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1. In my pack med kit is also includes electrolytes, metronidzole, azithromycin (Z-Pack), Imodium a-d. (Metronadzole = Flagyl.) Although I would use a life straw water filter, or a Katadyn pump, and would boil water if there were dead bodies in the water, or a known virus in the area, having diarrhea on the trail would be life threating, as water may not be easily accessed during some parts of the journey. The backpacker is usually somewhat dehydrated during some parts of the day, and dysentery would make travel away from a water source a dangerous prospect. Being just one quart too low, a person can feel the weakness, and delirium of dehydration. This combination meds during WROL would be priceless, as it could keep one on the trail, or get them back on the trail sooner rather than latter, and to the safety of their destination. A side effect could be more diarrhea, yet it would be a necessary part of the process, the cure. Shigella, cholera, and protozoa are common water borne causes of diarrhea and dysentery.

   I ain’t no doctor, so the reader is on their own here. Do your own research. I highly recommend getting a signed copy of Dr. Alton’s Antibiotics and Infectious Diseases. It is a easy read. See what it can do for you. Or pick up a Merck Manual, or PDR, and then get Dr. Alton’s book. I have a pile of medical books for reference, bot cheap at the thrift store.
   http://www.survivalmedicine.com/

   Metronidazole:
   https://fishmoxfishflex.com/collections/metronidazole-fish-zole-fish-antibiotics/products/fish-zole-forte-metronidazole-500-mg-tablets-30-count

   Azithromycin:
   https://fishmoxfishflex.com/collections/bird-azithro-azithromycin-250mg

2. Great article Dr. Marc! I appreciate you covering this topic, as dehydration can kill or disable as quickly as any factor can during WTSHTF/ if we turn into a third world country overnight.

   In addition to the filters you recommended, I also like the Berkey water filters…especially the large units for homestead drinking if your well, city water connection, or other water source is at risk of contamination. While not portable, they would work well in a kitchen.

   https://www.berkeyfilters.com

   Dr Marc, your recipe for hydration was great. Balanced solutions of water, salt/electrolytes, and sugar is key to retaining the water…just ask the folks at Gatorade who have made billions figuring this out for athletes.

   Speaking of Gatorade, since it’s available right now in our first-world economy, I recommend keeping this constantly stocked at your home for everyday hydration as well as long-term preparedness supplies.

   Rectal Hydration may be necessary in a situation where the patient (human or potentially an animal I suppose) cannot take oral medications/fluids due to excessive hydration or other factors, and when an IV hydration therapy isn’t an option. Here is a link to one scientific article about it. If you look at the text boxes on the right hand side, it provides some simple step-by-step instructions that even a lay person could use. Rectal hydration is used in the third world often because it is much easier/cheaper than an IV to make and administer by non-medical folks to children who are severely dehydrated. We were taught about it in medical school to demonstrate the physiology of how the large intestine cells work to absorb water, and also as a backup plan for rehydration therapy for those of us who intended to do medical mission trips during our careers.

   https://www.researchgate.net/publication/38036037_Proctoclysis_emergency_rectal_fluid_infusion

   (I would provide age/weight-appropriate doses of the fluids Dr. Marc recommended, but just give it rectally when necessary.)

   Here are some supplies on Amazon you could purchase in order to provide this therapy; they may be worth stocking up on:

   1a.) Foley Catheters (normally used in a bladder cath situation, but they can be placed rectally and the balloon inflated gently until it seals against the bowel wall:

   https://www.amazon.com/Dynarex-4956-Foley-Catheters-16FR/dp/B00VS485DQ/ref=sr_1_9?crid=2SQ5ZNGKTFSVM&keywords=foley+catheter&qid=1565204326&s=gateway&sprefix=foley%2Caps%2C211&sr=8-9

   1b.) or you can use these as an alternative, but there is no balloon in the tip to get a good seal:

   https://www.amazon.com/HealthAndYoga-TM-Enema-Supplies-Discomfort-Free/dp/B06X3VVDL8/ref=sr_1_6?crid=2SQ5ZNGKTFSVM&keywords=foley%2Bcatheter&qid=1565204326&s=gateway&sprefix=foley%2Caps%2C211&sr=8-6&th=1

   2.) These syringes are useful for both inflating/deflating the Foley catheter balloon, but also for administering oral medication doses to kiddos, such as pediatric tylenol or ibuprofen.

   https://www.amazon.com/10ml-Syringe-Sterile-BH-SUPPLIES/dp/B07KW4KLG2/ref=sr_1_4?crid=3HDK2FBCI9J1T&keywords=10+ml+syringes&qid=1565214755&s=gateway&sprefix=10+ml+syringe%2Caps%2C215&sr=8-4

   3.) And finally, these syringes are useful in delivering all the fluids through the catheter into the bowel:

   https://www.amazon.com/60ml-Catheter-Syringe-Airtight-Covers/dp/B07HYZGCSW/ref=sr_1_6?keywords=foley+catheter+syringe&qid=1565214993&s=gateway&sr=8-6

   So, to summarize this purchase, you would need either 1a or 1b, plus 2 and 3. Please do the math and get matching numbers (some quantities are much different than others), so that you have as many functional sets as possible. You might also want some K-Y type lubricating gel and some gloves.

   Lastly, for those readers who have medical training placing IV catheters, if you can obtain a stock of IV fluid bags, IV tubing, and angiocath IV needles, these are all extremely useful in fluid replacement therapy for dehydration.

3. Thanks for this article and the comments.

   I purchased (stored for emergency) boxes of Medi-Lyte electrolyte supplement, which have 50 packets of 2 tabs per packet.

   Listed ingredients: Calcium (from 27.0 calcium carbonate) 10.8 mg, Potassium (from 80 mg potassium chloride) 40 mg, Magnesium (from 20 mg magnesium oxide) 12 mg.

   Any suggestions of administration and dosage would be welcomed. Please advise.

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