Camps have their rules. Troop leaders have their rules. I have often told Scouts to disregard certain camp rules for specific reasons (to make sure they understand they are not being told to disregard the camp rules, period). This has led to many interesting discussions with camp directors over the years, but I was never thrown out of a camp. Might be different in the 21st Century version of Scouting.

Oh no! It's a "rules" thread again? Oak Tree, aren't yeh just supposed to say "J20" or somethin' from da canonical list?

aren't yeh just supposed to say "J20" or somethin' from da canonical list?

Yeah, yeah, I know.

I'm just curious about how the rules advocates would handle an actual situation like this.

We actually had one Scout diagnosed by the Health Lodge as suffering from hyponatremia (drinking too much water and having his salt concentration get too low).

Common sense should take over at a certain point and make the decision for you.

Drinking too much water does not prevent dehydration and it's associated problems. I have had people go down around me simply because their body temperature was too high and they had been drinking plenty of water.

Vigilance and common sense should over-rule rules that are not doing what they were intended to do.

Stosh

First, I'm not sure this is a rule, more of a suggestion to the group disguising itself as an order (since it came from one of the camp's "big cheeses". Second, I'm not sure how you would go about policing it - I'd expect that if a staffer was trying to enforce it a Scoutmaster would tell the staffer to back off. Third, I've got to give props to the Program Director - on a hot day, to suggest (order) a final toast of water at the close of a meal - and often, people think they've had enough fluids when they really haven't. Fourth, unless someone was already right at the very edge of hypnoatremia, I don't think another 6 ounce glass of water would do much harm, and the benefits likely will outweigh the risk. Fifth, 12 year olds decide to break rules all the time - for instance, there are rules to baseball, but when playing a pick-up game of baseball in the park with friends, they'll pick and choose which baseball rules they're going to use when they play baseball. Sixth, civil disobedience isn't climbing on a table and shouting that the rule is stupid and you aren't going to follow it - civil disobedience is sitting at the table, not drinking a cup of water. Seventh, my opinion is that a Scout is Obedient allows for civil disobedience, not following a rule if it will cause others harm, or if it conflicts with other rules. Eighth, had you decided that the order must be followed and the Scout refused, what would you do about it - is it something you would fall on your sword for when you, yourself, thought that maybe it wasn't necessary?

As for your case of hypnoatremia, how was this diagnosed in the health lodge? Just curious since an accurate diagnosis requires a urinalysis and blood tests and the physical symptoms mimic a lot of other physical symptoms relating to heat related injuries, and I've see very few health lodges with the capability to do these kinds of tests.

Kinda depends on the rule and who made it.

Some rules are hard for Scouts to comprehend;
Why can't we ride in the back of the pick-up?
Why can't we sleep under a tarp at Philmont?

Some rules are hard even for adults to comprehend;
What's wrong with not reporting all my income?
What's the big deal about going 10 over the limit, everybody else is doing it?

Hopefully the one making the rules make them for good reason. We get into trouble when we make rules that have no real purpose or they are not perceived as being useful or needed. In my opinion there's lots of stupid rules, but I realize I don't know all the reasoning behind every rule.

Sometimes you follow the rules because you trust the organization that makes them and that they have good reason, even if you don't know why (take airport security rules as an example).
Sometimes you follow the rules just because the penalty for failing to do so is too great (decking the mouthy CC isn't worth going to jail over).
And sometimes you follow the rules to set the example for others. (Since I've been teaching my son to drive I make sure I do the speed limit when he's in the car and not even 1 mph over)

One final thought, ever read Lord of the Flies?

As for your case of hypnoatremia, how was this diagnosed in the health lodge?

Well, nausea, headaches, fatigue, cramps - basically the symptoms of dehydration - except the patient has been drinking plenty of water and most likely not eating very much. It's pretty important to understand the difference between dehydration and hyponatremia in the field, where you don't have access to blood tests, so you don't tell a hyponatremic kid to drink water.

Perhaps "diagnose" isn't technically the correct word here, and "suspect" is better. The camp suspected the scout had hyponatremia. It's actually apparently much more common in endurance sports than most people thought, likely somewhere between 10% and 30% of the athletes had hyponatremia at the end of the race. There's also this:

There have been at least 8 reported deaths from EAH (Exercise-associated hyponatremia). Many of these reports relate to a series of fatalities in the military between 1989 and 1996. During this period, military recruits were encouraged to ingest 1.8 L of fluid for every hour they were exposed to temperatures above 30C. At least four other deaths have been attributed to EAH in the United States. It is interesting that two of these deaths occurred in doctors. The exact incidence of mortality related to EAH is not known but is likely to be low. - Clinical Journal of the American Society of Nephrology

http://cjasn.asnjournals.org/content/2/1/151.long

Interesting there - the military had rules intended to help keep recruits healthy that ended up killing a few instead becaues the (well-intentioned) rules were outdated.*

Anyway, for those of us with scouts out in the heat, don't automatically assume it's dehydration. The kids at greatest risk of hyponatremia are probalby the ones in the worst shape who have been taking the most breaks because they're drinking the most water. The key in the field is recognizing that there's a problem early, before it's a crisis so you have the luxury of going slow with your response.

* edit to add, outdated and monolithic one-size-fits-all. That's also the problem with the dining hall "rule" - it didn't account for the kids who had been drinking enough water already and treated everyone as if they were inexperienced at managing their fluid intake. Certainly we have scouts like that, but we also have scouts who do fine. Sort of like the poor rules on tool use - one-size-fits-all fits nobody very well.

Better are rules that encourage personal capability and responsibility, rather than group-wide dictates.

(This message has been edited by JMHawkins)

Hyponatremia eh?

I'd bet my last 5 years salary it was NOT EAH. Not sure of your quote about 10-30% of endurance atheletes being over-hydrated. The military recruiting illnesses and deaths, yes they are documented. I was active duty Army at the time. There is more to the cases than simple over-imbibing of h2O.

Here's the thing. Unless the kid had some type of compromised kidney function, the likelihood he could be drinking enough water to cause an electrolyte imbalance is pretty much nil. Especially assuming he consumed SOME type of food in the same day. Anything, trail mix, jerky, cliff bar, etc... would have enough electrolytes to pretty much make up for whatever diluting was going on in his fluid intake.

Second, unless the kid is pissing like a cow on a flat rock and its clear as moonshine... it NOT hyponatremia. Again, the kidneys are great filters and will start shedding the excess water long before an imbalance occurs.

Third, the way to avoid any type of issue with this... have every 2nd to 3rd intake of fluids contain a 1/2 to 1/3 parts sports drink / Gatorate / etc.... type of fluid. Not full strength, its made WAY TOO sugary and osmotic to be any good for you. It should be about 50% water and 50% sports drink mixed together and drank. Again, unless you have some underlying nephro issue no one knows about, this should keep you pretty even keel on the water to salt ratio.

Finally, when in doubt - treat it as dehydration. Heat stroke can and will still happen in a well hydrated person. Cool compresses, move to the shade, loosen clothing, and the good old dump a small bucket of water over their head and clothes does wonders for most folks. Evac to a cooler place (indoors w/ AC) and seek secondary attention.

Sorry for the hi-jack of the thread - but it really concerns me when potential misinformation is posted regarding common field medical concerns. I would NOT want someone to second quess themselves on proper treatment for dehydration because they're thinking in the back of their mind, "Hmmm, it could be hyponatremia." Thats like stating you don't wear your seatbelt in a car, just in case it goes off the road into the lake, so you can get out faster and not drown.

Not sure of your quote about 10-30% of endurance atheletes being over-hydrated.

It's from the report at the link Dean. It's speculative, the studies weren't entirely controlled and there may have been sample problems, but there seems to be enough to think about it, eh?

It's also a reason the L in SAMPLE is important. "Have you been drinking water?"

If he answer is no, then you can probably rule out hyponatremia. If the answer is "yes, losts" then maybe you need to think through it a bit more. And yes, "have you been eating anything?" is one of the next questions, along with when did he last pee and what color was it.

It's probably dehydration and not hyponatremia, but asking the question is important. The guy in the dining hall wasn't asking the question.

It was diagnosed in exactly the manner that JMHawkins describes. It was definitely not dehydration.

Hyponatremia is not that rare. Here's a study that showed that 13% of runners in the Boston marathon had hyponatremia: http://www.nejm.org/doi/full/10.1056/NEJMoa043901

In this case, though, the question is really, should you force/encourage a kid to drink a glass of water - I'd estimate it at 16 ounces - when he already feels he has had more than enough?

It was not given as a suggestion, or a "join me in a toast." It was, "Ok, everybody listen up. I want every one of you to take a glass. Go ahead, take it... Fill it up with water. Do it now. Everyone. Whether you've had plenty of water or not. Take a glass and fill it with water. Now, we'll all drink it together. Everyone. Ready? Ok, let's drink." If you weren't drinking, you definitely felt like you were disobeying a direct order.

God made the human body with a fantastic feedback system: when there is not enough water in it, a thing called "thirst" is triggered and the brain sends down the signal to "go drink". It works pretty well considering the longevity of the human race. Maybe some guy that cruised the internet for knowledge that transcends all else stands up on a chair and pontificates "me is all knowledgeable and powerful... thou shalt drink now... or die..." - maybe he's right, and maybe he just wants to be right. Yawn ...

Everybody drink up kind of reminds me of mandatory sentences for criminals. The rare, but sometimes wrong response to behavior.

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Actually, I don't think it works as well as it might. I think it's reasonable and prudent for leaders to encourage youth and adults to stay well hydrated, especially in how weather when doing vigorous activities and in out of the ordinary situations, such as camp or outings.

Heat and dehydration injuries are FAR more common than excessive water consumption.

At a hot weather Idaho summer camp (Camp Grizzly), one of our adult leaders, an old Idaho boy, wound up in the hospital after returning from camp with a kidney infection probably due to lack of adequate hydration.

The camp staff made a point of demonstrating and encouraging water drinking during meals and other activities in hot weather that was around 90 degrees most days.

I think that was a good practice.

Stop the presses! I agree with SeattlePioneer.

While any "manadatory" rule is bound to be erroneous under certain circumstances "drink when you become thirsty" may be drinking too late in many cases.