Hydration Question

A reader writes: “I have been told that under most circumstances a properly hydrated person should be urinating every 1 and 1/2 to 2 hours. Is this accurate?”

This is probably a reasonable statement, although there is no absolute correlation of time interval between episodes of spontaneous (e.g., associated with the urge to urinate) urination and state of hydration. For instance, a person might be well hydrated and exercising, so not appreciate an urge to urinate. Exercise is also the reason why a person may not appreciate thirst, so until someone takes a break from the exercise and attempts to urinate, it may be difficult to tell exactly where someone is from a hydration perspective.

The general rule is to drink enough liquid so that the urine is light-colored and copious, no matter what the interval between episodes of urination. If the urine is dark-colored, this may indicate that it is concentrated (with waste products), which occurs when the kidneys (and body) are working to conserve fluid. “Cloudy” (not clear) urine may be caused by excess protein in the urine, a urinary tract infection, or some other reason. Using the urine hydration chart depicted above, urine should not be darker in color than #4.

It’s easy to become dehydrated outdoors, as most people underestimate their fluid requirements. Situations of particularly high risk include cold, dry weather (respiratory fluid loss from breathing, particularly if it is rapid), high altitude (loss of thirst and breathing cold, dry air), extreme heat (nausea, inadequate thirst), during times of great exertion, and with any intercurrent illness (particularly if it involves nausea and vomiting). These are times when it is important to drink a minimum of two liters (quarts) of water when there is no significant fluid loss (e.g., at rest in a non-stressful environment), and more if conditions warrant. So long as alcohol is not ingested and one avoids any beverage with a diuretic effect, it doesn’t make much difference what beverage is chosen. Drink what you like, and drink enough.

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

Tags: hydration, dehydration, wilderness medicine, outdoor medicine, healthline

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Thank You to Suture for a Living for Grand Rounds

Thank you to Suture for a Living for including my post about seabather's eruption in this week's edition of Grand Rounds. Grand Rounds is a weekly compilation of posts related to health care compiled by a host, who makes a great effort to compile an interesting collection for readers.

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Sea Bather’s Eruption

From the month of May through September, oceangoers along the U.S. Gulf coast need to be concerned about a particular form of skin rash caused by tiny jellyfish. As the summer season progresses, this can also become a problem along the entire eastern seaboard. I've been afflicted while scuba diving in Cozumel, Mexico, and the episodes can be much more than a minor annoyance. Indeed, the intensity with which some people react to these particular stings was an impetus for the development of Safe Sea, a jellyfish sting inhibitor product for which I participated in the design of clinical trials.

Sea bather’s eruption, often misnamed "sea lice" (which are true crustacean parasites upon fish), occurs in seawater and more often involves bathing-suit-covered areas of the skin, rather than exposed areas. The skin rash distribution is very similar to that from seaweed dermatitis, but no seaweed is found on the skin. The cause is stings from the nematocysts (stinging cells) of thimble jellyfish, such as Linuche unguiculata, and the larval forms of certain anemones. The victim may notice a tingling sensation under the bathing suit (breasts, groin, cuffs of wet suits) while still in the water, which is made much worse if he takes a freshwater rinse (shower) while still wearing the suit. The rash usually consists of red bumps, which may become dense and confluent. Itching is severe and may become painful.

Treatment is often not optimal, because application of vinegar or rubbing alcohol to stop the envenomation may not be very effective. An agent that may work better is a solution of papain (such as unseasoned meat tenderizer), which may be applied using a mildly abrasive pad, although a good outcome is not guaranteed. After the decontamination with any agent and a thorough freshwater rinse, apply hydrocortisone lotion 1% twice a day to treat the inflammatory component of the skin reaction. If the reaction is severe, the victim may suffer from headache, fever, chills, weakness, vomiting, itchy eyes, and burning on urination, and should be treated with oral prednisone as if he suffered from poison oak. Topical calamine lotion with 1% menthol may be soothing.

Prevention is obviously quite important. If you are able to obtain the product, cover exposed skin areas with Safe Sea. This includes at least a few inches underneath the cuffs of wet suits or Lycra-type "stinger suits" that are equipped with elastic cuffs at the wrists and ankles, and sometimes around the neck. If you only wear a normal bathing suit, which does not have tight cuffs, the tiny creatures can easily wash onto your skin underneath the suit, where they can wreak havoc. So, if you are concerned about the possibility of seabather's eruption, you must also apply the Safe Sea underneath your bathing suit. If there are "thimbles" (jellyfish) visible in the water, it is best to stay out. If you are swimming in apparently uninfested water and begin to feel a tingling sensation on your skin, then the "swarm" may be moving into your location and you should exit the ocean.

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

Tags: sea bather's eruption, sea lice, Safe Sea, marine, wilderness medicine, outdoor medicine, healthline

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Lifeguard Situation in California

Here's a recent communication that originated with the Orange County (California) Register:

Wednesday, April 9, 2008
State lifeguard funding gets a reprieve. Public safety mandates staffing.
By FRED SWEGLES
The Orange County Register

Lifeguard service at area state beaches will be as robust as in years
past this spring and summer – but after Labor Day, all bets are off.

That's the message from Rich Hayden, acting sector superintendent for
San Clemente, Doheny and San Onofre State Beaches. The move follows a
Register news article that reported a warning from Hayden's
colleague, Steve Long, about dangerously low levels of lifeguard
staffing due to budget constraints.

"Steve Long's (warnings) in the Sun Post News and the Register did
set off some seismic shock waves up in Sacramento, as you might
imagine," Hayden told San Clemente parks commissioners Tuesday
night. "Action at the Sacramento level was very swift. Monies were
freed up and sent down to our district. We got some money that made
us whole, meaning that from now until the end of the fiscal year on
June 30 there will be no change in the state lifeguard service."

This applies to the entire South Coast District – San Onofre, San
Clemente, Doheny, Crystal Cove, Huntington Beach and Bolsa Chica
State Beaches, said Rich Rozzelle, district director.

"We are moving monies around from one pot to the other to put
lifeguards on the beach and maintain a level of service for public
safety," Hayden said.

He said the plan is to extend traditional levels of service through
the summer, although uncertainties surround a new state budget that
is due July 1. That budget may not be adopted until the fall, Hayden
said.

"Once we get a signed budget, I don't know … if it does come up that
we take a (forecasted) 50-percent cut." Hayden said. He spends 60
percent of his budget for seasonal lifeguards in July and August so
there would be consequences. "I'm going to have to find that money
someplace or ask for forgiveness at the end of the fiscal year.
That's the stark reality of it," he told the city.

City officials had voiced concerns and invited Hayden to appear
before the commission to discuss state lifeguarding scenarios
affecting San Clemente.

"State parks has gotten to a point where we're at critical mass,"
Hayden said. "We cannot take any more cuts."

He said the current park entry fees – $10 per car – are about as high
as users can take.

Parks commissioners voted 6-0 to encourage area residents to write
Gov. Schwarzenegger and state lawmakers to protest lifeguard cuts in
the new budget. Commissioners also asked San Clemente's city staff to
work closely with state parks to ensure there is ample protection on
state beaches bordering the city's beaches.

Residents can send e-mails to governor@governor.ca.gov

Contact the writer: fswegles@ocregister.com or 949-492-5127

Outdoor health and safety concerns are not immune from economic conditions. The public's opportunity to be kept safe requires money and manpower. Lifeguards, park rangers, road warning crews, firefighters, outdoor educators, and every other position imaginable require robust budgets and infrastructure, and in our current declining economy become vulnerable to fiscal constraints. As we can learn from the report above, advocates for safety are now required to be vocal up to the point of political lobbying, because it may no longer be safe to presume that health and safety will take priority over competing programs.

There are solutions to cut-backs, such as shifting resources and volunteers, but these may only be stop-gap and insufficient to replace the original services. It will be tragic to witness the curtailing of essential safety programs leading to increased injuries or even deaths. Of course, we all understand the hard choices presented by insufficient funding and that recreational safety may not be able to compete with other very appropriate public health initiatives, such as immunization programs.

So, given that we know that times may become tough, and that the definition of discretionary (e.g., non-essential) spending may be expanded, we should be prepared to make the case for our causes, and be prepared to find solutions should resources become limited. Safety and injury prevention in a problematic economy should be everyone's concern, beginning right now.

image of lifeguard courtesy of FreeFoto.com

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

Tags: lifeguard,California, ocean safety, wilderness medicine, outdoor medicine, healthline

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Thank You to Doc Gurley for Grand Rounds

Thank you to Doc Gurley for including my review of Sharkwater in this week's edition of Grand Rounds. Grand Rounds is a weekly compilation of posts related to health care compiled by a host, who makes a great effort to compile an interesting collection for readers. Doc Gurley has certainly accomplished that feat in an entertaining and novel way this week! As a high school wrestling coach, I like his style...

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