Modern medical care is largely dependent on complex pharmaceutical and medical equipment that will be impossible to create locally-with one exception: intravenous fluids. While we currently use pre-packaged, disposable iv access devices, tubing and fluids, these are a relatively recent phenomenon. In the 1950's, IV fluids were prepared in our kitchen in a sauce pan on the stove, packaged in reusable glass bottles, administered via reusable heavy gage latex tubing through reusable, resharpened steel hypodermic needles. The old man was educated in 1935, when they taught folks how to roll their own pills out of leaves, roots and berries. And make their own IV fluids, in bottles sterilized much the same way as baby bottles and canning jars are currently treated. IV fluid therapy can support the patient until their their immune system can fight off the bugs. Childhood viral diarrhea is a common fatal illness of children in third world countries-and rarely fatal here. This is not because we have good drugs-it's a virus, antibiotics do not work on it-its the iv fluids we give the kids. Little ones dehydrate fast, and once dehydrated, everything stops working. The old man mixed normal saline by adding a teaspoon of salt to a quart of distilled water,; the patients never complained, and the all seemed to heal up. Please note: the patients were cows, the old man a veterinarian. I am not recommending this as an alternative to moden medical care, and this is not the sort of thing one would try at home. But in extremis, I would be tempted to try it.
Comments?

I think this would require a great deal of equipment to have on hand in advance. Other problems would be increasing incidence of latex allergies, difficulty in long-term storage of latex tubing (have you ever seen old latex products, especially if exposed to high environmental heat). The incidence of IV related complications, even with sterile single use products can be high (phlebitis, catheter related infections, etc).

There is experiential evidence that oral rehydration is superior to IV rehydration, especially in suboptimal environmental conditions (Google: Dilip Mahalanabis ,director of International Centre for Diarrhoeal Disease Research, Bangladesh and his experience with rehydration in refugee camps during the Bangladesh Liberation War and Indo-Pakistani War of 1971.
Another alternative, if unable to take oral fluids, might be: Hypodermoclysis. This is an older form of non-oral hydration little used in human medicine, but sometimes inveterinary medicine. It is technically easier to institute as venous cannulation isn’t required.
Unfortunately in survival situations if someone is ill enough or has injuries such that oral rehydration isn’t possible, they may not survive.
Just my thoughts, with 35 years of IV therapy experience, seen all the bad things that can happen even in well controlled situations.

Diarrhea and dehydration can successfully be treated under austere conditions without SU fluids by administering Oral Reyhydration solution (ORS), which can be prepared with fairly common ingredients or from commercial packets mixed with water.

In a post-disaster environment where medical care and sanitation systems have collapsed, diarrhea is likely to emerge as a major killer, as a consequence of several different diseases, such as cholera, that may flourish in such an environment.

I strongly encourage anyone interested in survival to learn how to make, and prepare to make and use, ORS.

The home recipe is to simply mix 8 tsps of table sugar and 1 tsp of table salt in a quart of boiled and cooled or filtered water.

The more technical recipe is:
2.6 g Sodium Chloride
2.9 g Trisodium Citrate Dihydrate (OR 2.5 g Sodium Bicarbonate)
1.5 g Potassium Chloride
13.5 g Anhydrous Glucose (OR 14.85 g Glucose Monohydrate)
1 L clean water

The easiest method is simply to buy the commercially available pre-mixed packets and mix as needed with clean water.

Once mixed, the solution will last about 24 hrs without refrigeration.

Google "oral rehydration salts," or "oral rehydration therapy" for more information.

Also, remember that most diarrheal diseases are a result of oral-fecal contamination, so simple handwashing, proper waste disposal and other basic field sanitation techniques offer a lot of protection.

Jeff

Half-strength Gatorade or other "sports drink" also is an easy alternative.

Oral re hydration is effective if you have a motivated patient (or committed coach)-which is probably why one doesn't often see children of paramedics, doctors or nurses in the er with dehydration. It is less effective with sicker patients, younger patients, and ineffective with vomiting patients. One of our physicians recommended a re hydration fluid composed of fruit juice diluted to half strenggth with water, to lower the sugar content, and supplemented with 1 teaspoon of table salt. OJ and apple juice typically have lots more potassium than equivalent volumes of commercial preparations, but he never provided a footnote or journal reference.

Maintaining good hygiene solves lots of problems, but is difficult under extreme conditions and impossible among toddlers.
Latex deterioration is an issue, but deterioration over time is an issue with most survival supplies. A bigger issue might be finding a manufacturer. This would suggest adapting the pediatric fluid resuscitation approach of using a 20cc-60cc syringe and a straight hypodermic needle or butterlfy to administer bolus doses of fluid. a At least this stuff is commercially available, and might store better and would pack down smaller. Solves the allergy issue, too.

Hypodermoclysis is a great piece of medical history,and occasionally is revived for rehydration in long term care settings, as is rectal infusion (*shudder+, and seems still to be in use in veterinary medicine. As I recollect, we pre-administered subcutaneous hyaluronidase before doing a clysis, an enzyme that improves absorption of the fluid. Reabsorption rates are variable with clysis, and dependent as I recollect of peripheral blood flow; peripheral perfusion may be compromised in significant dehydration, which is probably why clysis is not used much anymore.

Mike:

If IV rehydration simply isn't available, then oral rehydration is really the only game in town, and enjoys the advantage of being a game anyone can play. It can be used effectively in the presence of vomiting, but, as you correctly point out, it takes real persistance, and some patients will still die. Nonetheless, it has been a huge lifesaver, especially in peds, in the third world, and that suggests it will have significant value in austere, post-disaster conditions, as well. Zinc supplementation also showed some promise, if I recall correctly; but I'll have to have my wife research it for me.

Jeff

I don't think anybody has mentioned rehydration by enema.

You can use unpurified and/or brackish water and rehydrate by obsorbing the water through your colon. I've read about at least 2 occations this saving the lives of people who didn't have drinkable water but did have lots of water.

Makes sense but I don't think I'd use my Nalgene bottle again...

I guess that's natures back door backup filter. Although I'm wondering about how salty the water can be... I assume full strength saltwater is still going to be trouble.

Emergency NG and Rectal Rehydration in the Home Setting
By Grattan Woodson, MD, FACP
Updated 9Dec2006

http://www.birdflumanual.com/resources/A...e%20Setting.pdf

Jeff

[ [quote] quote=marduk]
Unfortunately in survival situations if someone is ill enough or has injuries such that oral rehydration isn’t possible, they may not survive.


Absolutely, unarguably true. But mostly, this forum is about finding ways to not die in a situation that would be greatly simplified by death. Some of the medical techniques that worked in the late 19th and early 20th centuries might be adaptable to survival scenarios in which current therapies fail due to lack of resources. Next topic: field surgery under ether anesthesia.

IIRC, most water absorption in the colon is pretty independent of salt content. Most ions and what-not are absorbed fairly early in the small intestine. The rectum is purely fecal storage, so you'd need to get the fluids up at least 10 inches or so (NO, you don't have to push a tube in 10 inches....)

The colon also uses sodium transport to absorb water, which it does very efficiently.

I don't know exactly where you'd draw the line as far as concentration goes, but sea water is too salty to work as an enema. Your body wouldn't be able to create a big enough osmotic gradient to absorb much water from the salty sea water. Actually, you'd probably end up dehydrating yourself even more as water was drawn into your colon from your body tissues by the sea water enema.

I stand corrected; you're right regarding sodium and water transport.

I'd have to agree about hypertonic enema's though; very likely to dehydrate the person!