
IV Bags May Not Be Necessary to Rehydrate Patients - curtis
https://slate.com/technology/2018/02/marias-iv-bag-shortage-taught-me-something-new-about-hydration.html
======
mabbo
> 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 even more miserable. Got a hangover? This will make things better for
you.

The only part of this I've never realized was how much sugar is needed to
optimize it. Good to know for next time.

~~~
nradov
Would drinking oral rehydration solution mixed with vodka prevent the hangover
from occurring in the first place?

~~~
awakeasleep
A lot of the hangover effect comes from acetaldehyde, a somewhat toxic product
of the metabolism of alcohol.

A big part of the hangover is waiting for your body to get rid of
acetaldehyde. Drinking more reduces your awareness of the effects of
acetaldehyde, but increases the total amount of it in your body, prolonging
the hangover.

~~~
logfromblammo
Aldehyde dehydrogenase enzymes employ the sulfur chemistry of cysteine. Taking
n-acetyl cysteine before you drink helps your body to synthesize the ALDH.
Glutamate (easily available from monosodium glutamate) is required, along with
water, for the enzyme to process aldehydes into carboxylic acids. The reaction
is powered by NAD+/NADH, so adequate niacin and tryptophan in your diet would
help you have enough of that, but that system also powers the alcohol
dehydrogenase that is producing the aldehydes.

Whether you get hangovers or not largely depends on the relative efficiency of
your ADH versus your ALDH enzymes. If you clear aldehyde faster than you can
metabolize the alcohol, you never get hangovers unless you have some odd
sulfur-based chemistry happening in your body. If you clear aldehyde slower
than you metabolize alcohol, you get hangover effects. If you have an ALDH
defect, or are taking a drug that antagonizes it, you might experience "Asian
blush", with immediate unpleasant reactions to drinking alcohol.

Dehydration has its own unpleasant symptoms, and since alcohol is a diuretic,
it can dehydrate you. Drinking water or electrolyte rehydration solutions will
help with that. You can be fully hydrated and still have a hangover, but at
least you won't have a hangover and be dehydrated too.

I have never had a hangover, but the chemistry suggests that if you get them
routinely, supplementing your diet with NAC might help. Eating tofu and
shiitake (high in tryptophan/niacin) with MSG as you drink or after you drink
might also help. It's mostly your genetics, though. If you get bad hangovers,
there's no easy cure for it other than to drink less alcohol.

------
nscalf
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 gain an advantage on naturally smaller
opponents. There wasn't a large scale shift in the fighter's weight classes
though. They just swapped to oral rehydration.

One of the big concerns from this change though is that some doctors are
claiming you don't rehydrate fully in a short period of time this way.
Fighters weigh in the day before a fight, so they're peak dehydrated roughly
24 hours before they fight. There are claims that it takes the brain many days
to fully rehydrate after a weight cut if you're not using IV's, so people
paying attention in the sport are really worried that brain injuries are going
to start going up.

~~~
LeifCarrotson
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 show up to the scales hungry, but that's more
healthy than sweating.

And by 'they', sure, the UFC could make a big change...but where this really
needs to start is the high-school wrestling mat, where you have kids
establishing a culture of 'grit' as defined by running in hoodies. I haven't
been a wrestler myself - I was a track kid in high school - but I can vividly
remember swiftly passing our varsity wrestling team during winter training on
the indoor track in our gym. They shuffled along in their uniform, heavy
sweats, fists bunched up to their chests (from too much bench pressing and
curling and not enough triceps/lats work) while I wore nothing but some short
shorts and was dripping with sweat anyways.

UFC fighters are appropriately compensated and informed of their risks. High
school kids are not.

State wrestling finals for my state are in two days. It's 11:45 here, so right
this minute, a lot of kids are just wrapping up their lunch and some of the
best wrestlers across the state are going back to class hungry and dangerously
thirsty - on purpose - so they can make weight this weekend.

[http://bleacherreport.com/articles/2555772-weight-cutting-
so...](http://bleacherreport.com/articles/2555772-weight-cutting-solving-the-
biggest-problem-in-combat-sports)

~~~
shkkmo
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.

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inetsee
A neighbor of mine became dehydrated because of an infection (I think it was a
kidney infection, but I'm not sure). She went to the emergency room and they
pushed IV fluids, and I mean pushed. They hung a total of three bags, and at
one point they were squeezing the bags to increase the flow of fluids. They
over-hydrated her, and then they had to give her something to deal with the
over-hydration. The over-hydration, or the medicine they gave her for that,
affected her heart. She went into the hospital with a simple infection, and
left needing expensive heart medication.

~~~
phaedrus441
This sounds more like the patient had previously-undiagnosed heart failure,
didn’t respond well to rehydration (since it’s easier to become volume-
overloaded with heart failure), and required further work-up.

~~~
inetsee
To the best of my knowledge, she was in good health before she developed the
infection. Her body mass index was in the normal range, and she did the
recommended amount of aerobic exercise (150 minutes, moderate intensity /
week).

It sounds to me like an intern over-reacted to her dehydration, and over did
it with the IV fluids.

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jinushaun
True, but where IV bags shine is hydrating those that can’t drink water.
(Vomiting, nausea, etc)

~~~
raverbashing
Yes, so save that for the really necessary cases

Even if the person has nausea, they can drink a bit at a time

> Second, she says, is to resist the temptation to drink at a normal rate—let
> alone chugging the stuff. An ounce at a time every few minutes decreases the
> odds that the liquid will, um, return from whence it came.

~~~
athenot
> Even if the person has nausea, they can drink a bit at a time.

Not necessarily. Sometimes the nausea is so severe that even a teaspoon of
water gets sent back the way it came in… a most unpleasant feeling when the
body refuses to take anything and ends up vomiting fluids beyond the
stomach—e.g. bile.

~~~
raverbashing
Yes, my phrase is missing "in some cases"

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Tharkun
I was sent to the ER a while ago. I spent several hours there, mostly waiting
in between test results. After a while I got really thirsty. But they wouldn't
let me drink until a doctor cleared me for drinking. This went on for several
more hours, at which point I ended up dehydrated. They gave me an IV bag to
rehydrate. The cynic in me suspects they routinely tell people they can't
drink water simply so they can charge for IV bags.

~~~
cloverich
In this case, if you needed a surgical intervention (or anything requiring
sedation), its safer to be hydrated via IV fluids. Unfortunately ER's (and
Hospital's in general) can move incredibly slow (often for no reason) and
outside of emergencies are rarely good at any kind of prioritization. Add it
all up and you get situations like yours :(

~~~
bluGill
Actually there is a reason the ER moves slow for what looks like no reason:
they need to always have free beds and time just in case a more serious
emergency comes up. If you can wait it is better to not see you even though
they could to ensure that if somebody comes in with a seconds count emergency
they are able to take care of it in seconds.

------
jcadam
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?

~~~
taneq
> I'm guessing the solution that was forced on me [...] was probably not the
> best idea?

Indeed, it wasn't a solution!

~~~
davak
Underrated reply for the chemistry pun.

As a physician we do occasionally see folks die from hyponatremia (low salt)
from overly correcting dehydration with water. It’s a terrible tragedy.

------
teslabox
> Better yet, we’ve learned since that you can still get most of the benefit
> without WHO-approved stockpiles of ORS. You can use a number of widely
> available commercial products that essentially replicate ORS, from sports
> drinks to Pedialyte. 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. There are just two pitfalls
> to avoid, according to my colleague Regan Marsh, an emergency physician at
> Brigham and Women’s Hospital and a medical director for Partners in Health.
> First, fight the urge to sweeten it too much. “People want to make it more
> sugary because of the taste, but that proportion of salt and sugar is
> important.”

I did this several years ago, after dehydrating myself while working outside
on a hot day. Water didn't touch my thirst, then I realized I needed
electrolytes. I used lemon juice, sugar, and a good amount of salt. It was
delicious.

~~~
neolithic
what was the exact mix, if you don't me asking?

~~~
rjeli
In the fasting world this is “snake juice”

“take around 4700 mg of potassium per day max 2000 up to 3000 mg of sodium per
day max” into a liter of water for a full day’s worth

------
Slansitartop
Hospitals also insanely overcharge for IVs. A few years ago I was in the
hospital, and I knew I could keep down oral re-hydration solution. The
hospital put me on a saline IV anyway. When I got the bill, the _IV line item_
was $2000! Insurance discounts brought that down to $200. I paid all that for
a couple dollars of salt water I didn't need.

~~~
gasgasgas
The charges are inflated because of insurance. The actual paid amount is less.

~~~
Slansitartop
The actual paid amount was $200, which is still excessive, especially for
something I didn't really need.

~~~
LeifCarrotson
Well, that's the amount you paid. Some fraction of the insurance premiums
which you and your employer paid also went to the hospital for that IV.

I wonder how much. Obviously not $2000, that's absurd. But maybe $200. Or $2.
Or maybe the insurance company gets paid $20 by the hospital so they get to
make $180 off of you for the IV.

~~~
Slansitartop
I'm on an HSA. The hospital would have gotten nothing from the insurer, and I
would have had to pay the whole bill, if I hadn't hit my deductible. If I'd
just been to the ER and not been admitted, I would have probably had to pay
for it all.

I have it on good authority that saline IV bags are dirt cheap. The hospital
used a machine to control the delivery rate, but that cost should have been
amortized over hundreds or thousands of patients. The nursing labor involved
was negligible, not more than a half-hour for the whole stay.

------
amluto
You can buy approved oral rehydration powder pretty cheaply [1]. I keep it
around for backpacking trips and such.

Also, I've heard, but have not verified, that coconut water is a decent
approximation. I'm not sure if this is true, but it's certainly delicious.

~~~
dwyerm
I second this. Because it keeps forever and is relatively small, I keep it
around in the medicine cabinet. If you've ever had a guest lose a fight with a
Norovirus, you appreciate having some of it right at hand.

By the way, the Amazon product searches for this return a cesspool of magic
woo. I recommend going to your local drug store, looking for the powdered
Pedialyte, then looking in the meter-or-so surrounding that area for the
cheaper store-brand version.

~~~
masklinn
> I second this. Because it keeps forever and is relatively small, I keep it
> around in the medicine cabinet. If you've ever had a guest lose a fight with
> a Norovirus, you appreciate having some of it right at hand.

Then again sugar and salt also keep forever. I guess the sealed unidoses help
though.

------
KaiserPro
IV bags are there to get you out of the shit.

In the UK its pretty rare to get an IV bag, unless you are a celebrity.

~~~
imglorp
EMT here. Venous access is mandatory protocol in many emergent cases, such as
trauma and cardiac. If they already have hypovolemia, eg bleeding, it's not
going to get better by itself. Reduced BP, impaired perfusion, or anemia will
all end up shorting the brain and heart muscle eventually, so they want to
stay ahead of that. Also, if a surgery is expected later, they want an empty
stomach because vomiting is not good when inhaled. Another reason is for drug
delivery, even if it's just an "saline lock" (no bag, just a port for later)
to insert meds. I think oral fluids are great, but only when indicated.

~~~
KaiserPro
Aye, but then, you're potentially in the shit right? emergency medicine is
basically assuming the worst.... an unknown patient, suffering potentially
large injuries, its best to get that cannula in right now, before its much,
much harder. Its totally prudent to get a line in.

What I was talking about was walking in to A&E with a slight cold and a
headache, you might get a drip if your totally drunk, but you're going to get
a grey needle (the largest one you can get.) and its not going to be
comfortable.

------
cat199
>But as my colleagues and I have manifestly demonstrated in our lackluster
response to these efforts over the past several years, spending more money on
something is kind of the American way, because spending more feels like doing
more, measurable upside be damned.

The higher the cost, the higher value of the percentage skimmed off the top
from insurance.. there is no cost incentive here from the POV of the charging
institution.. this has nothing to do with 'measurable upside'

------
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...](https://en.wikipedia.org/wiki/Sodium-
glucose_transport_proteins) 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](https://news.ycombinator.com/item?id=16440265))

------
breatheoften
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](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 improved dramatically.

It’s funny to read about how iv’s aren’t useful so quickly after having used
one for the first time and been genuinely persuaded that it was effective ...

~~~
masklinn
The article isn't about IV being ineffective, rehydration IV are absolutely
effective.

The article is about them being un _necessary_ unless absolutely humongous
amounts of rehydration are necessary (emergency rehydration), "modern" oral
rehydration is amply sufficient, cheaper, simpler, and less risky (ORS
requires clean water but IV requires aseptic fluid and procedure and even then
there's a risk of infection).

~~~
J_Sherz
Perfect answer, relevant link for those that are interested:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419333/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419333/)

~~~
masklinn
ORT is even recommended for cholera (to upgrade to IV on a case-by-case basis
if necessary), that's about as bad as things can get dehydration wise.

~~~
girzel
One of the most amazing disease-related things I've ever read was something
about cholera (of course I will never remember the original source), and the
fact that it doesn't have to be fatal at all, so long as you rehydrate
properly. Apparently in the vast majority of cases the body will fight off
cholera just fine, so long as it doesn't run out of fluids in the meantime. If
only people had known that they couldn't just drink plain water...

The (possibly apocryphal) article also went into modern educational efforts in
rural India, where people were being taught the proper handfuls of sugar and
salt to add to water, to combat cholera there.

------
tacon
With Vitamin Water and Raw Water, can a startup to market "Hangover Cure
Water" or "Headache Water" be far behind?

~~~
jws
A specific medical claim will trigger FDA requirements to prove efficacy in
the US. Thats why you see lots of products _not_ making claims, for instance —
“High in antioxidants!”, some people will interpret that to mean improved
health outcomes, but the manufacturer is not claiming it.

~~~
M_Bakhtiari
Part of me wants to try to market some strong reducing agents as "high in
antioxidants". Like carbon monoxide air fresheners, cyanide candy, hydrazine
sport drinks, etc.

------
gasgasgas
The title sounds misleading. It has to be judged on case to case basis. I do
not understand why this well known thing is posted here. ORS is commonly used
and prescribed.

------
jwilk
Translation for metric units users:

32 ounces ≈ 0.95 litre

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

~~~
CapitalistCartr
Recipe ratios in metric: 1 liter water 31 ml sugar 2-1/2 ml salt

~~~
acranox
Wouldn’t it make more sense to measure the sugar and salts in grams, rather
than milliliters?

~~~
pluma
In fact I think teaspoons are reasonable for those if it's something you'd
prepare at home. Faster to measure with a teaspoon than using a scale or
measuring cup, I'd think.

~~~
koolba
I never liked spoon based measurements as the spoon size varies. There’s also
the never ending question of level vs heaping.

~~~
Double_a_92
With those things it doesn't have to be exact. I can imagine how much 6
teaspoons or 2 tablespoons are. But I can't really do anything with 25g
without a scale.

~~~
mistercleo
I was curious because I sometimes estimate recipe ingredients so I and
compared my intuitive notion of a teaspoon and tablespoon to their measured
amounts using table salt and found it to be off by a larger margin than I
expected.

