blunt injuries

Ouch! That hurt Your Health DR GITA MATHAI Injuries occur unexpectedly all the time. You may walk into a door, slip and fall or be thrown against the dashboard as a vehicle brakes suddenly. Any blunt trauma (as differentiated from a sharp injury that may cause bleeding) to the muscles and bones immediately causes an inflammatory reaction. The area becomes red, swollen and painful. The appearance may mimic an acute infection but differentiated from it by the history of trauma and the absence of fever. The injury may be a contusion, the result of trauma to the belly of the muscle, tendon or bony prominence. Blood coagulates in the affected area forming a discoloured bruise. Untreated, this can eventually form scar tissue. Sprains and strains occur in areas where a ligament is attached to the bone, such as the back, knee, ankle or elbow. The injury is mild when there is only over stretching and a few microtears. If there is a partial tear, the joint may become loose and unstable. Emergency first aid must be given for traumatic inflammation even before obtaining a medical opinion. Ignored and delayed, (while awaiting a medical consultation), it can lead to stiffness, pain and loss of normal function. As soon as possible the RICE principle should be followed. R is for rest. The part should immediately be placed at rest. This means minimal weight bearing till the pain subsides. Usually 2-3 days are sufficient. I is for ice. Ice should be placed in a plastic bag and applied to the affected area. It should be left on for 20 minutes at a time every hour for the first hour and then continued three times a day for 3-4 days until total relief is obtained. Faster and greater pain relief may be obtained if the ice is actively massaged on the swollen area. Ice reduces the swelling, numbs the pain, decreases muscle spasm and helps accumulated blood to renter circulation. C is for compression. Swollen areas can be compressed with an elastocrepe bandage. This should initially be applied by trained personnel. Faulty and tight application can cut off blood supply to the affected limb. Once the technique is learnt, bandaging can be done at home. E stands for elevation, a neglected step. Swelling reduces rapidly if the injured part is placed above the level of the heart. Blunt injury causes pain. This can be relieved by medication like paracetmenol, brufen and diclofenac and other Nsaids (non-steroidal anti inflammatory agents). These are commonly available over the counter (OTC) either as single agents or combination tablets. They relieve pain but cause side effects. There may be nausea, vomiting or symptoms of heartburn. A pre-existing ulcer may be aggravated. Long term use and overdosage are dangerous. Some like diclofenac has been associated with kidney damage. If there is no improvement after 2-3 days, see a doctor. If there is no serious injury, after the swelling has subsided reconditioning of the injured area has to be done. This will help to regain flexibility, endurance and power. Joints and muscles can be strengthened with targeted exercise. Flexibility is equally important. A weak or relatively immobile joint is prone to re-injuries with much less trauma. The joint may also become unstable and weak. Physiotherapy is important to tackle all this. Even without an injury, there may be a sudden cramp in the muscle. This occurs when muscles are overused in hot and humid conditions. It can also occur due to calcium deficiency. The muscles contract and the limb gets painfully fixed. The muscle needs to be stretched to relieve the pain. This can be done in the calf by keeping the leg straight and pushing the foot (not the leg) towards the head. In the thigh the knee should be bent with the foot touching the buttocks. Water, lightly salted limejuice, buttermilk or tender coconut water should be given. A fall or accident may also lead to broken bones. If the bones are already weak as a result of osteoporosis or repeated stress, even a slight injury is enough to result in a fracture. There is severe pain, inability to bear weight on the bone and a localised tender area. Fractures are diagnosed using X-rays and should be treated by an orthopaedic surgeon. Either POP (plaster of Paris) casts are applied or surgery needs to be done. Bones do not heal with medication alone. Neither is it advisable to go to unqualified “bone healers” as they immobilise the bone using cloth and a poultice. Since the treatment is not based on X-rays, it may not be wise to pursue this line of treatment. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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pica and eating mud

When you crave mud
DR GITA MATHAI

Hyhyhyhy
“My child does not eat” moaned the mother, “she refuses food.”

“Have you tried to figure out what she likes to eat?”

“I don’t think I can give her what she likes. I don’t think a diet of uncooked rice, mud and newspapers is healthy.”

Her logic cannot be faulted. Her daughter is a classical case of “pica,” the correct medical term for a perverted appetite, in which the person consumes non food items such as dirt, clay, raw rice, slate and chalk, paint, plaster, coffee grounds, cigarette ashes, cigarette butts, burnt match heads, rust, glue, hair, buttons, paper, sand, toothpaste, soap, sea shells, and even broken crockery. Pica is diagnosed if such items are eaten for a month or longer, after the age of two, by a mentally normal person unable to rationally control his or her behaviour.

Pica is not confined to India. It is an international phenomenon affecting 10-30 per cent of people of all ages and both sexes. It tends to be more common in the underprivileged, uneducated, mentally challenged and psychologically handicapped. It is aggravated by a lack of supervision.

In some areas, pica is culturally accepted. Consumption of clay and chalk is believed to protect against diseases such as jaundice, diarrhoea and morning sickness. Sometimes, it is believed to confer mystical powers, if eaten at the right time, like during a full moon. Another misconception is that it runs in families, with all members eating chalk or lime.

Many of these items are indigestible. Over a period of time they can get trapped inside the body, usually in the stomach or intestine, forming a hard lump called a bezoar. This has to eventually be surgically removed. Dirt and clay can lead to infection and parasitic infestation. Paint and newspapers can cause slow lead poisoning. Toothpaste damages intestinal villi. Even crunching ice and eating refrigerator frost damages teeth enamel. Lack of a nutritious diet can end in anaemia and malnutrition. Fatigue, palpitations, pallor, thinned out spooned concave nails, flattened tongue papillae, superficial erosions in the mucosa of the mouth and fissuring at the angles of the lips are the other effects.

Pica is different from bullemia nervosa, in which there are periodic intervals of binge eating. Unusually large amounts of a particular food item are consumed, with the feeling that the eating is out of control. The difference is that in bullemia edible items are consumed whereas in pica non-edible ones are eaten.

Children lack subtlety and openly exhibit their strange food preferences. They put everything into the mouth to feel its texture. This oral fixation is usually outgrown by the age of two but it can persists and metamorphise into adult pica.

Pregnancy has long been associated with accepted but peculiar food cravings, which unfortunately, is also accepted as the norm. Such cravings may be hidden from doctors, ignored by patients and condoned by family members.

Nutritional deficiency of iron, zinc or calcium may trigger appetite- regulating brain enzymes and specific cravings. The non-food items consumed in an effort to assuage this do not supply the deficient minerals, and the person is caught in a vicious cycle. The more they eat, the more they crave.

Geophagia (eating clay and mud) may become a habit, like having a cigarette in the morning. It may be an acquired behavioural response to unexpressed stress. It may be learned in childhood by watching other family members. It can in itself cause iron deficiency, aggravating the problem.

Emotional disturbances causing pica are more difficult to tackle, especially if the person is autistic, mentally challenged or has a psychiatric illness. Corporal punishment and ridicule only aggravates the problem, and is eventually self defeating.

Even though the cause is unproven, and varied, treatment is successful. Pica responds dramatically to iron, zinc, multivitamin and calcium supplements supported by regular deworming.

While administering these supplements, certain principles have to be kept in mind so that they are optimally absorbed. Zinc and iron compete for the same absorption sites in the intestine. They cannot be administered together as they “lock” the absorption site, and both are eventually not absorbed but eliminated. They need to be given separately on different days or at least 12 hours apart. Calcium precipitates with iron and zinc and prevents its absorption. It should be given separately. Manufacturers forget these principles and recommend the administration of a “hotchpotch” to patients, usually an elixir, tonic or capsule containing iron, zinc, calcium, vitamins and trace elements all mixed together. It offers little benefit.

After a satisfactory response to pica, no further treatment is required. However a close watch, for recurrence of the symptoms, may have to be kept on the individual for a couple of months by an involved and motivated caregiver.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

gout

Out with gout

Your Health
DR GITA MATHAI

“Them that can eat have no meat and them that have meat cannot eat!” said Henry VIII who suffered from gout. Gout was then considered a disease of aristocrats, as they were the only people who could afford red meat and alcohol. Excessive consumption of the two was for centuries considered to be precipitating factors for the disease. Today, we know that it is due to high uric acid levels in the blood (more than 7 mg /dl). The incidence of gout is increasing, with the highest rates of change being in India, China and Thailand. Gout now affects 0.3 per cent of the Indian population.

Uric acid is a product of purine metabolism found in all living cells with high concentrations in protein rich foods such as red meat, fish, yeast, broccoli, cabbage, cauliflower and some beans. Beer too has a high purine content while other liquors elevate uric acid levels in the blood as they are metabolised.

The levels of uric acid can increase despite a normal diet if there is increased cell destruction in the body as in leukaemia and sickle cell disease. The levels may also go up as a side effect of certain medications.

Typical gout starts abruptly — in the middle of the night when the temperature dips. Sharp shooting pains appear in the big toe, ankle or knee. The joint becomes red and swollen. There may be fever. This may initially lead to a mistaken diagnosis of inflammatory arthritis.

With or without treatment, the pain may subside 48-72 hours later, and then disappear forever in a lucky few. In others, it re-appears after months or years. Eventually, if left untreated, it may progress to chronic gout, with swollen and deformed joints. Crystallised uric acid may be deposited under the skin as visible “gouty tophi” on the ear, fingers and toes. These appear as movable lumps which eventually grow larger, become painful and interfere with joint movement. The kidney tries to excrete the excess uric acid, which may precipitate there to form stones. It can eventually lead to kidney failure.

Uric acid levels may increase if the body has a problem with eliminating normal quantities of uric acid. This occurs in the obese, the diabetic and those with abnormal lipid levels. Genetically predisposed males develop gout in the forties. Women are protected till menopause, after which their uric acid levels can go up.

Not everyone with high uric acid levels exhibits symptoms. Some people remain asymptomatic all through life.

The diagnosis of gout is confirmed by blood tests to estimate blood uric acid levels, aspiration of fluid from the joints to demonstrate crystals, X-rays or a synovial biopsy.

During an acute attack of gout, the pain can be relieved with medication. Some non steroidal anti-inflammatory agents work better in some people than others. Indomethecin and Nalidixic are particularly effective. Injections of steroids into the affected joints may also be needed. Later, once the acute attack has subsided, drugs like allopurinol may have to be taken regularly to lower blood uric acid levels.

Although medication is the mainstay of gout treatment, for faster pain relief soak the affected joint in hot water with rock salt in it. Then apply ice.

Lifestyle modifications can help to reduce the severity and frequency of attacks.

• Maintain ideal body weight. Although a BMI (body mass index) of 23 is ideal, gout is precipitated when BMI goes above 35.

• Reduce alcohol intake. Beer and binge drinking increase the likelihood of attacks.

• Increase your consumption of carbohydrates. Reduce red meat. If you are vegetarian, remember that some vegetables too contain a lot of purine.

• Coffee reduces blood uric acid levels.

• Vitamin C reduces uric acid. Eating more than 500mg a day as tablets can cause side effects. It is better to get your requirements by squeezing half a lime into every glass of water.

• Eat 2-3 bananas a day.

• Drink 4 litres of water a day. This will help wash out the uric acid and prevent it forming stones in the kidney.

• Exercise for an hour a day. It will correct obesity, metabolic derangements in sugar and lipid levels and help to maintain ideal body weight.

The chance of developing diseases is radically reduced by maintaining ideal body weight and exercising daily. Just putting one foot in front of the other and walking on the road for 40 minutes a day will increase your longevity and keep you healthy.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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sleep

Good night, sleep tight YOUR HEALTH Dr. Gita Mathai “I just can’t sleep.” At a conservative estimate, 10 per cent of the population voices this complaint to friends, relatives or busy practitioners. But the condition is seldom taken seriously, especially by those who sleep soundly, and sleeping tablets are prescribed as a temporary panacea. The sleep requirements of individuals vary, with infants and children sleeping 16 to 20 hours a day, adults (till 60) seven to eight hours and senior citizens approximately six hours. Some people get by on just four hours a day. The deepest and most refreshing kind of sleep diminishes with age, with the result that sleep in people over 60 becomes fragmented, with brief awakenings. A common misconception is that constant daytime drowsiness or early-morning awakening is a part of aging. Actually, older adults sleep less because of an inability to sleep, and not because their sleep requirement is reduced. Insomnia is present if there is difficulty in falling asleep, frequent or early awakening, daytime drowsiness, inability to function efficiently, absenteeism, inadequate performance, poor concentration and dysfunction in the workplace. Other symptoms are tension headaches, stomach upsets and constant worry about not getting enough sleep. It can be acute or chronic. Everyone has a normal sleep-wake rhythm, and this may become disturbed with “shift” work, frequent late nights, or travel to different time zones. Medical conditions like hyperthyroidism, the restless leg syndrome, bronchial asthma and hot flushes (menopause) can disturb sleep. An urinary tract infection or an enlarged prostrate can necessitate frequent trips to the toilet, particularly at night. Pain because of arthritis or a peptic ulcer can keep a person awake. Many prescription drugs, antidepressants, heart and blood pressure medications, allergy medications, stimulants (Ritalin) and corticosteroids cause insomnia. Some of these medications are prescribed. Others, (like cough suppressants containing pseudoephedrine) are over-the-counter (OTC) medications. Some herbal weight loss products contain thyroid extract, ephedrine or caffeine. They too can keep a person awake. Antihistamines may initially sedate, but they can increase your night-time loo visits. An alcoholic beverage before bedtime may appear to lead to good sleep, but it produces early awakening and reduces restful sleep. Caffeine, present in tea, coffee, chocolate and cola, is a stimulant that produces mild exhilaration and prevents sleep. Do not drink coffee or tea after lunch if you find sleeping difficult. Colas have a similar effect. Nicotine is a central nervous system stimulant found in cigarettes, beedis, chewing tobacco and snuff. Using these products within an hour of bedtime will compromise sleep. Psychological problems like grief, anxiety, depression and unresolved stress prevent sleep. The unsettled conflicts and images prey on the mind, preventing sleep. Exercise will contribute to good sleep but only if done 3-4 hours before bedtime. Exercise releases stimulatory chemicals from the leg muscles and it takes 3-4 hours for the chemicals to be removed from the body. Hunger can keep you awake. So having a light snack with warm milk (which contains the sleep inducer tryptophan) at bedtime is a good idea. A heavy meal on the other hand will make you feel bloated, uncomfortable and may cause acid regurgitation. All this contributes to insomnia. To tackle insomnia, try correcting all these factors. Exercise regularly for 40 minutes a day and combine it with yoga and meditation. Try to visualise your problems (financial, familial) as images instead of figures. Remove all distractions (computer, television) from the bedroom. If you cannot fall sleep in 30 minutes, get up and read a book. If nothing works, you can go to a sleep laboratory to rule out sleep apnea and do a test called a polysomnography (overnight sleep study). This is expensive and offered only at a few centres. Popping pills should be the last resort. Many sleeping tablets are addictive and habituating, requiring higher doses for the same effect. They can produce severe allergic reactions, or cause confusion, memory loss and bizarre behaviour. If the insomnia is due to depression, psychiatric help and antidepressants may cure it. If you’re having trouble falling asleep, wake frequently once you do fall asleep, or wake up earlier than you want to, try acupressure. Just maintain the pressure for a minute on the spirit gate, which is below the little finger at the wrist or the inner gate, which is two-and-a-half finger widths below the wrist at the centre. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

praying hands

Reading the hand Your Health DR GITA MATHAI Praying Hands (see pic) is a famous pen-and-ink drawing by Albrecht Dürer. A close look at the drawing makes several medical assumptions possible.  The person is middle-aged or older.  The hands have been used to manual labour.  The person is diabetic or will shortly become so. Diabetes produces changes in the structure of the hands so that when they are folded, as in prayer, a small gap is visible between the two little fingers. As people walk, they unconsciously move their arms. Watch to see the position of the thumb. If it is rotated inwards, the person has a body mass index (BMI) over 29 and is already obese or heading there. The creases and lines on our palms, formed when the foetus is 12 weeks old, are genetically determined. Normally, three lines are formed. If there are only two lines (single palmar crease), the child must be followed up for Down’s syndrome, or other genetic abnormalities. It is rare for normal people to have a single palmar crease but some do have it only on one palm, a trait shared by many in the family. Some people are prone to chronic infectious diseases such as tuberculosis. They too tend to have only two lines but their single abnormal line is situated just above the thumb. Hormone levels in the uterus influence finger length. A person (irrespective of sex) whose index finger is shorter than the ring finger will have had more testosterone (male hormone) in the womb and a person with an index finger longer than the ring finger will have had more estrogen (female hormone). The difference in the lengths can as little as two or three per cent but is important. Professional women and female scientists tend to have higher levels of testosterone relative to their oestrogen level, while the converse is true of men in the fine arts and social sciences. Marfan’s syndrome is a genetic disease in which the person has abnormally long fingers (arachnodactly), like that of a spider. Congenital hypothyroidism, certain renal diseases and some forms of dwarfism are associated with a tripartiate hand where the index, middle and ring fingers are of the same length. Palmar creases, tripartate hands and archnodactly can be picked up on ultrasound examination after the 12th week. All of five fingers are essential for the hand to function properly. The thumb is the most important as it helps us to grasp something securely. If there are extra fingers, they need to be surgically removed. They may be associated with internal organ abnormalities, particularly of the kidney. The tips of the fingers have loops and whorls, some closed and circular, others open ended. No two individuals have identical fingerprints. Strangely, people with mental illnesses have more open loops and fewer whorls. Smokers have yellowish brown nails. In chronic respiratory ailments or congenital heart disease, nails bulge with a convex parrot beak appearance and are blue in colour. The skin of the palm may be yellow. Jaundice causes this. It can also occur because of excessive consumption of yellow vegetables and fruits. Hard labour can make the fingers gnarled and knotted; housework, which involves dealing with harsh detergents, makes the skin rough. Office work makes the hands soft and smooth. Regular manicures keep the hands looking good. The occupation and financial status of a person can be determined by looking at the hands. Fingers may get fixed in the flex position with sudden painful release, the “trigger finger”. The tissues of the hand may get thickened, causing them to contract. These conditions need to be seen by an orthopaedic surgeon. Osteoarthritis sets in with age and is commoner in women. The fingers become painful and work becomes difficult. This is a localised condition and other body systems are not affected. Rheumatoid arthritis occurs in younger people. The joint deformities give the fingers a spindle shaped appearance. This disease can affect other organs as well. Treatment is long drawn and includes medication, physiotherapy and regular exercise. Most joint pains, whatever the cause, respond well to immersion in hot salted water and underwater exercises. Involuntary shaking movements called tremors can be first seen in the hands and may be associated with tingling. Sometimes these are familial and harmless. Tremors can also be the result of too much coffee, medication induced or the manifestation of a neurological disease like Parkinson’s. Tremors need to be evaluated by a physician. Hands reveal a great deal if observed carefully. No wonder palmistry is a successful profession! Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

saving lives in emergencies

Saving lives in emergencies YOUR HEALTH DR GITA MATHAI A few days ago while driving, my grandson suddenly shouted, “Stop, stop! Look at all the blood on the road.” I pulled up to the side, and saw a dazed, 75-year-old man fast losing consciousness. A motorbike had knocked him down and sped away. There was a gaping hole in the side of his leg and he was exsanguinating rapidly from a cut artery. We had no first aid equipment but we ripped off his shirt and applied sufficient pressure to reduce the bleeding till we got him to hospital. Most of the bystanders did nothing while a few clicked snaps on their cell phones. India has only one per cent of the world’s motor vehicles but accounts for six per cent of global road traffic accident (RTA) deaths. Over 1,20,000 people die on the roads every year (one every two minutes), and a majority of them is pedestrians. Twenty per cent of the accidents are the result of alcohol consumption. The majority of the workforce in India is males under 45. This means that the greatest number of deaths also occur in this age group. Of those who survive, most are bedridden or confined to a wheel chair. Usually, they are the sole bread earners for their families. Stop and take charge as people are looking for leadership. Check if the person is bleeding. Apply pressure over the site to stop the bleeding. Get the person to the nearest hospital. Maintaining heartbeat and breathing is very important. If necessary, perform cardio-pulmonary resuscitation (CPR). Learn it as 15 per cent of people will have the opportunity to perform CPR sometime in their lives. Basic resuscitation can be remembered as ABC. A. Clear the airway because if it is blocked with blood, mucous, a foreign body (bones, nuts) or water, air cannot enter. Then perform the Heimlich manoeuvre. Stand behind the person and wrap your arms around the waist. Make a fist and place the thumb side of your fist against the victim’s upper abdomen, below the ribcage and above the navel. Grasp your fist with your other hand and press into their upper abdomen with a quick upward thrust. Do not squeeze the ribcage; confine the force of the thrust to your hands. Repeat until the object is expelled. If the victim is pregnant or obese, it is difficult to wrap the arms all the way around. Then stand behind the victim, move your arms up into the victims armpits, and make a fist in the centre of the chest, over the sternum, before proceeding with swift inward movements. If the person is unconscious or unable to stand, place the victim on his or her back. Kneel astride the victim’s hips. Place one hand on top of the other. Place the heel of your bottom hand on the upper abdomen below the rib cage and above the navel. Use your body weight to press into the upper abdomen with a quick upward thrust. Repeat until the object is expelled B. Once the airway is clear, listen and look for breathing by watching for the rise and fall of the abdomen. If the person is not breathing Pinch the victim’s nostrils firmly Place your mouth over the victim’s mouth Blow air in forcefully at the rate of one breath per second. If the mouth is full of vomited material or blood, administering chest compressions alone will help. C. Circulation has to be maintained. If there is no heart beat: Place the heel of one hand over the lower half of the sternum. Place the heel of the second hand on top of the first. Keep the arms straight. Rhythmically depress the sternum 2-5cm at the rate of 100 compressions a minute. In children use the thumbs one on top of the other and press down only 1-2 cm. It is easier if two people work in tandem, with 15 chest compressions to two breaths (15:2) ratio. There is a so called “golden hour,” the first hour after trauma, when the person has the best chance of survival provided he reaches the emergency department of a hospital geared to deal with accidents. By following these steps, you too might save a life. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in Share on emailShare on printShare on facebookShare on twitterMore Sharing Services

thirst and rehydration

Beat the heat, correctly DR GITA MATHAI Summer is here in full force and advertisements for fizzy drinks, colas, sports drinks, beer (surrogate advertising) and even plain glucose have started flooding prime time television. They claim to quench your thirst, give a much needed energy boost and improve flagging sports performance. Everyone needs adequate fluid and electrolytes in summer, to replace the visible amounts lost as sweat and the unseen lost as evaporation from the body. In hot and humid climates, the fluid loss may go unnoticed till the body signals dehydration with thirst, a parched mouth, headache, nausea and muscle cramps. Urine may become scanty and darker. If these symptoms are ignored, dehydration can proceed to heat exhaustion or heat stroke, with the temperature rising to 104°F or more, dry flushed skin with no sweating, delirium, loss of consciousness and even seizures and death. Healthy adults recognise the symptoms of thirst and proceed to drink water. Those over 65 may not recognise the symptoms or ignore them. They may also be more vulnerable if they are on medication like beta blockers or anti depressants. These affect the body’s ability to stay hydrated. Infants are unable to express themselves when they are thirsty. They also lose more fluid as their exposed body surface is greater than in adults. Some, though not all, may stick out their tongue in a serpentine movement if they are thirsty. Parents and caregivers need to recognise their need and offer fluids at frequent intervals. A child that is not thirsty will refuse the fluid. School going children may become engrossed in play and ignore thirst. They need to carry at least a litre of water with them to school. Even while playing in the compound, they should carry water. Fluids that are “isotonic” and contain water and electrolytes in the correct proportions replenish body fluids. Many advertised fruit drinks, colas and reconstituted powders are “hypertonic”. The body loses fluid from its cells into the stomach as it tries to make them isotonic and utilisable. Thirst is aggravated instead of being quenched. Sugar or plain glucose is often added to drinks. Since the body requires glucose for metabolism, this should in theory provide the body with an instant energy boost and quench thirst. If the drink is isotonic (some sports drinks are), the extra glucose will provide a temporary energy boost. After an hour, in some people there is a rebound effect with increased thirst, fatigue and drowsiness. The instant calories also prevent the body from efficiently breaking down its fat stores, negating the effect of exercise on weight loss. Although ice water may appear refreshing, the body has to expend energy to bring the water to room temperature before it is absorbed. Fluid at room temperature is absorbed faster. Fluids should be drunk before thirst sets in so that you never become dehydrated. Adult men need around three litres of water a day and women around 2.5. Children need 100ml/kg until they are 10kg. Over 20kg they need 1,000ml (1 litre) plus 50 ml/kg. This is the baseline requirement. Activity requires additional fluid; adults need 300ml for every 20 minutes and children 200ml. Fluid needs do not stop when the activity is over. Around 500-600ml needs to be drunk after activity. A mouthful of liquid for an adult is roughly 30ml and a child’s 15ml. If you are rarely thirsty and pass around 1.5 litres of urine a day, your hydration is probably adequate. Plain water is best for rehydration. Lightly salted butter milk, lime juice or coconut water are also effective. Ready mix drinks and sports drinks should be either avoided (unless you are an endurance athlete) or used judiciously. If a person has heat exhaustion: nBring them indoors to a shady place and switch on the fan Give them fluids Place ice in the armpits and groin Swab them with a towel soaked in water at room temperature. Allow the water to evaporate Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in