11 ms·
IV Bags May Not Be Necessary to Rehydrate Patients
- jwilk 9y agoTranslation for metric units users: 32 ounces ≈ 0.95 litre
- King-Aaron 9y agoThank you for that, I wish more articles would use SI units of measurement.
- CapitalistCartr 9y agoRecipe ratios in metric: 1 liter water 31 ml sugar 2-1/2 ml salt
- acranox 9y agoWouldn’t it make more sense to measure the sugar and salts in grams, rather than milliliters?
- pluma 9y agoIn 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 9y agoI never liked spoon based measurements as the spoon size varies. There’s also the never ending question of level vs heaping.
- yrro 9y agoA flat tap is 5 ml isn't it?
- Double_a_92 9y agoWith 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 9y agoI 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.
- mrob 9y agoDifferent types of salt and sugar have different densities too.
- Libturd 9y agooh no! an extra grain in my recipe! lol you fucking people.
- KarenSatantsby 9y agoI can weigh an amount of water that fits my coffee pot.. but that is learned over 20 years.. I can add amounts to warm cups or make oatmeal but I would need a food scale and I dont have one.
- julian_t 9y ago1l water, 25g sugar, 2.5g salt (approx)
- zeveb 9y ago> 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!
- cimmanom 9y agoThe measurements don't even have to be exact. There was a program that taught women in developing countries to make oral rehydration solution for their children - the result was decreasing deaths due to cholera by an order of magnitude. Many of these women didn't have tools for measuring the ingredients, and the program didn't distribute them - requiring such tools would restrict the spread of the program. The heuristic is a liter of water, a handful of sugar and a generous pinch of salt. The result may not be exactly the optimal concentration, but it's essentially always close enough to have the desired effect. This heuristic has saved millions (probably tens of millions) of lives.
- bitexploder 9y agoRight. The formula is for rapid absorption. If you are a little off you will still absorb it eventually. This is a big deal in the ultra running world. You will inevitably dehydrate or get to a bad place unless you learn some electrolyte blend that works well for you. Plain water can work for a short time but most runners will suffer in their later hours (10+).
- teslabox 9y ago> 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.
- deleted 9y ago[deleted]
- neolithic 9y agowhat was the exact mix, if you don't me asking?
- rjeli 9y agoIn 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
- chopin 9y agoHow much is a teaspoon in gram? Edit: Nevermind, I should have read the entire thread first...
- J_Sherz 9y agoDisregarding the sweetness angle, what's interesting is that we perceive the saltier solutions as tastier when we are dehydrated. If you try drinking an ORS product when you're not dehydrated it will taste worse than when you are in that run down sweaty state on a hot day.
- jinushaun 9y agoTrue, but where IV bags shine is hydrating those that can’t drink water. (Vomiting, nausea, etc)
- cimmanom 9y agoYup, and those who are unconscious.
- credit_guy 9y agoAnd babies.
- bewo001 9y agoAnd hung-over medical personnel..
- fian 9y ago...who have nausea.
- JumpCrisscross 9y ago> And hung-over medical personnel You're being down-voted, but I know a number of military medics and hospital employees who do this after heavy drinking. Seems to work like a charm.
- chopin 9y agoWasn't there a scene in Hangover (the movie) where this was offered as service in Las Vegas?
- carbocation 9y agoThere appears to be a scene in reality where someone is doing this, too: https://www.theivdoc.com/ https://www.theivdoc.com/ ("Food Poisoning Relief")
- mabbo 9y ago> 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.
- albertgoeswoof 9y agowhat does the sugar and salt do in this case? edit: it's in the article: > for rehydration, glucose is basically as important as sodium. The two compounds work together to pull water into shriveled cells that have been deprived of ample water.
- masklinn 9y agoIIRC it's mostly a factor for gut absorption: when gut cells absorb glucose, sodium is cotransported (goes along for the ride) and thus pass through the gut and into the bloodstream at a much greater rate, and the greater sodium gradient increases the rate of water absorption: https://www.ncbi.nlm.nih.gov/pubmed/11193601 https://www.ncbi.nlm.nih.gov/pubmed/11193601 And the sodium also (and originally) serves to combat hyponatremia, as lost fluid generally brings sodium along for the ride if you rehydrate with non-electrolytic water you find yourself with mild to severe low sodium levels.
- dwyerm 9y agoIt drove me a little bit crazy to hear a mom complaining about how she couldn't find sugar-free Pedialyte for her child. It is difficult to explain that to a person who has spent their whole adult life demonizing artificial colors, artificial flavors, and of course sugar.
- 9y ago
- jcadam 9y agoSo 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?
- 893helios 9y agoPossibly, you're not dead so it worked. The better solution would have been ORS, and water. In the military and other physically demanding activities with a culture of water drinking, a concern can be hyponatremia.
- mathgeek 9y agoI recall being taught (public school system) roughly 20 years ago that "we used to think salt was good for countering dehydration if you were stranded in the desert, but now we know that plain water is better." This isn't necessarily false (water is likely better than pure salt), but I wonder if we threw the baby out with the bathwater at the time as far as salt was concerned.
- taneq 9y ago> I'm guessing the solution that was forced on me [...] was probably not the best idea? Indeed, it wasn't a solution!
- deleted 9y ago
- KaiserPro 9y agoIV 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 9y agoEMT 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 9y agoAye, 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.
- bluedino 9y agoIn Las Vegas there's a hangover bus that travels around that hooks you up to an IV and gives you medicine to recover in an hour
- masklinn 9y agoIn some asian communities clinics provide "ringer" glucose IV. It definitely boosts you up, but you can also end up with life-threatening infections: https://www.nytimes.com/2015/03/21/nyregion/despite-warnings-asian-immigrants-rely-on-glucose-injections-as-a-cure-for-ailments.html https://www.nytimes.com/2015/03/21/nyregion/despite-warnings...
- Tharkun 9y agoI 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 9y agoIn 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 9y agoActually 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.
- breatheoften 9y agoThis 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 9y agoThe article isn't about IV being ineffective, rehydration IV are absolutely effective. The article is about them being unnecessary 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 9y agoPerfect 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 9y agoORT 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 9y agoOne 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 9y agoWith Vitamin Water and Raw Water, can a startup to market "Hangover Cure Water" or "Headache Water" be far behind?
- jws 9y agoA 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 9y agoPart 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.
- amluto 9y agoYou 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.
- J_Sherz 9y agoCoconut water is marketed for hydration because it does have a relatively high electrolyte content, but it's mostly potassium with minimal sodium, so not as effective as an oral rehydration powder which has those specific ratios of electrolytes / sugar that maximize the speed of uptake/hydration.
- dwyerm 9y agoI 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 9y ago> 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.
- amluto 9y agoThe trick is to search for "WHO" oral rehydration salts.
- inetsee 9y agoA 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 9y agoThis 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 9y agoTo 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.
- na85 9y agoExcellent anecdata.
- Slansitartop 9y agoHospitals 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 9y agoThe charges are inflated because of insurance. The actual paid amount is less.
- Slansitartop 9y agoThe actual paid amount was $200, which is still excessive, especially for something I didn't really need.
- LeifCarrotson 9y agoWell, 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 9y agoI'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.
- moftz 9y ago
- nscalf 9y agoI 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.
- adrianN 9y agoWhat would be a plausible mechanism for a faster brain rehydration using an IV? To me it seems that once the fluid is in the blood stream, it doesn't matter anymore which way it entered. It certainly doesn't take days for ingested fluids to reach the blood.
- rsync 9y ago"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." I have always been skeptical of this notion that rehydration takes hours or days or whatever. First of all, practical experience shows that mucus, urine, sweating[1], etc. very quickly revert to full hydration. You can go from dark yellow urine to clear urine in less than two hours. Second, what mechanism could there possibly be to restrict water absorption in your body while dehydrated ?[2] I don't think you could slow down rehydration if you tried to[3]. Your body doesn't have to digest it and it can transport nearly immediately outward to every tissue (as evidenced by nasal mucus production which reverts as quickly as your urine color does). I think it's just bro-science and it's surprising that it is so persistent (I have heard it in the gym, at basic training, in the fire service, etc.) because immediate, practical evidence contradicts it. [1] I am not talking about heatstroke, etc., which are separate issues. [2] The only thing I can possibly think of is stuffing yourself with very absorptive food prior to rehydrating ... which would be odd. [3] Assuming normal water with normal mineral content. Obviously, distilled water will cause problems.
- cat199 9y ago>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'
- gasgasgas 9y agoThe 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.
- kragen 9y agoThe 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_proteins 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 https://news.ycombinator.com/item?id=16440265)
- member221 9y agoI was diagnosed with hepatitis B six years ago when I became pregnant with my first child. My husband got tested for the virus as well but the results turned out negative. I had no idea how or where I contracted that virus. I had no signs or symptoms before the test. Last year I was getting some burning sensations in both feet and insomnia. I have not had any medications. December 2017 our family doctor started me on Green House Herbal Clinic Hepatitis B Virus Herbal mixture, 5 weeks into treatment I improved dramatically. At the end of the full treatment course, the disease is totally under control. No case of insomnia, burning feet, or weakness. Visit Green House Herbal Clinic official website www. greenhouseherbalclinic .com. I am strong again and able to go about daily activities. This Herbal Formula is Incredible!! My life is back.