Dehydration Causes

How does dehydration occur?

Dehydration develops when you consume less water than you lose ^[1]. Dehydration means loss of water that results in loss of more than 1% of body weight, for example, more than 1.5 pounds in a 150 lbs person ^[13].

You cannot prevent water loss due to invisible perspiration, breathing, urination and defecation. This obligatory water loss is at least 1 liter of water per day in adults ^[2]. Additionally, you almost always lose some water by sweating.

A healthy sedentary adult living in a moderate climate loses at least 1-2 liters of water per day ^[2]. Physically active adults living in hot climates may lose as much as 10 liters of water per day ^[2,13]. A person who vomits repeatedly, has diarrhea or a condition with excessive urination, may lose more than 10 liters of water per day.

Causes of dehydration:
1. Insufficient drinking
2. Excessive sweating
3. Hyperventilation
4. Vomiting
5. Diarrhea
6. Excessive urination
7. Burns
8. High altitude

1. Insufficient Drinking

Common causes for insufficient drinking:

Not being aware of thirst due to tiredness, anxiousness or preoccupation with work
Weak sense of thirst, for example, in elderly ^[6], in cold environment or after arriving at high altitudes ^[4]and in conditions, such as head injury, stroke and liver cirrhosis ^[6]
Inability to drink due to painful mouth sores, strep throat, mouth or throat injuries or surgery, gastroparesis, gastric cancer, severe nausea during pregnancy (morning sickness), dementia,delirium orsedation ^[24,26]
No available drinking water
Unwillingness to drink due to an attempt to lose weight quickly (boxers before weighing), psychological conditions, such as depression, anorexia nervosa, obsessive-compulsive disorder (OCD) or psychosis ^[23,26]

How much water do you need per day?

2. Excessive Sweating

Common causes of excessive sweating include high ambient temperatures (summer, tropics, sauna, certain jobs), exercising in warm clothes (skiing in winter) and heavy physical work. Marathon runners can have the sweating rate 0.5-2.5 liters per hour or more, so they can lose about 1.5-10 liters of water per marathon ^[17]. Miners, workers in tropics can lose as much as 10 liters water during one shift ^[18].

Another common cause of excessive sweating is fever, for example in flu, pneumonia, thyrotoxicosis or due to prolonged dancing after ecstasy use ^[20].

3. Prolonged Hyperventilation

Quite some water can be lost through breathing, especially during prolonged hyperventilation in:

Heavy exercise
Anxiety, hyperventilation syndrome
Conditions, such as pneumonia, kidney disease and diabetic ketoacidosis (in poorly treated diabetes)
High altitude ^[13]
Poisoning with salicylates (aspirin in doses greater than 1 g) or amphetamine ^[19]

4. Repeated Vomiting

During repeated vomiting, you can lose a large amount of gastric juice and thus water ^[4]. Common causes of persistent vomiting:

Alcohol intoxication
Motion sickness
Morning sickness during pregnancy (hyperemesis gravidarum)
Migraine
Infectious diseases (H. pylori infection of the stomach, bacterial meningitis)
Kidney stones, urinary tract infection (UTI), including kidney infection (pyelonephritis) ^[25], or kidney failure (uremia)
Hepatitis, acute pancreatitis, gallbladder attack, appendicitis, intestinal obstruction
Cancer and chemotherapy
Hypercalcemia, hyponatremia
Cyclic vomiting syndrome
Bulimia nervosa

5. Severe or Prolonged Diarrhea

Common causes of severe acute diarrhea:

Excessive alcohol ingestion
Food poisoning
Gastroenteritis or “stomach flu” (mainly in infants and toddlers)
Cholera (with water loss greater than 1 liter per hour) ^[21]

Common causes of chronic diarrhea ^[5]:

Celiac disease
Crohn’s disease
Intestinal parasites
Antibiotic-associated diarrhea
Laxatives abuse

6. Excessive Urination

Causes of excessive urination (an increased daily amount of urine or polyuria):

Cold ambient temperatures, which induce the excretion of the urine (“cold-induced diuresis”) ^[8]
Water pills (diuretics) ^[15]
Untreated diabetes mellitus type 1 ^[12]
Kidney disease, such as polycystic kidney disease or lithium toxicity, resulting in nephrogenic diabetes insipidus
Hypokalemia
Hormonal imbalance, such as pituitary tumor (adenoma) causing central diabetes insipidusor severe acute adrenal insufficiency in Addison’s disease ^[16]

7. Burns

Burns can cause damage of the skin vessels resulting in an increased water evaporation from the skin and quick water loss ^[22].

8. High Altitude

After arriving at high altitudes (over 11,500 feet or 3,500 m), unacclimated individuals often feel less thirsty ^[4]. They may also lose 1-2 liters of water due to increased urination, probably due to cold-induced diuresis, and may remain dehydrated for about 14 days ^[8,10]. Additionally, dry air at high altitudes stimulates water loss through skin and breathing.

Do alcohol, caffeine and protein cause dehydration?

Alcohol, caffeine (in tea, coffee, cola and energy drinks) ^[14] and foods high in protein ^[27,28] mildly stimulate water excretion through the kidneys and transitionally increase urination, but this should not result in any significant dehydration ^[13].

References