COVID-19 patients should think twice about rehydration

This is the 4186th article of Da Yi Xiao Hu

Recently, with the increase in the number of people infected with Omicron, the number of patients visiting hospitals has also increased significantly, and the amount of fluid replacement in outpatient and emergency departments has increased several times compared to usual times.

In daily life, there is a saying that you should drink more water when you have a cold. This statement makes sense. First, when you have a cold, patients often have symptoms such as fever, which increases the loss of fluid in the body; second, some patients have poor appetite, reduce water intake, and sometimes vomit and diarrhea. It is emphasized that drinking more water can actively replenish the lost water; third, drinking more water promotes urination, which can take away some toxins and heat in the body. For patients with normal heart and kidney function, drinking more water may prevent dehydration and promote recovery. However, if the patient is an elderly person, the heart and kidney functions are often weak. Drinking too much water may cause overload of fluid capacity in the body. If it cannot be discharged in time, it may cause heart failure and pulmonary edema. Whether you should drink more water when you have a cold varies from person to person.

The question of whether COVID-19 patients should be rehydrated should also be analyzed on a case-by-case basis. In the emergency department, I met many elderly people who had poor appetite after infection, had not eaten or drunk properly for several days, and had already developed symptoms of dehydration when they came to the hospital. For these patients, if they cannot be rehydrated in time, the internal environment disorder and deterioration may soon cause a series of complications. For such patients, rehydration is very necessary. Sometimes doctors do not have to drip any medicine into them, but simply replenish the patients with some electrolyte fluids.

However, there are also many young people in the waiting line who seem to be in good spirits and claim that they are here for infusion. This is unnecessary. Not to mention whether they need fluid replacement, even if they do, they can just drink water by themselves. Why do they need intravenous drip? It is not only unsafe, but also increases pain and the risk of cross-infection. Many people believe that intravenous administration is fast-acting and effective, but most of the time this is unreasonable. Most outpatient and emergency drugs have dosage forms specifically for oral administration, and the oral absorption rate of many drugs is very high, comparable to the utilization rate of intravenous medication. For example, the commonly used levofloxacin is completely absorbed orally, and the relative bioavailability is close to 100%. Oral medication is both cheap and safe, and the effect is not inferior to intravenous medication.

There is another problem that many patients have not thought of. Some infused drugs, such as antibiotics, need to be used 2-3 times a day to fully exert their efficacy. This is related to the way the drug is metabolized in the body. If the infusion is given in the outpatient department, it is obviously impossible for the patient to come to the hospital for infusion every 8-12 hours. Doctors often take the method of infusing multiple doses of medicine at once, or infusing medicine that should be used in two doses only after a few hours. This not only fails to fully exert the effect of the drug, but also increases the risk of side effects of the drug due to the large dose in a short period of time. If it is oral medication, it is very simple. It is not difficult for patients to take medicine every 8-12 hours. It is convenient and the efficacy of the medicine is fully exerted, and the effect is good.

When COVID-19 develops in patients, or even progresses to "white lung", intravenous infusion should be done with extreme caution. Many medical experts emphasize that it is necessary to strictly limit the rehydration of patients at this time, and even use diuretics to keep patients in a state of mild dehydration to keep the lungs "dry". These views are not just one person's opinion, but are supported by sufficient evidence-based medicine. If the patient has already developed COVID-19, and still blindly drinks more water, or even goes to the outpatient department for unnecessary rehydration, it may aggravate the lung lesions.

In short, outpatients should be aware of the pros and cons of intravenous infusion and should not blindly believe that intravenous infusion is better than oral medication. Although we do not rule out that some outpatient doctors also hold wrong views on intravenous infusion, many times patients insist on intravenous infusion and even argue with doctors. Doctors are fed up and have to prescribe intravenous infusion to calm the situation.

Author: Songjiang District Central Hospital, Shanghai

Emergency Critical Care Department

Wang Xuemin