Hesham A Hassaballa's COLUMN

Beware of How You Hydrate This Hot Summer

Sometimes, drinking just water can be very dangerous in the summer heat.

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It was a very hot summer. A young man showed up to my ICU several years ago after suffering a seizure. His sodium level was dangerously low, which was the cause of his seizure. He was treated and recovered quickly. When he regained consciousness, I asked him his story.

He told me that he rode from Ohio to Illinois on his motorcycle. He had a helmet on, and it was very hot. He sweat profusely. Here’s the key: he drank only water the entire time.

This summer is also turning out to be very hot, especially in the Western United States. That means we will be sweating…and sweating a lot. When that happens, we not only lose water, but we also lose electrolytes (that’s what the white marks on our hats are). If we only replace water and not the electrolytes, we “dilute” the level of the electrolytes in our blood.

So for my patient above, he lost a lot of salt in his sweat, and he only replaced the water. By the time he reached me in the ICU, his sodium level was so dangerously low it caused him to suffer a seizure. Mind you, this only took a few hours to happen.

The same thing can occur during a competitive race, such as a marathon. When running for several hours and sweating, if only water is consumed, then the blood sodium level can also decrease to dangerously low levels and cause serious illness and even death.

That’s why we need to be very mindful this summer when rehydrating. If we will be out in the heat for hours and hours, we need to make absolutely certain we also consume foods with electrolytes, such as sodium and potassium.

Commercial hydration drinks have those electrolytes (albeit not very much). But so do foods like pretzels or even fruits and granola bars. Coconut water is also an excellent choice for rehydration. When I ran the Chicago Marathon in 2010, I made sure to drink Gatorade and not just water at each hydration station. And, thank God, I never cramped up.

I love summer: I love the warmth, the sun, the long days. There is so much fun to be had. With the summer fun comes the summer heat. We need to be very careful on how we rehydrate when out in the heat and sweating profusely. Sometimes, drinking just water can be very dangerous.

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Dr. Hesham A. Hassaballahttp://drhassaballa.com
Dr. Hesham A. Hassaballa is a NY Times featured Pulmonary and Critical Care Medicine specialist in clinical practice for over 20 years. He is Board Certified in Internal Medicine, Pulmonary Medicine, Critical Care Medicine, and Sleep Medicine. He is a prolific writer, with dozens of peer-reviewed scientific articles and medical blog posts. He is a Physician Leader and published author. His latest book is "Code Blue," a medical thriller.

4 COMMENTS

  1. Great post Hesham, and very timely. A friend of mine also suffered a seizure from exactly the same issue. Is there any sort of indictor on how much water you could safely consume under these conditions, even perhaps daily? What’s too much, and obviously size and weight affect the amount you can safely drink right?

    • The amount depends on the individual, yes. Under normal conditions with a normal constitution, it is very hard to drink enough water to cause hyponatremia. That is because the body will just eliminate the excess water in the kidneys. I have known of patients who drank themselves to hyponatremia because they had delusions that they needed to drink gallons and gallons of water. But, this is rare. That said, if you are actively losing salt (like in sweat or vomiting/diarrhea) and drink enough water, then hyponatremia can occur within hours.

  2. Yes I’ve been experiencing this very issue also. I started noticing tingling sensation going down.y legs. I went and got Gatorade and it’s been keeping everything in check. Also I would wake up sweating in my sleep due to the extreme heat we’re having in Western Canada. And being on a top floor where the Sun shines in didn’t help. But YES Gatorade seems to be doing the trick. Looking forward to cooler weather.

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DR HESHAM A HASSABLLA

Medika Editor: Cardio and Pulmonary

Dr. Hesham A. Hassaballa is a NY Times featured Pulmonary and Critical Care Medicine specialist in clinical practice for over 20 years. He is Board Certified in Internal Medicine, Pulmonary Medicine, Critical Care Medicine, and Sleep Medicine.

He is a prolific writer, with dozens of peer-reviewed scientific articles and medical blog posts. He is a Physician Leader and published author. His latest book is "Code Blue," a medical thriller.

Medika are also thrilled to announce Hesham has recently joined our team as an Editor for BeingWell, Medika's publication on Medium

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