Symptoms of dehydration include: feeling thirsty, tired, lethargic, dizzy, or lightheaded, dark and strong-smelling urine, dry eyes, lips or mouth and passing urine less than 4 times a day. In children sunken eyes, restlessness, irritability, and a pinch of the skin going back very slowly are also symptoms of dehydration. In very severe cases patients may be unconscious or not able to drink. 14
The best way to check hydration levels is to check the colour of urine (see figure 115) and to find out how often urine is being passed.

Figure 1: Urine colour chart – source https://www.nhsinform.scot/campaigns/hydration

urine colour chart

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How can we help the public drink more?

Putting the science into practice is key to good nutrition. As health professionals we are well placed to help improve hydration. Firstly talking about the benefits of hydration, as well as the dangers of dehydration can help some people (depending where they are on the cycle of change). Secondly giving them practical tips and support to drink more. Below are some ideas of how to increase water intake.
For adults:
1. Have a glass of water by your bed to have when you wake up in the morning
2. Have a bottle of water on your desk to remind you to drink – one with millilitre markers on the side can help show you how much you need to drink
3. Set an alarm every couple of hours to have a drink
4. Have a glass of water half an hour before having a meal
5. Consider using an app for example Planet Nanny or Daily Water

For children:
1. Make water fun – have different cups they can use, use straws (preferably reusable one which can be safely washed), use fun shaped ice cubes to put in their water (with supervision to avoid choking)
2. Give them some control – ask them which cup they would like, leave water around their play space so they can access it and let them use a jug to fill their cup
3. Have water at each meal and snack time
4. Give them a water bottle to take to school so you can monitor how much water they are having
5. Talk to them about the colour of their wee and do an experiment with them to see if they can make it change colour (only if it is dark and they need to drink more of course)

If water is not well received

Not everyone will love water. It is a good idea to persist and try small amounts. On top of this, unsweetened, non-alcoholic beverages are also good for hydration. Help clients to regulate the amount of caffeine they have and also give information about how tannins can affect absorption but we need to strike the right balance here – hydration is really important.
And finally, as it is Nutrition and Hydration week this month, share lots of tips on social media, in waiting rooms, in newsletters and with colleagues. Here are some resources which might help:
Infection Prevention Control poster – Are you drinking enough?
BDA Food Facts Sheets: Fluid https://www.bda.uk.com/foodfacts/fluid.pdf
BNF Healthy Hydration for adults and teenagers https://www.nutrition.org.uk/attachments/article/429/Healthy%20hydration%20for%20adults.pdf