Drinking too much water can also cause complications

Health Care, Heart Care Foundation of India, Medicine Comments Off

Understand your body’s requirement of water and be aware of how to maintain a balance

New Delhi, 24th May 2018: A recent research has indicated that over hydration or excess fluid accumulation can lead to dangerously low sodium levels in the blood or result in brain swelling, especially in the elderly and other susceptible individuals

Over hydration activates Trpv4 – a calcium channel that can be found in glial cells that act to surround hydration sensing neurons. It is a cellular gatekeeper implicated in maintaining the balance of water in the body.

Hyponatremia occurs when the concentration of sodium in the blood is abnormally low. Sodium is an electrolyte, and it helps regulate the amount of water in and around cells. When one drinks too much water, it simultaneously leads to a rise in the body’s water levels, and the cells begin to swell. This swelling can cause many health problems, from mild to life-threatening.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “Over-hydration can lead to what is known as water intoxication. In this condition, the amount of salt and other electrolytes in the body become too diluted. A person who drinks normal amount of water has a straw-colored to transparent yellow urine. Although most people believe that clear urine is the healthiest sign of hydration, having urine with no pigmentation at all may be an indication that one is drinking too much water. The normal levels are eight to ten glasses a day. This varies depending on an individual’s height, weight, and exercise patterns. Drinking a lot of water or not having an effective mechanism to remove it from the body can cause water levels to build up. This in turn dilutes important substances in the blood. Endurance athletes, such as those who run marathons and triathlons, sometimes drink too much water before and during an event.”

Some common symptoms of over-hydration include nausea and vomiting, headache, changes in mental state such as confusion or disorientation. Overtime and if not treated, this can lead to muscle weakness, spasms, or cramps, seizures, unconsciousness, and coma.
Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “Some other conditions that can cause hyponatremia include certain medications; problems with the heart, kidney, or liver; chronic diarrhea; and hormonal changes. It is important to trace the cause and take adequate precautions to prevent over-hydration, failing which the condition can become critical.”

Some tips from HCFI
• Treat associated conditions that can contribute to hyponatremia.
• Educate yourself and be aware of the signs and symptoms.
• Take precautions during high-intensity activities. Athletes should drink only as much fluid as they lose due to sweating during a race. Thirst is generally a good guide to how much water or other fluids you need.
• Ask your doctor about replacing water with sports beverages that contain electrolytes when participating in endurance events such as marathons, triathlons and other demanding activities.
• While drinking water is vital for health, don’t overdo it. Thirst and the color of your urine are usually the best indications of how much water you need.
• Normal way to know is to have 30 ml /kg body water liquid intake with 500 ml extra in summers.

Investigate your patients for iron deficiency

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Many patients present to us with complaints of exertional dyspnea or tachycardia. Such patients may undergo extensive cardiovascular assessment, indicating an underlying sinister pathology for their symptoms. While this evaluation is justified, sometimes the underlying cause may not be so dangerous.

Iron deficiency, even before a full-fledged anemia develops may be the cause of such symptoms, which have been shown to improve on iron supplementation.

Iron deficiency (depleted iron stores in the body) and anemia are often perceived as interchangeable terms. While iron deficiency is the most common cause of anemia, but the two are different.

Deficiency of iron without anemia is much more prevalent than is detected. A person may have iron deficiency even if the hemoglobin is normal. The majority are unaware of their iron deficient state

Iron has a crucial role in oxidative metabolism within the mitochondria and production of hemoglobin and myoglobin (BMJ Open. 2018 Apr 5;8(4):e019240). Anemia due to iron deficiency impairs oxygen-carrying and tissue oxidative capacity, resulting in a diminished peak oxygen consumption (pVo2) and ability to endure submaximal exertion. Even in the absence of anemia, iron deficiency can attenuate exercise performance (J Am Coll Cardiol. 2008;51(2):103-12).

The FERRIC-HF trial, published in the Journal of the American College of Cardiology in 2008, which examined the effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency showed that IV iron supplementation improved exercise capacity and symptoms in patients with CHF and evidence of abnormal iron metabolism. Benefits were more evident in anemic patients.

If the patient has exertional breathlessness or symptoms such as fatigue, palpitations, headache or has a history of frequent absenteeism, also look for iron deficiency as a cause. Iron study, which measures serum iron, ferritin, transferrin, transferrin saturation, total iron-binding capacity should be done. Low serum ferritin is indicative of iron deficiency. Ferritin levels can be elevated by inflammatory processes and can mask iron deficiency (BMJ. 2017;357:j3175).

Iron supplementation, if iron deficiency found, improves functional capacity in these iron-deficient individuals even before anemia is corrected.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA