About Dehydration: Symptoms and Treatment

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Dorine Lam, RDN, MS, MPH

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About Dehydration and Adrenal Fatigue

About dehydration and the warning signsAs mentioned earlier, aldosterone output is typically compromised while adrenal weakness progresses. The more advanced the Adrenal Fatigue, the lower the aldosterone level. Without adequate aldosterone to retain sodium, the body tends to lose water faster than it can keep, resulting in a chronic state of subclinical dehydration. It is essential for individuals to know the facts about dehydration and maintain proper fluid balance.

The more advanced the fatigue, the more evident this becomes. Typical symptoms include chronic low blood pressure, lightheadedness, dizziness, and orthostatic hypotension. Electrolyte balance is not usually a problem early on, but ultimately can be very fragile as AFS progresses when fluid imbalance is not addressed and reversed properly.

Eventually, if stress remains unresolved and fluid depletion is allowed to continue, as part of the survival response, the brain will activate the emergency alarm system. This leads to the release of adrenaline and norepinephrine, two powerful compounds, as a compensatory response to increase blood pressure. While the body is saved and the brain obtains the necessary fluid and blood pressure maintained for survival, there are collateral damages. Side effects peripherally include cardiac arrhythmia, nightmares, shortness of breath, tachycardia, pounding heart rate, chest tightness at rest, resembling a heart attack. These are very scary experiences. They are often accompanied by a sense of impending doom and anxiety as the brain also becomes stimulated by these emergency hormones and on high alert centrally. Frequent visits to emergency rooms are made but cardiac workups are negative as all laboratory tests continues to be normal. AFS sufferers at the interim are sent home and told to relax. If that fails, they are put on anti-anxiety agents and antidepressants. Little attention is paid to investigating the adrenal glands and aldosterone, the culprit of fluid imbalance.

About Dehydration: Warning Signs

Fortunately, as AFS progresses there are telltale signs that our body provides us well in advance as notification of its need for fluids. This usually takes years and sometimes even decades to develop. Signs and symptoms to be on the lookout for include: brain fog, thirstiness, heartburn, constipation, urinary tract infection, dry mouth, reduced skin elasticity, wrinkles, dry skin, dark colored urine, and constipation. Unfortunately, few are aware of these signals, as they are subtle, especially in the early stages of adrenal fatigue.

Advanced signs of a body hungry for fluid include chronic low blood pressure, postural hypotension, postural tachycardia, dizziness on arising, cardiac arrhythmia, adrenal crash, lethargy, and heat intolerance. These are more commonly seen in those with stages 3 or higher of AFS. It only became evident when water depletion or electrolyte imbalance is well entrenched in very advanced stages. Even then, routine laboratory studies for fluid, including sodium, potassium, and creatine clearance normally continues to be normal despite signs of subclinical fluid depletion being evident if one is attentive.

About Dehydration: Fluid Replenishment

The obvious solution to fluid depletion is fluid replacement. In the setting of adrenal fatigue, this should be done with care because of possible concurrent electrolyte imbalance that can be made worse. Therefore, in addition to water, the proper amount of sodium should be administered to maintain optimal osmolality.

A girl who knows about dehydrationUnder normal conditions, our body requires an intake of over two quarts of water (8 glasses of 8 ounces each) for basic normal function. Depending on our type of diet, about half to one quart each day is provided in the food we eat. The balance has to be taken in externally. A good rule of thumb is to drink eight glasses of pure water (non-caffeinated drinks) a day in addition to your food.

To achieve optimum hydration for adrenal fatigue recovery, it is important to bath the body internally with ample water balanced with electrolytes. About one quart (32 ounces or four glasses of 8 ounces each) of pure filtered water per day for every fifty pounds of body weight is the recommended minimum. This translates into three quarts (12 glasses of 8 ounces each) a day, or fifty percent more than that recommended for routine bodily function for the average 150-pound adrenal fatigue sufferer. Those exposed to a hot environment would need substantially more. That is why AFS sufferers should avoid excessive direct sunlight and cut down outdoor activities during hot weather. Likewise, your water intake should increase by one 8-ounce glass for each 25 pounds above your ideal body weight.

If you are taking in liquids that act as a diuretic (such as coffee, tea, and certain sodas), you will need more water to compensate for the water loss due to these dehydrating drinks. A good rule of thumb is to drink one extra glass of water for the equivalent amount of these drinks you consume.

The above are general guidelines only. The exact amount varies from body to body and the state of fatigue a person is experiencing. Those who are in advanced stages need to be very careful not to drink too much water while making sure that the body’s internal electrolyte balance is well regulated. Too much water without enough sodium can lead to a state called dilutional hyponatremia. Symptoms can include lethargy, fatigue, and in extreme cases, coma. Too much salt without enough accompanying water can drive up blood pressure, reduce potassium, and trigger abnormal cardiac function. Professional guidance is needed for anyone in a sensitive state of electrolyte dysregulation or has a history of sodium/potassium imbalance because the body can decompensate quickly.

About Dehydration: Practical Hydration Tips

Those afflicted with Adrenal Fatigue Syndrome are usually in a state of subclinical fluid and salt depletion as well as fragile electrolyte balance. Therefore, their fluid requirement is higher than those of a normal healthy individual. The following tips should be considered:

About dehydration prevention and carrying a water bottleIt is good practice to always carry a filled water bottle throughout the day so as never to be out of reach of water. As tolerated, a bit of lemon juice or a few slices of lemon should be placed inside the bottle. The container should be glass if possible. Those with sensitive gums should consider using a straw when taking in water with lemon.

Make it a habit to take in more fluid than you need. Do not wait until you are thirsty, as thirst itself is a late warning sign of underlying dehydration.

Because sodium depletion is common, many feel energized when their water contains a bit of salt. Sea salt can be considered if tolerated.

Avoid exposure to direct sunlight. For some, this may mean under a few minutes, especially if they are in advanced stages of AFS.

If outdoor exposure is unavoidable, carry an umbrella for shade, or wear protective hat and clothing. Take frequent hydration breaks. Always have snacks handy to prevent hypoglycemia.

It is important that water intake be consistent and gradual. Drinking water too fast, while quenching thirst, can trigger an adrenal crash if there is a sudden over dilution of sodium within the body. As mentioned earlier, this is called dilutional hyponatremia. When this happens, fatigue increases and one should seek medical attention. In severe cases, symptoms include stupor and lethargy. Hospitalization may be required.

About Dehydration: Food and Beverage Alert

From a beverage perspective, it is important to avoid any caffeinated drinks such as tea and coffee as they contain caffeine, a natural diuretic. Fruits such as pineapple, watermelon, cranberry, pear, peach, grapefruit, honeydew melon, and strawberry should be moderated because of their high potassium content that opposes sodium. Lemon also falls in this category, but with AFS, it has a positive attribute, that of a pH balancer. The fact that lemon slowly releases vitamin C far outweighs its slight diuretic property and should be continued if possible. Likewise, apple is an exception because of its tremendous value in providing a steady source of carbohydrate when the body is fatigued.

Green vegetables with high water content are among the most naturally potent of diuretics, because of their mineral, water, and fiber content. Many are high in potassium and magnesium, both of which, opposes sodium. These include celery, cucumber, carrot, eggplant, asparagus, beet, spinach, seaweed, pumpkin, green bean, artichoke, garlic and onion. Cruciferous vegetables are rich in sulfur and have diuretic properties. They include Brussels sprouts, cabbage, and watercress.

Always consult your physician if you decide to drastically alter your diet to include natural diuretics when you are currently taking diuretic medication.

Summary About Dehydration

About Dehydration, Caffeine and Adrenal FatigueFluid imbalance, subclinical dehydration and sodium depletion are hallmark signs of Adrenal Fatigue Syndrome. Early symptoms can include salt craving, thirst, lightheadedness, reduced mental acuity and fatigue. Advanced symptoms include chronic low blood pressure, cardiac arrhythmia, chest pain, tachycardia, and anxiety. Laboratory tests are usually unremarkable until AFS is well advanced. It is recommended that those with mild AFS should drink at least 12 glasses of pure filtered water daily with a bit of lemon and salt. If tolerance to minerals is not a problem, sea salt can be considered. Bear in mind those in advance stages of AFS may find minerals very stimulating and may present paradoxical reactions. Intake should be steady and gradual. The ideal drinking water for the human body to go about dehydration prevention properly should be slightly alkaline and should contain some minerals like calcium and magnesium. Filtered water is recommended for regular use if taken from a good reverse osmosis system because it tends to be neutral to slightly alkaline. However, be sure that minerals are added by way of vegetables or nutritional supplementation.

Fluid balance can be very challenging in those with advanced AFS. There may be salt intolerance along with electrolyte imbalance, both of which warrant professional guidance and help for optimum recovery.

If you think that you are in, or have symptoms of fluid imbalance and suffer from Adrenal Fatigue Syndrome, recovery needs to be personalized. An improper approach to recovery can complicate, deter, or even exacerbate your current state.

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© Copyright 2015 Michael Lam, M.D. All Rights Reserved.

About dehydration

5 - "Thank you."
Thank you. It's not very often I find a doctor that has knowledge of all my conditions! We need more like you. Thank you again. Looking forward to learning more and reading your book!!


  • Victor says:

    Hello dr lam took a few days with hyponatremia dilucional taking the same amount of salt and water that I’ve been doing throughout the winter. Does climate affect the amount of water we have to drink? In winter should you be drinking less water to avoid dilucional hyponatremia? More quantity of salt makes entering hypertension. Right now I’m drinking litre and half to the day when I used to drink two litres and a half. Can the weather affect? Thank you

    • Dr.Lam says:

      Weather can play a big role. The key is to listen to the whispers from your body and be attuned. Everyone is different.


  • Stacey Geohagan says:

    Dear Dr Lam,
    What do you think of a 14 y/o male, small body frame (110 lbs) with the following symptons: low BP 80/60, low sodium levels, reported low urine output, not thirsty, and on ADHD meds. Got weak after playing soccer one day, went to ER, was dehydrated, given IV fluids, and salt tablets. Referred to cardiac dr. Cardiac dr found no problems. His Mother thinks its his ADHD meds, cause the meds make him not hungry. I think it could be more of an adrenal gland issue and suggested speaking with family dr about it instead of relying on therapist only. What do you think?

    • Dr.Lam says:

      Unfortunately, we are seeing an explosion of AFS in teenagers in our telephone based nutritional coaching. We deal with many with similar history, but only conventional medicine has rule out everything else. The good news with young people is that they rebound quickly if put on the right track.

      Dr Lam

  • Rose says:

    I think your articles are a tremendous help to those of us who have been trying for years to figure out what has gone wrong. I especially like the articles on dehydration and on adrenal dysfunction. Having heard of the adrenal issue only weeks ago, everything is beginning to make sense. Thank you for providing insightful articles on health issues that tend to get missed under the current western medical model.

  • Susan says:

    With all due respect sir I notice your articles are unnecessarily filled with dread over the simplest things. No recovery plan can be uptight and perfect anyways. There need to be remove for flexibility. This is rest and restore not brain surgery.

    Do I need to be ‘advised by a professional’ as to what types of lemons to use in my water too? Something as plain as water, salt, and lemon as if it carries the danger of a whisky overdose. B and C Vitamins (not Minerals) can actually be slightly stimulating to some. Minerals are relaxing.

    When it comes to hydration just look at the color of your urine. If it’s slightly yellow your hydrated plain and simple. A cup of water with 1/4 himiliyan salt upon rising suffices for many. Plain and simple.

    • Dr.Lam says:

      More power to you if you can self navigate. People come to us in very advance stages and unable to do so effectively. Some people cannot tolerate lemon or salt at all. You are obviously not in that category and I am happy for you.

      Dr Lam

  • Rich says:

    How much total salt per day should be added to the recommended amount of drinking water to help with adrenal fatigue?
    I am stage 3 AF, with low blood pressure and constipation.
    Thanks, Dr. Lam

    • Dr.Lam says:

      There is no set amount. Each person is different. What works for one may make another person worse. You need to gauge its appropriateness by trail and error, or best is with professional help to ensure you are on the right track. If you have cardiac or electrolyte and dehydration issues, do consult your doctor first.

      Dr Lam

  • Calli says:

    How do I know if I need more salt in my diet? How do I know when I have enough?

    • Dr.Lam says:

      If you have AFS, then take in more salt usually makes you feel better. Do check with your doctor first to make sure you do not have blood pressure or cardiac issues. If all is well, learn to listen to your body.

      Dr Lam

  • Sam says:

    Hey Dr. Lam. What is the difference between subclinical fluid depletion and mild dehydration?