Monday, January 4, 2010

Dehydration and Parkinson's Disease

It's so easy to confuse PD symptom side effects with dehydration 

You don't have to be in a desert, the middle of the ocean, an athlete in training or even a gardner pottering around under a hot summer sun to suffer from dehydration.  Dehydration is always a risk of disease and aging.  For a Parkinson's disease patient it is very easy to misread symptoms of dehydration.  Dehydration is an urgent condition.

We've talked about the effects of weight loss on PwPs and some of the causes and effects in previous posts.  There is no question that some medications and improper diet can also cause constipation.  In all of these posts we have touched upon dehydration. Now it is time to get serious about the effects of dehydration, the symptoms, why they are easily overlooked in PD and why dehydration must be treated immediately. 

Water is 75% of our body weight. Wrestlers, dieters and models know this fact when they need to drop a few pounds quickly to make weight class.  In the body it really is "water water everywhere".  Water in the cells, the blood and in the spaces between the cells.  And that is what Mother Nature intended. 

It is easy to forget that a significant amount of water is lost every day when we breathe it out with every exhale, when we sweat and lose more water, when we urinate or move our bowels even more water is gone.  This lost water has to be replaced to avoid kidney damage or failure, cardiac problems, coma caused by reduced blood flow to the brain, and death as a worst case scenario.  Along the way there can be some very unpleasant problems.

Body chemistry is in constant flux and requires balancing to maintain homeostasis.  Parkinson's Disease is all about the loss of balance in so many areas.  Prompt treatment is the best possible way to approach restoration of balance. Dehydration is no exception.  It is crucial to avoid the effects of the loss of fluid balance as dehydration can acerbate existing Parkinson's symptoms and take you to a very bad place.

When concerned about urinary frequency, many people with Parkinson's simply stop drinking enough. There are Depends for that - not drinking is NOT an acceptable option.

Swallowing problems create another reason for fluid avoidance because of the fear of choking. 

Medication side effects can also contribute to to loss of interest in eating and drinking.  Another medication side effect is nausea (leading to vomiting) and diarrhea which deplete even more body fluids.
The problem is that when a PD patient stops drinking for whatever reason, additional damage is done to the kidneys and bladder, to the circulatory system as heart rhythm is affected, to the GI tract as constipation is made worse and the cycle feeds upon itself and to the brain.

Many patients can't tell you or won't tell you that they aren't drinking enough.  Some PwPs are so prone to depression or apathy that they just can't. Being dehydrated also feeds upon itself, as it progresses, you feel less inclined to drink anything.  So when symptoms are noticed, that's the alarm indicating it is time to look for more clues so that you can take action.

Some of the warning signs of dehydration are:
  • Dry Mouth, Lips and Nasal Passages (can also be a side effect of the meds)
  • Lack of Tears (and there are other reasons in PD)
  • Muscle Cramps (always suspect fluid loss, potassium imbalance)
  • Nausea leading to Vomiting
  • Lightheadness - Syncope - Dizziness (can occur for several reasons)
  • Blood pressure changes (both high and low can occur)
  • Heart palpitations
  • Feeling too warm (may also indicate fever)
  • Lack of sweating
  • Confusion (is not just meds, disease progression, or lack of sleep)
  • Weakness (another sign of low potassium levels)
  • Tiredness
  • Lack of skin elasticity (a common and rapid symptom in the elderly)
  • Changes in behavior and mood - irritability
  • Darker colored or strong smelling urine (concentrated urine)
  • Headaches
  • even Allergy symptoms.
Although dehydration can cause dizziness which we often see as lower blood pressure, blood pressure may of necessity rise as fluid levels drop. Hyoptension or hypertension can occur and can create additional problems

Electrolyte homeostasis is effected.  These electricity conducting salts are found throughout the body in fluids, blood and skin and muscles.  Sodium, potassium and calcium are the salts most commonly out of balance in dehydration but chloride, magnesium and carbonate can also be affected.  We know how important electrical conductivity is for PD and how delicate that balance can be.  Electrolyte balances can be checked through blood tests ordered by your physician.

At the doctor's appointment when dehydration is suspected, blood pressure will also be checked, temperature taken, urinalysis performed  If the problem is too extreme or if swallowing is a serious issue, it may be necessary for IV fluid administration.

Don't wait for that appointment to make sure that the fluid levels are gradually increased.  Water is most important, ice chips, fruit juice, sports drinks designed to restore electrolyte balance, soups or broth, popsicles are fun and easy; jello has a high water content.  Since tea and coffee act as diuretics, they should not be included. You can also go online to find herbal remedies which might help to increase thirst as well.

When there are swallowing problems which prevent drinking, do not postpone the home vocal exercises, but also consider getting speech therapy.  In addition to exercise, address the eating and drinking issues associated with PD and consider the need to purchase drinking utensils which will facilitate holding a cup that doesn't spill.

Dehydration can sneak past a caregiver just as easily as it can the patient. If you notice changes, are aware of water left in the glass or consistent lack of thirst, it is time to rehydrate. Don't wait - Drink up.

An observation
In the dehydration process, there seems to be a connection between not drinking enough and not feeling thirsty. 
As a caregiver you may find resistance in your patient because they do not perceive what you actually can see, that they simply don't have a sufficient fluid intake. 
As a patient, the less you drink, the less thirsty you feel and you need to help your body...your self...by supplying it with the necessary fluids so that you do not become sicker. 
It does not take long for confusion and disorientation to appear, not to mention many of the symptoms listed above.

On a personal note:
Our beloved Harry, the Lab mix, became quite sick a couple of months ago.  I knew he was sick but the diarrhea (which I addressed immediately) didn't immediately signal me to check his skin resiliency and then the alarm went off.  He who normally drinks like a horse, had stopped. I realized it when I didn't have to add a quart of water to the cat fountain a couple of times a day. 
A pinch of his skin prompted me to whip out some chicken rice soup which he loves. I kept diluting it but he didn't care, it was wonderfully flavored "people food" and he drank and drank...not all at once but gradually.  He went through a half gallon over two days before he began drinking from his water dish and the fountain.

On an informative note: Apparently the chicken soup had a good electrolyte balance for Harry. Had he been a human child, he would have been on Pedialyte or an electrolyte drink such as Gatorade. Or I would have made a drink for him using the following formulation:
  • 1/2 teaspoon salt
  • 6 level teaspoons sugar
  • 1 quart (1 liter) drinking water
Change the formula above and you can actually do more damage than good. For an adult daily fluid intake you should multiply that by 2 or 3. I suggest dedicating one ice cube tray (if you have any) and using at least 1 quart or more to make ice cubes. We have found that Steve prefers very cold drinks when we feel his fluid intake is dropping.

Addendum:  Steve suffered another bout of stress induced dehydration in late July of 2011. We caught it early but he relapsed and we are still working through those issues which have had a swift and profound effect on his cognition much like his first bout.

9 comments:

  1. My husband has parkinsonism with lewy body disease. He is at the stage now where it is almost impossible for him to have a bowel movement without extreme aides. Is there a solution? Is it drinking more water even with incontinence.

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    Replies
    1. I have PD. I used to have very poor bowel movement. I found out that taking 500mg of magnesium early in the morning and 500mg before bed time solved the problem. Too much magnesium is indicated by diarrhea. Go to 400mg or lower until diarrhea stops. Make sure to drink plenty water. Check with your doctor first before you try any supplements or medications.

      Delete
  2. More water will not hurt and certainly might help but it is not the only solution.

    There are no great solutions to the constipation problem in PD or with parkinsonism and LBD in part because of the condition and in part because it is often a medication side effect. For many people constipation is a temporary inconvenience but it is an ongoing problem for PwPs and those with related conditions.

    Maintaining a healthy fluid level is important but it is not the only solution to constipation. We are great believers in fiber here and have found that by adding fiber from various sources, we think we have a fairly workable solution. You can read about the food sources in the referenced article below.

    (And a little chocolate doesn't hurt either - if he doesn't like it, treat yourself.)

    I suggest beginning your search for help with the article we posted on 9/15/2009. "Having Constipation and Parkinson's Is Not Like Talking About the Weather"
    Here is a link for cutting and pasting into your browser:
    http://parkinsonsfocustoday.blogspot.com/2009/09/having-parkinsons-and-constipation-is.html

    You can also find a link to the post in the right column if you scroll down to "Symptoms of PD". Constipation is also linked in the right column under LABELS. There are 8 posts which reference constipation.

    You should discuss the issue with his primary care doctor. It is important to find a stool softener which will work - whether fiber or something from a medicine bottle or both. Be insistent. This is a serious matter. And don't be afraid to enlist your pharmacist as well. Often the pharmacist is more aware of drug interactions than the doctor.

    About the urinary issues: if adult incontinence pants aren't doing a complete job, you can also add a pad inside for better absorbency. But because of the incontinence issue, it may be time for (another?) prostate exam. In many men, prostate enlargement symptoms aren't just the disease condition but a natural function of ageing.

    Since you mention the incontinence, if you aren't using the flannel incontinence pads for the bed and even the chairs he uses, that is another online shipping trip if you can't get to a medical supply store. You can also find the sheeting in infant's departments. We used them when the children were babies and it saved a lot of rush laundry.

    Caregivers need all of the aids possible because it is best when caregiving is not a chore but an act of love.

    Best Wishes to you both

    ReplyDelete
  3. My mom has Parkinson. For constipation, I tried many ways (both natural way and medication). Eventually, the only medication that works well is 'Polyethylene Glycol'. If you are interested, you can visit my blog: http://i-care-parkinson.blogspot.com

    ReplyDelete
  4. Our thanks to I.Care for her helpful link. We are relieved to say we are not at this point in neither patient nor cargiver needs and requirements. Since many people are, however, just cut and past her URL into your browser.

    'Polyethylene Glycol'is known by MiraLAX, Smooth Lax, Lax Clear and several other names on the market.
    Please consult your doctor first if you are on prescription medications although no specific drug interactions are noted.
    Be aware of the side effects: nausea, bloating, cramping, flatulence. Higher doses may actually produce diarrhea or excessive stool frequency.

    Always remember to keep your fluid (water) intake substantial if constipated.

    ReplyDelete
  5. I have found that parkinsons related constipation has much to do with muscle movement of the involuntary muscles that are involved in the natural process as well as diet and hydration.When I feel the involutary movement and do not act on it right then, for whatever reason, it may be hours or even days before it occurs again.

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  6. You are so right. We have to pay close attention to our bodies. Muscle movement is a huge PD issue which is why it needs the assistance from diet and hydration.
    Listen to what your body tells you.

    ReplyDelete
  7. Aha! Thank you! My mother-in-law has PD and diabetes and avoids drinking because she's afraid she won't make it to the bathroom. I broached the subject of adult undergarments and was surprised when she seemed somewhat receptive to the idea.

    She drinks about 3 ounces of water 6x/day to take her pills, and about 3 ounces 3x/day of generic Mt Dew with her meals (the caffeine concerns me but she won't budge). I know 27oz/day is not nearly enough fluid for an adult, and the information you've provided will hopefully help me convince her to start drinking a LOT more (as her doctor has advised).

    She has been increasingly weak, and wakes every night because of severe leg-cramp pain. In short, she shows a startling number of the symptoms you've listed.

    I'll be spending lots of time reading your other messages, this site is a wonderful information resource. Thanks again.

    ReplyDelete
  8. Symptoms and signs of dehydration can be minor, such as increased thirst, or severe and life-threatening, depending on the extent of the dehydration. Along with thirst, initial symptoms of dehydration include reduced urine output and darkening of the urine as it becomes more concentrated. If the condition progresses, other symptoms develop, including dry mouth, decreased perspiration, lightheadedness, muscle cramps, weakness, palpitations, and absent tear production by the eyes. The skin may feel cool and clammy. Confusion, organ failure, and coma leading to death eventually occur if dehydration is not corrected.

    ReplyDelete

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