From: Dave Edelman (dedelman@iname.com)
Date: Thu Aug 08 2002 - 18:50:28 CDT
I'm afraid that I'm unable to play the audio that you referenced but I
remember the gist of the message. It was the right answer to the wrong
question.
The concept that a healthy person needs to drink some specific amount in
order to "Flush the system" needs to be taken with a grain of salt (and the
remaining electrolytes would be a good idea as well :-).)
As others have said, the conditions on the trail at Philmont are different
from those routinely encountered by most of us (I believe it was John who
talked about sitting in front of a CRT) If it were just a simple matter of
replacing the water that is lost either sensibly or insensibly it would be a
relatively simple task of drink until you are clear and copious.
Unfortunately, as we sweat, we also need to replace electrolytes. Since this
is more complicated to monitor than clear and copious we really just do our
best and rely on the fact that sodium is pretty abundant in PhilFood and
that a healthy individual will excrete what isn't needed. Since sodium is
the predominant extra cellular ion and is lost in proportionally high
quantities we usually come through the experience okay.
Having said the obvious, I seem to remember that someone reported severe
muscle cramps and associated them with sodium loss. I would strongly commend
that person for realizing that there might be an electrolyte imbalance but
my professional guess would be that the problem was a lack of ionized
calcium, not sodium.
As to the problem of iatrogenic hyponatrimia, I've seen it exactly once in
more than fifteen years of intensive care practice. I would suspect that the
Marines in the report would have been just fine if they had eaten even a
minimal amount of food as they were tanking up on the water. By the way, my
patient was an infant that had been pumped full of fluid by a gastric
feeding pump that had been misadjusted. Not even the smallest infant would
intentionally drink that much fluid.
By the way, for those of you who are trivially inclined, cellular
respiration does produce water as a byproduct. The amount is a function of
how much oxygen you burn and how much CO2 you produce with in turn is
directly correlated to what you eat (carbohydrate, protein, and fat.)
If I keep this up, I might get my money's worth for all that grad and
post-grad work :-)
Dave Edelman
-----Original Message-----
From: owner-philmont@troop47.com [mailto:owner-philmont@troop47.com]On
Behalf Of Gary Boyd
Sent: Thursday, August 08, 2002 6:48 PM
To: Multiple recipients of list philmont
Subject: [Philmont]: Water (again)
On the subject (I know, I know - once again) about how much water is enough.
>From NPR's Morning Edition program from today, 8 August 2002.
"A new study says the conventional wisdom that people should drink eight
cups of water a day to stay healthy is not necessarily true. NPR's Renee
Montagne talks with Dr. Heinz Valtin of Dartmouth. "
You can listen to the report here:
http://www.npr.org/ramfiles/me/20020808.me.07.ram
Gary Boyd
Troop 151 CC
Georgetown, Texas
www.troop151.org <http://www.troop151.org>
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