The water jug is on the table, and an older person can still dry out. They may not feel thirsty. The mouth is sticky, the urine is dark, and there is less of it. Standing up from the bed makes the room tilt for a moment. Dehydration means the body has lost more fluid than it has taken in, or has not been given enough to match what it is losing.
Hot weather, fever, diarrhoea, vomiting, and a day of not drinking because of a sore throat are common reasons in a Nepali house. So is a well relative who simply forgets the glass unless someone puts it in their hand.
Signs to notice
A dry mouth, thirst, dark yellow urine, and passing urine less often are early signs. The person may feel dizzy, tired, or headachy. Skin can look less lively. In a baby or young child, watch for a dry mouth, fewer wet nappies or trips to the toilet, sunken eyes, and unusual sleepiness or irritability. Tears may be absent when they cry.
Older adults may skip the thirst. Confusion, sleepiness, a new unsteadiness, or urine that is scant and dark can be the whole story. Ask when they last passed urine, and look at the colour if that is practical and dignified. A long gap, in someone who usually passes urine through the day, deserves attention.
Thirst alone is an unreliable guide. Some medicines and some illnesses change thirst. The clinic's record of what this person usually drinks is more useful than a general rule about jugs per day.
What to offer
If they can swallow safely and they are not vomiting everything back, offer oral fluids. Water is the usual drink. Oral rehydration salts, made as the packet says, are reasonable when a clinician or pharmacist has suggested them for diarrhoea or heavy fluid loss. Do not invent a strong homemade salt mixture. Too much salt in a glass can harm, especially a child.
Small sips, often, are easier than a full glass held to the mouth. Ice, if you have it, or a cool drink may be accepted when a warm one is refused. If fever is the reason they are dry, light clothing and the rest of that care sit alongside fluids. See fever at home.
Food still matters once vomiting settles. A little rice water, dal soup, curd, or fruit they already eat can come back before a full plate. Ongoing drinks and meals for older people are discussed in nutrition and hydration for older adults.
Do not force a large jug on someone with heart or kidney disease who was told to limit fluid. The clinic's limit wins. Extra water can work against a plan that sets a fixed amount for the day. If they have diarrhoea or fever and also a fluid limit, call the clinic and ask how to adjust for this illness. Do not guess upward, and do not withhold the allowed amount because you are afraid of the limit.
People who have been told not to eat or drink before a procedure, or who have been told not to swallow because of a swallowing problem, need the clinician's instruction before any drink is started.
When drinking at home is not enough
Stop the home plan and get medical care if they are confused, unusually sleepy, or passing very little urine. Get care if they cannot keep fluids down, if vomiting or diarrhoea is relentless, or if a child has sunken eyes. A baby who is too listless to feed, or whose soft spot looks sunken, needs urgent assessment.
Breathlessness, chest pain, or a sudden stop in passing urine needs medical care the same day. Severe breathlessness or chest pain needs emergency care.
Blood in the vomit or stool, a fever with a rash that does not fade, or a seizure needs emergency care. While you wait for advice, keep offering small sips only if they are awake and swallowing safely.
Write down how often they have passed urine, how many times they have vomited, and what you have managed to give. That page is more helpful at the clinic than a guess that they "drank a bit."
