# Recovering from severe dehydration **URL:** \ **Category:** Factual Questions\ **Created:** [March 25, 2023, 8:37pm UTC](https://boards.straightdope.com/t/recovering-from-severe-dehydration/981656 "2023-03-25T20:37:05Z")\ **Posts on this page:** 7\ **Page:** 2
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [March 26, 2023, 9:41pm UTC](https://boards.straightdope.com/t/recovering-from-severe-dehydration/981656/21 "2023-03-26T21:41:47Z")
> [@puzzlegal](#): > > A friend claimed that doctors sometimes treat dehydration with an enema in places where it’s hard to get a sterile IV. I’m curious if that would work. Don’t see why it wouldn’t - the large intestine lining is designed/whatever to absorb water from the poop [well, the chyme - it becomes poop as water is removed and it thickens into a more solid output] It would be slow as hell, but it would work as long as the person does not have diarrhea. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [March 26, 2023, 11:39pm UTC](https://boards.straightdope.com/t/recovering-from-severe-dehydration/981656/22 "2023-03-26T23:39:17Z")
Never heard of it being done myself but apparently there are areas where that is a least poor option. > **[Proctoclysis for rehydration in children – A scoping review and a pilot...](https://www.sciencedirect.com/science/article/pii/S0965229922001042)** > > Although proctoclysis (enema) is a historically proven, safe and cost-effective rehydration method that needs little training for users and can effect… ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [March 27, 2023, 2:30am UTC](https://boards.straightdope.com/t/recovering-from-severe-dehydration/981656/23 "2023-03-27T02:30:32Z")
> [@DSeid](#): > > I’ll dispute this definition. It’s the significant loss of free water full stop. I was going by UpToDate’s definition in their article on “Etiology, clinical manifestations, and diagnosis of volume depletion in adults”. They split the definition of free water loss between the terms ‘dehydration’ and ‘hypovolemia’ with the former being where most of the loss is intracellular, while the latter is where most of the loss is extracellular. That split in the definition over the issue of where the most water loss was coming from was new to me, compared to my training and figured I’d not gotten the earlier memo. But I’m comfy with your version of it too, as it’s what I learned waaaay back in the day. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [March 27, 2023, 3:41am UTC](https://boards.straightdope.com/t/recovering-from-severe-dehydration/981656/24 "2023-03-27T03:41:38Z")
Interesting. And searching I am finding no shortage of articles agreeing with that distinction! On the Peds side at least we never have. So I missed the memo too! Most recent _Pediatrics in Review_ on it anyway also missed the memo … [https://publications.aap.org/pediatricsinreview/article/36/7/274/34894/Dehydration-Isonatremic-Hyponatremic-and](https://publications.aap.org/pediatricsinreview/article/36/7/274/34894/Dehydration-Isonatremic-Hyponatremic-and) > [@](#): > > Children with hyponatremic dehydration have hypotonic body fluids with serum osmolarity less than 270 mOsm/kg (270 mmol/kg) that can lead to fluid shifts from the extracellular to the intracellular space. The degree of dehydration may be overestimated because these patients have diminished intravascular volume that is manifested by more severe clinical symptoms. They are very likely to require immediate circulatory support. On the other hand, children with hypernatremic dehydration have hypertonic body fluids with serum osmolarity, often in excess of 300 mOsm/kg (300 mmol/kg). Fluid shifts from the intracellular to the extracellular space to maintain intravascular volume. The degree of dehydration in these children is often underestimated, contributing to late presentation for medical care. So on. The hyponatremic dehydration happens in kids when diarrheal losses are responded to with hypotonic fluid replacements (water, tea, ginger ale, apple juice …) along with elevated ADH. Again though, interesting that that perspective is apparently wide spread adult side anyway. Huh. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [March 27, 2023, 4:12am UTC](https://boards.straightdope.com/t/recovering-from-severe-dehydration/981656/25 "2023-03-27T04:12:45Z")
Many years ago, I read a true story about a group of people (IIRC a family) that spent a few weeks on a raft in the middle of the ocean after their boat capsized, and one of them was a nurse. They had some tubing in the raft that they managed to salvage before the boat went down, and at one point after their fresh water ran out, she did indeed fill that tubing with ocean water, and ahem, found some OTHER way for them to “drink” it. All of them did survive this ordeal. After he was shot, James Garfield’s doctors, after inadvertently trying to kill him by probing the wound with their unwashed bare hands, tried to feed him rectally when he couldn’t keep solid food down due to sepsis. They mixed up all kinds of concoctions with milk, eggs, honey, sugar, etc. to unknown efficacy. This was also used for pregnant women with HG; if nothing else, they may indeed have gotten enough fluid to keep them alive. p.s. My sister did not have C. diff, and the diarrhea did go away after she stopped that medication. ---
**Author:** ![scarbrow](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@scarbrow](https://boards.straightdope.com/u/scarbrow)\ **Post date:** [March 28, 2023, 8:12pm UTC](https://boards.straightdope.com/t/recovering-from-severe-dehydration/981656/26 "2023-03-28T20:12:15Z")
> [@](#): > > To me though the following claim is of note: > > > [@mixdenny](#): > > > > the writer said that he could feel life flowing back into his limbs as he drank water. > > Really? > > Mostly severely dehydrated individuals are nauseated and drinking large amounts risks upchucking! But could there have been some immediate perceived response to the brain from the sensory input? Or was that statement just storytelling? I’ve felt that sensation, mostly in my arms, just from quenching my thirst after moderate exercise. I’ve long assumed it was some kind of indirect feedback, since there’s no way water gets from my stomach to my arms that fast. But I’d love to know if there’s a real mechanism happening. ---
**Author:** ![Dr\_Paprika](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr_paprika/32/3042_2.png) [@Dr\_Paprika](https://boards.straightdope.com/u/Dr_Paprika)\ **Post date:** [March 29, 2023, 12:27am UTC](https://boards.straightdope.com/t/recovering-from-severe-dehydration/981656/27 "2023-03-29T00:27:55Z")
I think both definitions are used in practice but that Qadgop’s is slightly more precise. I have little to add to the excellent descriptions above. Generations of medical school students learn about estimating percentage dehydration by various clinical signs. Of course this is approximate, but the symptoms for 10% fluid loss (3% in small children) or 30% fluid loss are very different. With mild hypovolemia there may be few signs, with moderate and severe dehydration there are predictable changes in heart rate, blood pressure, the difference between the two blood pressure numbers, salivation, sweating, skin colour and tone, whether certain areas appear sunken, and several other things. in severe cases tissue will not receive the desirable amount of oxygen. There may also be differences between how fast fluid is given in settings where bloodwork can be done and monitoring is available, and field settings where it may be more difficult to establish intravenous lines (sometimes a challenge in severe dehydration). In the ER one might give up to three quick aliquots of 20mL/kg, or more, of an appropriate fluid depending on the response for very severe dehydration. If giving lots of fluid one would prefer to give at least half of it over a day or so, unless other things supervene. Sodium levels can help estimate deficits and rule out other causes of what one sees clinically, as can ultrasound, and in the setting of trauma one considers many factors for high heart rate and low pressure including dehydration, which sometimes coexists with other causes. I have heard some patients describe the feeling of receiving badly needed fluid in that way. It can hardly go to all places at once, but especially with electrolytes, the fluid crosses membranes quite quickly. [Previous page](https://boards.straightdope.com/t/recovering-from-severe-dehydration/981656.md?page=1)