The "dogs days of summer" with temperatures approaching 90 and above plus high humidity levels remind us of the importance of hydration. While you are focusing on quenching your thirst, don't forget about your wound care clients.

Who is At Risk of Dehydration?

Clients who are traveling to the wound care clinic or homebound individuals without air-conditioning are certainly at high risk for dehydration. Individuals experiencing nausea, vomiting or diarrhea or with draining wounds are losing fluids, electrolytes and nutrients which must be replaced. You may have a client that is suffering from a combination of these problems. As clinicians, we are familiar with the signs and symptoms of dehydration such as changes in weight status, skin turgor, urine output and elevated serum sodium but that may not be your immediate focus each time you see a wound care client. Dizziness, changes in mental status or a decrease in blood pressure could be a signal of dehydration especially on these hot, humid days.

Fluid is critical for all of our body functions and serves as a solvent for vitamins, minerals, glucose, and other nutrients. Fluid transports nutrients and waste products throughout the body. Older adults are at increased risk for dehydration for a number of reasons. Our total body weight declines to approximately 55% down from 75% of an infant's body weight. The thirst sensation diminishes with age along with the body's ability to concentrate urine. Many medications such as routine diuretics, antihistamines, and laxatives can also result in fluid loss. We can live a long time without food but fluid is critical to our well-being.

Assessing Fluid Intake Requirements

How can we address the problem of offering adequate hydration for our clients? There are some predictive equations to determine fluid needs for adults, such as 1mL per calorie consumed or 25mL/kg body weight for those over 65, but further research is needed to validate them. The general suggestion is eight glasses of fluid daily. Fluid needs can also be met with food in particular fruits and vegetables with a high water content such as watermelon, strawberries, lettuce, celery, spinach, cabbage and cantaloupe. All food has some measure of fluid even meat.

Hydration Tips:

• Keep water in an insulated container at the bedside or in the car
• Flavor water with orange or lemon slices or flavoring packets
• Offer water or a cool beverage before and after providing wound care
• Provide hydration between meals and expand the choices, colas, iced tea (try flavored tea), iced coffee, or lemonade
• Offer fruit smoothies, fruit bars, popsicles, ice cream, sherbet, melon and gelatin cubes
• Try cold soups such as gazpacho
• Include milkshakes and ice cream floats especially for those clients who need additional calories and protein

Concentrating on the hydration needs of your client impacts the wound healing process. Remember if you are hot and thirsty so, is your wound care client. Hydrate, hydrate, hydrate.

About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Advisory Panel and the American Dietetic Association's Unintentional Weight Loss work group.