oz. per hour, and whatever my daily total, not all at once, since I’m not interested in dying.
The story is not unique
As a physician, I hear about deaths like this a few times a year. Someone drinks either an unbelievable amount of water, or a somewhat unhealthy amount of water in a short time frame, dilutes the carefully balanced minerals in the bloodstream, which results in major malfunctions of the brain, and death.
It’s not an issue for most folks. If you drink a cup or two of coffee in the morning, a glass of water or similar beverage with lunch, and about the same near or after dinner, that comes out to something like 40 oz. of fluid spaced throughout the day. If anything, that’s probably on the low end of fluid intake, and you may have good reasons to drink more.
40 oz. is about a third of a gallon.
Drinking 3 times that amount — or more, which some individuals have done — should feel insane. I love oatmeal raisin cookies, and eat 1-2, maybe up to 5 cookies, if I love the batch. But eating 2 or 3 sheets of cookies would be unhealthy by any standard.
Yet, the analogous water situation, known as water intoxication or water poisoning when people drink way too much or too much too quickly, still happens. And that’s instructive.
Nihil humanum mihi alienum
The 35-year-old wife and mother of 2 didn’t drink 5 gallons of distilled water. She was out on a lake during the 4th of July, and drank the equivalent of two 30 oz. Yeti carafes of water — which I’ve often pointed to as a way to track water intake — after being extremely thirsty and having a related headache.
Scenario: a hot day, compounding the body overheating because of being on the water (high humidity, not as much evaporation from the skin for cooling), probably sweating a bunch. Having what seemed like a really tall glass of water, twice, suddenly does not seem that excessive.
Other cases in point: older patients in the ER as a result of heat and dehydration. We’ve all heard summer news stories about heat waves and deaths, especially among the elderly. Death by heat stroke or dehydration is the opposite problem to water intoxication, but it showcases a rationale for being vigorous with the water.
I have seen it with my own eyes: an elderly patient cannot walk or even stand, they’re so weak, coming from a living space during the summer that’s either uncomfortably warm or downright hot. They get into the clinic, or the ER with an inevitable wait, and just sitting in a 70 °F air-conditioned room, they unwilt and start perking up. Their heartbeat, initially triphammering like they’ve been running on a treadmill, slows to merely a little fast. And once they get IV fluids, they really perk up, the heart rate drops to normal, and the family is usually told, Looking good, please keep grandma COOL and WELL HYDRATED.
Under hydrating is more common; there are many more people drinking “too little” water than too much. I’ve seen kidney function labs return low enough to be concerned, that typically turn right around after drinking more water — flushing more fluid through the filtration pumps that are our kidneys. But while “sufficient” hydration is a common health and fitness suggestion, there are few significant problems that result from drinking a mere 3–4 cups of water or coffee a day, under normal conditions.
Going overboard on the fluids, however, can kill.
Instead of focusing on getting out of chokeholds, try not to get choked
If you can get into trouble drinking too little if it’s hot and your system is not great, and trouble drinking too much too fast if it’s super hot and your system is supposedly fine, what’s the answer?
The smartypants answer is that it depends on the circumstances. Cut to the chase answer: try to avoid extreme circumstances.
Drinking to thirst has been a common-sense medical recommendation for some time to trust the body’s hydration sensors — only that advice would not have helped the Indiana woman in question, who seems to have done just that. The thirst signal also tends to be less reliable in the elderly, athletes, and pregnant women.
Drinking up to HALF your bodyweight in ounces as a maximum amount is a more recent, vigorous hydration option, as is a longstanding guide to aim for 8 glasses, or 64 oz. daily — but again, while these would prevent deaths in people drinking gallons of fluid, 64 oz. meets both of those guidelines, but did not help the Indiana woman.
In fact, there is no one official guideline for hydration: thirst, 8 glasses (64 oz), half or up to total bodyweight in ounces have all been promoted, as have different amounts for men and women. One rate-based answer recommends no more than 1 liter per hour, whatever the total amount, since the kidneys can’t unload more than that if a person has taken in too much.
It DOES depend on the scenario and the individual.
An elderly, frail, and deconditioned individual will have more trouble with heat and humidity than a younger, active person who can move somewhere cooler, self-hydrate easily, etc.
Yet a young athlete sweating buckets has likely lost BOTH fluids and key salts through their voluminous sweating, and is more vulnerable to diluting the remaining electrolytes in their bloodstream.
And if you have medical conditions that involve not-fully-normal heart, kidney, or electrolyte function, the recommendations to correct become even more specific and cautious.
Try to stick to the middle path
Another martial arts lesson applied to general life: rather than trying to get good at fighting your way out of every possible scenario, work on driving the fight to your terms, the few scenarios that you’ve practiced getting good at.
The consensus seems to be that a person who is NOT in extreme environmental conditions and who lacks pertinent health issues, will generally do OK to drink to thirst, up to about 100 oz. spread across the day.
But so-and-so lives upstairs in the hottest room of the house. And doesn’t drink much and doesn’t want to come to cooler rooms. Or my brother, he insists on running ultra marathons in the Arizona summer. What do I do for them?
Well, try not to be them.
“What if I’m leaving the bar at 2 AM, and in the alley I’m attacked by 5 guys with pipes, and I disarm one but 2 others hold my arms, and the disarming counter I learned doesn’t work, I snatch up a brick but before I can throw it, they pin me down and sit on my limbs, what do I do then, teacher?”
Avoid bars at 2 AM, my son.
The guidelines work for the basic conditions, and everything goes out the window when the conditions get extreme. So focus your energy on not heading into extreme conditions. Or extracting yourself from them if they have unexpectedly, despite your best intentions and preparations, become extreme.
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