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IV Bags May Not Be Necessary to Rehydrate Patients

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Re: IV Bags May Not Be Necessary to Rehydrate Patients

#131

Post by kragen »

The article is wrong; although the practical recommendations it makes are mostly correct, it is promoting a potentially dangerous medical theory unsupported by any evidence.

The glucose is important because it enables the _enteric_ sodium-glucose cotransport mechanism to work, allowing the sodium to get out of your gut and _into your blood_ many times faster.

Neither glucose nor sodium directly help with rehydration; on the contrary, glucose and sodium in your gut decrease osmotic pressure and reduce rehydration. However, kidneys tightly regulate the osmotic pressure, and in particular the sodium content, of your blood. If you take in water without taking in sodium, your kidneys will work to excrete the water without the sodium, producing hypotonic urine. If you overwhelm this mechanism with too much water, or if your kidneys are damaged, you can go into hyponatremia, which can kill you.

So, even though sodium interferes with rehydration in the sense of "absorbing water", it is necessary for rehydration in the sense of retaining water.

This is where the glucose comes in. In addition to simple diffusion of sodium out of your intestines, it was discovered in 1968 that the small intestine has a much faster active sodium-glucose cotransport mechanism, which allows you to absorb sodium about ten times as fast. It transports a single ion of sodium together with a single molecule of glucose across your intestinal wall. Until this discovery, as explained in the UNICEF page linked from the article, diarrhea was the leading cause of death among children. Oral rehydration solution diminished that problem enormously, as the article points out, and now respiratory infections are the leading cause of death among children.

(In a stunning example of the failure of diffusion of knowledge, it turns out that enteric sodium-glucose cotransport had been discovered by Crane in 1960, but the discovery wasn't applied to save lives on a large scale for some 11 years. You can read more about the mechanism at https://en.wikipedia.org/wiki/Sodium-glucose_transport_prote... or PubMed.)

The article claims that this cotransport mechanism is important in absorption of sodium from the blood by all the cells in the human body, not just in kidneys and intestines. As far as I know, this is a novel medical claim, and should be treated as alternative medicine. I am not aware of any evidence that adding glucose to an IV drip speeds recovery from dehydration.

However, the article's recommendation that dehydration should be treated with oral rehydration solution when possible, rather than intravenous fluids, is sound, already an official recommendation of the WHO, and should be more widely practiced.

(Originally posted at https://news.ycombinator.com/item?id=16440265)

Re: IV Bags May Not Be Necessary to Rehydrate Patients

#132

Post by vanderZwan »

mabbo wrote: post #9

> You can also make good oral rehydration solutions yourself at home for pennies: Just take 32 ounces of water and add 6 teaspoons of sugar and a half-teaspoon of salt. > resist the temptation to drink at a normal rate... An ounce at a time every few minutes This should be something everyone learns. Many common headaches are just dehydration. When you've got a cold or flu, dehydration is common and makes you feel eve…

On the first day after I had my tonsils removed, I thought that maybe using oral rehydration solution at lukewarm temperatures would be less painful than water.

It worked so well that I barely needed any painkillerss during my recovery after that. Quite surprised my doctor didn't suggest it to me though.

Re: IV Bags May Not Be Necessary to Rehydrate Patients

#133

Post by calebsurfs »

LeifCarrotson wrote: post #94
jtuente wrote: post #81

Earlier quoted context omitted.

Some quick googling estimates 6 tsp of sugar is about 25 grams or 100 calories. For comparison, a 32oz bottle of Gatorade G2 (low calorie) has about 19 grams of sugar, and a 32oz bottle of normal Gatorade has about 56 grams. Adding - 1/2 tsp of salt is 2.5 grams of which it is 1 gram of sodium. G2 - 435mg sodium, 120mg potassium; normal - 400mg, 100mg.

As a third point of reference, the Strawberry Lemonade 32oz Powerade I have here next to my keyboard (now filled with water) contains 56g sugar, 400 mg sodium, 93 mg potassium. Note that the label says it contains 21g sugar, 150mg sodium, 35 mg potassium - per 12 fluid ounces . Multiply by 2.66 if you drink the whole bottle. In table format: DIY Oral Gatorade Gatorade Powerade Pedialyte Solution G2 Sugar (g) 25 19 56…

There is a major difference between Gatorade and Powerade, which is the type of sugar.

Gatorade has glucose (aka dextrose, the same sugar as an IV bag) while Powerade has high fructose corn syrup.

Glucose can be used directly by your cells while fructose is metabolized in the liver first. So for quick relief from dehydration I choose Gatorade.

* Glucose = 100% dextrose

* table sugar / sucrose = 50% dextrose

* high fructose corn syrup = ~40% dextrose

Re: IV Bags May Not Be Necessary to Rehydrate Patients

#134

Post by shkkmo »

LeifCarrotson wrote: post #110
nscalf wrote: post #88

I think the best place that this is illustrated is in the UFC. When they banned rehydrating through IV's (I read they test for it by checking for by products of rubber in the blood, which presumably would have come from running liquid through rubber tubes into the arm) we expected to see the entirety of the sport move up in weight classes. It was not a big secret that everyone was cutting large amounts of weight to g…

It seems that the ban would be more effective if, rather than banning a specific rehydration method, they banned the process of cutting weight through dehydration. A cheap urine refractometer costs $25 - you can grab one yourself on Amazon if you like - and would tell you whether the athlete at the scales was dehydrated (and also give you a urine sample to check for other banned substances). Sure, then athletes might…

I remember the wrestlers in my high school carrying water bottles in classes before competitions that they would spit in throughout the day for that little bit extra weight drop.

Re: IV Bags May Not Be Necessary to Rehydrate Patients

#135

Post by cthalupa »

mabbo wrote: post #9

> You can also make good oral rehydration solutions yourself at home for pennies: Just take 32 ounces of water and add 6 teaspoons of sugar and a half-teaspoon of salt. > resist the temptation to drink at a normal rate... An ounce at a time every few minutes This should be something everyone learns. Many common headaches are just dehydration. When you've got a cold or flu, dehydration is common and makes you feel eve…

The sugar was the big news to me, as well. I usually use an electrolyte mix if I've been drinking, and it usually works - but there's been some times when it hasn't. I just looked at the formula, and zero sugar.

I'll be adding some sugar to it to see if it improves things.

Re: IV Bags May Not Be Necessary to Rehydrate Patients

#136

Post by hugodahl »

LeifCarrotson wrote: post #94
jtuente wrote: post #81

Earlier quoted context omitted.

Some quick googling estimates 6 tsp of sugar is about 25 grams or 100 calories. For comparison, a 32oz bottle of Gatorade G2 (low calorie) has about 19 grams of sugar, and a 32oz bottle of normal Gatorade has about 56 grams. Adding - 1/2 tsp of salt is 2.5 grams of which it is 1 gram of sodium. G2 - 435mg sodium, 120mg potassium; normal - 400mg, 100mg.

As a third point of reference, the Strawberry Lemonade 32oz Powerade I have here next to my keyboard (now filled with water) contains 56g sugar, 400 mg sodium, 93 mg potassium. Note that the label says it contains 21g sugar, 150mg sodium, 35 mg potassium - per 12 fluid ounces . Multiply by 2.66 if you drink the whole bottle. In table format: DIY Oral Gatorade Gatorade Powerade Pedialyte Solution G2 Sugar (g) 25 19 56…

All three manufactured/retail products listed also contain a non-insignificant amount of potassium, particularly the Pedialyte, to which the homemade solution matches best. Is the value added by potassium minimal enough to not include it? Or is availability in a common household more of an issue?

I have seen in stores sodium-free salt, and reduced-sodium salt, which both substitute potassium for the "missing" sodium, which can be a source of potassium if the added benefit is worthwhile.

Re: IV Bags May Not Be Necessary to Rehydrate Patients

#137

Post by shkkmo »

breatheoften wrote: post #64

This is fascinating for me to read as a person who is rather convinced that trendiness tends to overwhelm reason in much of wellness practices. But I happened to try an elective iv clinic on Sunday — after a hard workout and long night the previous day — https://www.onusiv.com . I’ve never had an iv before — but the experience was genuinely awesome — muscle pain decreased, I felt lighter and energized, and my mood im…

The point of the article is that next time, just drink your rehydration fluid orally and save yourself the money.

Unless you are vomiting, unconscious or potentially going into surgery, using an IV to administer the fluid is unnecessary.

Re: IV Bags May Not Be Necessary to Rehydrate Patients

#138

Post by ars »

jcadam wrote: post #21

So that time back in my Army days when I collapsed from dehydration, I'm guessing the solution that was forced on me -- sit on this rock and chug two full canteens of plain water (no salt/sugar/electrolytes) -- was probably not the best idea?

> was probably not the best idea?

Plain water still works fine. It's just slower.

Re: IV Bags May Not Be Necessary to Rehydrate Patients

#139

Post by zeveb »

King-Aaron wrote: post #4
jwilk wrote: post #2

Translation for metric units users: 32 ounces ≈ 0.95 litre

Thank you for that, I wish more articles would use SI units of measurement.

> Thank you for that, I wish more articles would use SI units of measurement.

As someone who only uses traditional units, I wish that more articles would use them. Perhaps a good compromise between us would be for articles to use both!

Re: IV Bags May Not Be Necessary to Rehydrate Patients

#140

Post by breatheoften »

masklinn wrote: post #129
breatheoften wrote: post #119

Earlier quoted context omitted.

Thank you for this. The use of 'unnecessary' is super interesting to me and makes me empathize with the spectrum of problem's Dr.'s must have in deciding treatment plans ... I feel that arguing convincingly about the lack of necessity of a given effective technique would make for an incredibly hard communication/decision-making problem ... Also interesting, the presence or absence of necessity was not at all a factor…

> Also interesting, the presence or absence of necessity was not at all a factor in my usage. I elected to pay a bunch of money for what was certainly an 'unnecessary' use of an I.V. with a goal of enhancing well-being/accelerating recovery time. When I commented about unnecessary, I wasn't commenting about the goal but the means. You get the same benefits from ORT as you get from IV rehydration[0], at lower risk, an…

I changed the subject from use of IV for hospital rehydration treatment to possible performance enhancing uses in my original post and thank you for calling me out at incorrectly interpreting the original article.

Now, however, I think you might be guilty of extending the argument beyond its original domain in pursuit of snarkiness. Is it your claim that an IV is useful for no purposes beyond rehydration? It’s certainly possible to include other substances in the iv which are rapidly absorbed into the bloodstream.

It seems to me like studies showing suitability of ORT to rehydration wouldn’t necessarily offer insight into these other uses ...?

Also regarding complication likelihood — I think your argument glosses over the fact that the sheer complexity of the hospital environment introduces all sorts of incidental complexity not present in a simpler context. A “factory” that does one thing is much easier to optimize (including to optimize for safety) than a place like a hospital which has to house the entire complexity of the full medical process.

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