Shift in body fluid compartments after dehydration in humans

Skin-interfaced microfluidic sweat collection devices for personalized hydration management through thermal feedback

Non-electronic wearables that utilize skin-interfaced microfluidic technology have revolutionized the collection and analysis of human sweat, providing valuable biochemical information and indicating body hydration status. However, existing microfluidic devices often require constant monitoring of data during sweat assessment, thereby impeding the user experience and potentially missing anomalous physiological events, such as excessive sweating. Moreover, the complex manufacturing process hampers the scalability and large-scale production of such devices. Herein, we present a self-feedback microfluidic device with a unique dehydration reminder through a cost-effective "CAD-to-3D device" approach. It incorporates two independent systems for sweat collection and thermal feedback, including serpentine microchannels, reservoirs, petal-like bursting valves and heating chambers. The device operates by sequentially collecting sweat in the channels and reservoirs, and then activating thermal stimulators in the heating chambers through breaking the valves, initiating a chemical exothermic reaction. Human trials validate that the devices effectively alert users to potential dehydration by inducing skin thermal sensations triggered by sweat sampling. The proposed device offers facile scalability and customizable fabrication, and holds promise for managing hydration strategies in real-world scenarios, benefiting individuals engaged in sporting activities or exposed to high-temperature settings.

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 4: evolution, thermal adaptation and unsupported theories of thermoregulation

This review is the final contribution to a four-part, historical series on human exercise physiology in thermally stressful conditions. The series opened with reminders of the principles governing heat exchange and an overview of our contemporary understanding of thermoregulation (Part 1). We then reviewed the development of physiological measurements (Part 2) used to reveal the autonomic processes at work during heat and cold stresses. Next, we re-examined thermal-stress tolerance and intolerance, and critiqued the indices of thermal stress and strain (Part 3). Herein, we describe the evolutionary steps that endowed humans with a unique potential to tolerate endurance activity in the heat, and we examine how those attributes can be enhanced during thermal adaptation. The first of our ancestors to qualify as an athlete was Homo erectus, who were hairless, sweating specialists with eccrine sweat glands covering almost their entire body surface. Homo sapiens were skilful behavioural thermoregulators, which preserved their resource-wasteful, autonomic thermoeffectors (shivering and sweating) for more stressful encounters. Following emigration, they regularly experienced heat and cold stress, to which they acclimatised and developed less powerful (habituated) effector responses when those stresses were re-encountered. We critique hypotheses that linked thermoregulatory differences to ancestry. By exploring short-term heat and cold acclimation, we reveal sweat hypersecretion and powerful shivering to be protective, transitional stages en route to more complete thermal adaptation (habituation). To conclude this historical series, we examine some of the concepts and hypotheses of thermoregulation during exercise that did not withstand the tests of time.

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise

In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 2: physiological measurements

In this, the second of four historical reviews on human thermoregulation during exercise, we examine the research techniques developed by our forebears. We emphasise calorimetry and thermometry, and measurements of vasomotor and sudomotor function. Since its first human use (1899), direct calorimetry has provided the foundation for modern respirometric methods for quantifying metabolic rate, and remains the most precise index of whole-body heat exchange and storage. Its alternative, biophysical modelling, relies upon many, often dubious assumptions. Thermometry, used for >300 y to assess deep-body temperatures, provides only an instantaneous snapshot of the thermal status of tissues in contact with any thermometer. Seemingly unbeknownst to some, thermal time delays at some surrogate sites preclude valid measurements during non-steady state conditions. To assess cutaneous blood flow, immersion plethysmography was introduced (1875), followed by strain-gauge plethysmography (1949) and then laser-Doppler velocimetry (1964). Those techniques allow only local flow measurements, which may not reflect whole-body blood flows. Sudomotor function has been estimated from body-mass losses since the 1600s, but using mass losses to assess evaporation rates requires precise measures of non-evaporated sweat, which are rarely obtained. Hygrometric methods provide data for local sweat rates, but not local evaporation rates, and most local sweat rates cannot be extrapolated to reflect whole-body sweating. The objective of these methodological overviews and critiques is to provide a deeper understanding of how modern measurement techniques were developed, their underlying assumptions, and the strengths and weaknesses of the measurements used for humans exercising and working in thermally challenging conditions.

Renal and Endocrine Responses to Arm Exercise in Persons with Cervical Spinal Cord Injury

The aim of this study was to assess renal functions and endocrine responses to arm exercise in persons with cervical spinal cord injury (CSCI) under euhydrated conditions (free drinking of water), and to determine the physiological effects of exercise on renal function in these subjects. Eleven CSCI individuals (spinal lesions between C6 and C8, American Spinal Injury Association impairment scale A) and nine able-bodied (AB) persons rested for 30 min before performing 30 min arm-crank ergometer exercises at 50% of their maximum oxygen consumption, followed by 60-min of rest/recovery. Urine and blood samples were collected before and immediately after the exercise and recovery period. The CSCI patients showed no increase in plasma adrenaline and plasma renin activity compared with the AB controls, but showed similar changes in plasma aldosterone and the plasma antidiuretic hormone in response to the exercise. Creatinine clearance, osmolal clearance, free water clearance, and the fractional excretion of Na⁺ did not change during exercise in both groups of subjects, however free water clearance in the CSCI group was higher than in the AB group throughout the study. These findings suggested that activated plasma aldosterone without an increase in adrenaline or renin activity during exercise in CSCI individuals may reflect an adaptation to the disturbance of the sympathetic nervous system to compensate for renal function. As a result, no adverse effects of exercise on renal function in CSCI patients were observed.

The influence of exercise volume and posture on exercise-induced plasma volume expansion

Acute high-intensity interval exercise is known to expand plasma volume 24 h after exercise. Upright exercise posture plays a role in expanding plasma volume by influencing lymphatic outflow and redistributing albumin while supine exercise does not. We examined if further upright and weight-bearing exercises could further promote plasma volume expansion. We also tested the volume of intervals needed to induce plasma volume expansion. To test the first hypothesis, 10 subjects performed intermittent high-intensity exercise (4 min at 85% V̇_O2max , 5 min at 40% V̇_O2max repeated 8 times) on separate days on the treadmill and cycle ergometer. For the second study, 10 subjects performed four, six, and eight intervals of the same interval protocol on separate days. Changes in plasma volume were calculated from changes in hematocrit and hemoglobin. Transthoracic impedance (Z₀ ) and plasma albumin were assessed while seated before and postexercise. Plasma volume increased 7.3% ± 4.4% and 6.3% ± 3.5% following treadmill and cycle ergometer exercise, respectively. For four, six, and eight intervals, plasma volume increased by 6.6% ± 4.0%, 4.7% ± 2.6%, and 4.2% ± 5.6%, respectively. The increases in plasma volume were similar for both exercise modes and all three exercise volumes. There were no differences in Z₀ or plasma albumin content between trials. In conclusion, rapid plasma volume expansion following eight bouts of high-intensity intervals appears to be independent of upright exercise posture (treadmill versus cycle ergometer). Meanwhile, plasma volume expansion was similar after four, six, and eight intervals of cycle ergometry.

An epidermal wearable microfluidic patch for simultaneous sampling, storage, and analysis of biofluids with counterion monitoring

Simultaneous access to different biofluids enables an accurate analysis of multiple analytes, leading to a precision diagnosis and appropriate medication. Additionally, establishing a relationship between various markers in different biofluids and their correlation to biomarkers in blood allows the development of an algorithmic approach, which aids non-invasive diagnosis through single parameter monitoring. However, the main bottleneck that exists in multiple biofluid analyses for its clinical implementation is the requirement of an advanced microfluidic coupled device design, which empowers simultaneous collection and monitoring. To tackle this challenge, an epidermal wearable bio-fluidic patch that facilitates simultaneous on-demand extraction, sampling, and storage of sweat and interstitial fluid (ISF) together with monitoring of their corresponding counterions is presented. The clean room free development of a biofluidic patch is realized through 3D integration of laser patterned optimized microfluidic structures, a low-cost screen-printed stimulation module, and a potentiometric chloride (Cl^-) and calcium (Ca²⁺) ion sensing module for adequate dual biofluid sampling and analysis. The developed Cl^- and Ca²⁺ ion-selective sensors exhibit good repeatability, selectivity, acceptable stability, and sensitivity. The proof-of-concept demonstration of the fabricated patch for simultaneous dual-sampling, storage, and monitoring of the sweat Cl^- and ISF Ca²⁺ on a healthy volunteer during different periods of the day leverages its potential in real-time personalized healthcare clinical usages. Furthermore, the patch's electronic interface and use of wireless transmission facilitates a point-of-care non-invasive lab-on-skin application for monitoring the health status of individuals.

Behaviors of Water Intake, Hydration Status, and Related Hydration Biomarkers among Physically Active Male Young Adults in Beijing, China: A Cross-Sectional Study

Studies on the water intake of athletes in daily life are insufficient. The objective was to determine the water intake and hydration status among physically active male young adults. In this cross-sectional studies study, 111 physically active male young adults were recruited. The amount of daily total drinking fluid intake (TDF) among participants was recorded and evaluated in real time over 7 days using the "7-day 24-hour fluid intake questionnaire" (liq. In 7). The daily water intake from food (WFF) was calculated using the weighing, duplicate portion, and direct-drying method over 3 days. All urine samples over 3 days were collected, and urine biomarkers were determined. According to 24 h urine osmolality, the participants were divided into three groups with euhydration status, middle hydration, and hypo hydration statuses. Finally, 109 participants completed the study. The median daily total water intake (TWI), TDF, and WFF were 2701, ik1789, and 955 mL, respectively. Among participants, 17 participants (16%) were in euhydration status, 47 participants (43%) were in hypohydration, and 45 participants (41%) were in middle hydration. There were statistical significances in the 24 h urine volume, osmolality, urine specific gravity, and concentrations of K, Na, and Cl in different hydration statuses (χ ²  = 28.212, P < 0.01; χ ²  = 91.341, P < 0.01; χ ²  = 47.721, P < 0.01; χ ²  = 41.548, P < 0.01; χ ²  = 46.863, P < 0.01; and χ ²  = 40.839, P < 0.01). Moderate-intensity correlations were found between the TDF and 24 h urine volume, 24 h urine osmolality, 24 h urine Na concentration, morning urine osmolality, and morning urine Na concentration (r = 0.408, P < 0.01; r = -0.378, P < 0.01; r = -0.325, P < 0.01; r = -0.344, P < 0.01; and r = -0.329, P < 0.01). There were also moderate-intensity correlations between the TDF and 24 h urine osmolality, morning urine osmolality, and morning urine Na concentration (r = -0.365, P < 0.01; r = -0.371, P < 0.01; and r = -0.322, P = 0.01). Increased and higher moderate-intensity correlations were found between plain water and 24 h urine volume, 24 h urine osmolality, 24 h urine K and Na concentration, morning urine osmolality, and morning urine Na concentration (r = 0.374, P < 0.01; r = -0.520, P < 0.01; r = -0.312,P < 0.01; r = -0.355, P < 0.01; r = -0.446, P < 0.01; and r = -0.378, P < 0.01). Insufficient water intake and hypohydration were common among physically active male young adults. The amount and type of water intake were correlated with hydration status and urine biomarkers. The results could provide scientific and accurate references for the development of recommendations on water intake for athletes.

Fluid and electrolyte balance considerations for female athletes

This review explores the effects of oestrogen and progesterone fluctuations across the menstrual cycle on fluid and electrolyte balance. The review aims to provide information on this topic for the exercising female but also for researchers working in this field. Beginning with a basic introduction to fluid and electrolyte balance, the review goes on to describe how oestrogen and progesterone have independent and integrated roles to play in the regulation of fluid and electrolyte balance. Despite evidence that oestrogen can influence the osmotic threshold for arginine vasopressin release, and that progesterone can influence aldosterone production, these actions do not appear to influence fluid retention, plasma volume changes at rest and during exercise, or electrolyte losses. However, the large inter-individual variations in hormonal fluctuations throughout the menstrual cycle may mean that specific individuals with high fluctuations could experience disturbances in their fluid and electrolyte balance. During phases of oestrogen dominance (e.g. late-follicular phase) heat dissipation is promoted, while progesterone dominance (e.g. mid-luteal phase) promotes heat conservation with overall higher basal body temperature. However, these responses do not consistently lead to any change in observed sweat rates, heat-stress, or dehydration during exercise. Finally, the literature does not support any difference in fluid retention during post-exercise rehydration periods conducted at different menstrual cycle phases. Although these mean responses largely reveal no effects on fluid and electrolyte balance, further research is required particularly in those individuals who experience high hormonal fluctuations, and greater exploration of oestrogen to progesterone interactions is warranted.

The time course of calf muscle fluid volume during prolonged running

Muscle fluid is essential for the biochemistry and the biomechanics of muscle contraction. Here, we provide evidence that muscle fluid volumes undergo significant changes during 75 min of moderate intensity (2.7 ± 0.4 m/s) running. Using MRI measurements at baseline and after 2.5, 5, 10, 15, 45 and 75 min, we found that the volumes of calf muscles (quantified through average cross‐sectional area) in 18 young recreational runners increase (up to 9% in the gastrocnemii) at the beginning and decrease (below baseline levels) at later stages of running. However, the intensity of changes varied between analyzed muscles. We speculate that these changes are induced by muscle activity and dehydration‐related changes in osmotic pressure gradients between intramuscular and extramuscular spaces. These findings highlight the complex nature of muscle fluid shifts during prolonged running exercise.

Validity of water compartments estimated using bioimpedance spectroscopy in athletes differing in hydration status

We aimed to validate bioelectrical impedance spectroscopy (BIS), compared with tracer dilution measurements, for assessing total body water (TBW), intracellular water (ICW), and extracellular water (ECW) in athletes differing in hydration status. A total of 201 athletes participated. Reference TBW and ECW were determined by deuterium and bromide dilution methods, respectively; ICW was calculated as TBW-ECW. Water compartments were estimated by BIS. Urine specific gravity (USG) classified athletes into well-hydrated (WH) (USG < 1.023), euhydrated (EH) (USG:1.024-1.026), and dehydrated (DH) (USG>1.027). No significant differences were found between BIS and the reference methods for WH, EH, and DH athletes for TBW, ICW nor ECW (p>0.05). Concordance of TBW and its compartments by method was significant (p < 0.001) with coefficients of determination ranging by hydration classification [EH:52-96%;DH:56-98%;WH:71-96%]. Bland-Altman analyses showed no trend for TBW and its compartments with the exception of ICW in the WH athletes. The 95% confidence BIS intervals for the WH group ranged from -3.08 to 2.68 kg for TBW, -4.28 to 4.14 kg for ICW, and -3.29 to 3.02 kg for ECW. For the EH athletes, the 95% confidence intervals ranged from -2.78 to 2.24 kg for TBW, -4.10 to 3.94 kg for ICW, and -3.44 to 3.06 kg for ECW. In DH group, TBW ranged between -1.99 and 2.01 kg, ICW between -3.78 and 6.34 kg, and ECW between -6.22 and 3.74 kg. These findings show that BIS is useful at a group level in assessing water compartments in athletes differing in hydration status. However, the usefulness of BIS is limited at an individual level, especially in dehydrated athletes.

Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies

A rise in body core temperature and loss of body water via sweating are natural consequences of prolonged exercise in the heat. This review provides a comprehensive and integrative overview of how the human body responds to exercise under heat stress and the countermeasures that can be adopted to enhance aerobic performance under such environmental conditions. The fundamental concepts and physiological processes associated with thermoregulation and fluid balance are initially described, followed by a summary of methods to determine thermal strain and hydration status. An outline is provided on how exercise-heat stress disrupts these homeostatic processes, leading to hyperthermia, hypohydration, sodium disturbances, and in some cases exertional heat illness. The impact of heat stress on human performance is also examined, including the underlying physiological mechanisms that mediate the impairment of exercise performance. Similarly, the influence of hydration status on performance in the heat and how systemic and peripheral hemodynamic adjustments contribute to fatigue development is elucidated. This review also discusses strategies to mitigate the effects of hyperthermia and hypohydration on exercise performance in the heat by examining the benefits of heat acclimation, cooling strategies, and hyperhydration. Finally, contemporary controversies are summarized and future research directions are provided.

Salt and water balance after sweat loss: A study of Bikram yoga

Bikram yoga is practiced in a room heated to 105°F with 40% humidity for 90 min. During the class a large volume of water and electrolytes are lost in the sweat, specifically, sodium is lost, the main cation of the extracellular fluid. There is little known about the volume of sweat and the amount of sodium lost in sweat during Bikram yoga or the optimum quantity of fluid required to replace these losses. The participants who took part in this small feasibility study were five females with a mean age of 47.4 ± 4.7 years and 2.6 ± 1.6 years of experience at Bikram yoga. The total body weight, water consumed, serum sodium concentration, serum osmolality, and serum aldosterone levels were all measured before and after a Bikram yoga practice. Sweat sodium chloride concentration and osmolality were measured at the end of the practice. The mean estimated sweat loss was 1.54 ± 0.65 L, while the amount of water consumed during Bikram yoga was 0.38 ± 0.22 L. Even though only 25% of the sweat loss was replenished with water intake during the Bikram yoga class, we did not observe a change in serum sodium levels or serum osmolality. The sweat contained 82 ± 16 mmol/L of sodium chloride for an estimated total of 6.8 ± 2.1 g of sodium chloride lost in the sweat. The serum aldosterone increased 3.5-fold from before to after Bikram yoga. There was a decrease in the extracellular body fluid compartment of 9.7%. Sweat loss in Bikram yoga predominately produced a volume depletion rather than the dehydration of body fluids. The sweating-stimulated rise in serum aldosterone levels will lead to increased sodium reabsorption from the kidney tubules and restore the extracellular fluid volume over the next 24 hr.

Reviewing the current methods of assessing hydration in athletes

Background

Despite a substantial body of research, no clear best practice guidelines exist for the assessment of hydration in athletes. Body water is stored in and shifted between different sites throughout the body complicating hydration assessment. This review seeks to highlight the unique strengths and limitations of various hydration assessment methods described in the literature as well as providing best practice guidelines.

Main body

There is a plethora of methods that range in validity and reliability, including complicated and invasive methods (i.e. neutron activation analysis and stable isotope dilution), to moderately invasive blood, urine and salivary variables, progressing to non-invasive metrics such as tear osmolality, body mass, bioimpedance analysis, and sensation of thirst. Any single assessment of hydration status is problematic. Instead, the recommended approach is to use a combination, which have complementary strengths, which increase accuracy and validity. If methods such as salivary variables, urine colour, vital signs and sensation of thirst are utilised in isolation, great care must be taken due to their lack of sensitivity, reliability and/or accuracy. Detailed assessments such as neutron activation and stable isotope dilution analysis are highly accurate but expensive, with significant time delays due to data analysis providing little potential for immediate action. While alternative variables such as hormonal and electrolyte concentration, bioimpedance and tear osmolality require further research to determine their validity and reliability before inclusion into any test battery.

Conclusion

To improve best practice additional comprehensive research is required to further the scientific understanding of evaluating hydration status.

Calcium loss in sweat does not stimulate PTH release: A study of Bikram hot yoga

It has been hypothesized that sweat loss during exercise causes a disruption in calcium homeostasis that activates bone resorption and over time leads to low bone mineral density. The purpose of this small pilot study was to determine whether dermal calcium loss from a bout of excessive sweating during light intensity physical activity triggers an increase in biomarkers of bone resorption. Biochemical markers related to bone homeostasis were measured before and after a 90 min Bikram hot yoga practice performed in a room heated to 105 °F with 40 % humidity. Participants were five females with a mean age of 47.4 ± 4.7 years. Nude body weight, serum total calcium (Ca²⁺), free ionized calcium, albumin, parathyroid hormone (PTH) and CTX-I were measured before and after a Bikram hot yoga practice. Mean estimated sweat loss was 1.54 ± 0.65 L, which elicited a 1.9 ± 0.9 % decrease in participant's body weight. Mean Ca²⁺ concentration in sweat was 2.9 ± 1.7 mg/dl and the estimated mean total calcium lost was 41.3 ± 16.4 mg. Serum ionized Ca²⁺ increased from 4.76 ± 0.29 mg/dl to 5.35 ± 0.36 mg/dl after the Bikram hot yoga practice (p =  0.0118). Serum PTH decreased from pre- 33.9 ± 3.3 pg/ml to post- 29.9 ± 2.1 pg/ml yoga practice (p =  0.0015) when adjusted for hemoconcentration (PTH_ADJ), implying a decrease in PTH secretion. We conclude that calcium loss in sweat during 90 min of Bikram hot yoga did not trigger an increase in PTH secretion and did not initiate bone resorption.

Changes in salivary electrolyte concentrations in mid-distance trained sled dogs during 12 weeks of incremental conditioning

Regular exercise improves the health status of dogs; however, extreme exertion in the absence of adequate fluid and electrolyte replacement may negatively impact health and performance due to dehydration and cardiovascular stress. Unlike humans and horses, dogs thermoregulate predominantly through respiration and salivation, yet there is a dearth of literature defining exercise-induced changes to canine salivary electrolytes. The study objective was to investigate the effects of exercise on salivary electrolyte concentrations, and to determine if adaptations may occur in response to incremental conditioning in client-owned Siberian Huskies. Sixteen dogs were used, with an average age of 4.8 ± 2.5 years and body weight of 24.3 ± 4.3 kg. A 12-week exercise regimen was designed to increase in distance each week, but weather played a role in setting the daily distance. Saliva samples were collected at weeks 0 (pre-run, 5.7 km), 5 (pre-run, 5.7, 39.0 km), and 11 (pre-run, 5.7, 39.0 km). Samples were analyzed for sodium, chloride, potassium, calcium, magnesium, and phosphorous using photometric and indirect ion-selective electrode analysis. When compared across weeks, sodium, chloride, potassium, and calcium concentrations did not differ at any sampling time point; however, phosphorus and magnesium concentrations increased from baseline. Data were then pooled across weeks to evaluate changes due to distance and level of conditioning. Sodium, chloride, and magnesium concentrations increased progressively with distance ran, suggesting that these electrolytes are primarily being lost as exercising dogs salivate. Repletion of these minerals may assist in preventing exercise-induced electrolyte imbalance in physically active dogs.

Hydration Efficacy of a Milk Permeate-Based Oral Hydration Solution

Milk permeate is an electrolyte-rich, protein- and fat-free liquid with a similar carbohydrate and mineral content to that of milk. Its hydration efficacy has not been examined. The beverage hydration index (BHI) has been used to compare various beverages to water in terms of post-ingestion fluid balance and retention. Our purpose was to compare the BHI (and related physiological responses) of a novel milk permeate solution (MPS) to that of water and a traditional carbohydrate–electrolyte solution (CES). Over three visits, 12 young subjects consumed 1 L of water, CES, or MPS. Urine samples were collected immediately post-ingestion and at 60, 120, 180, and 240 min. BHI was calculated by dividing cumulative urine output after water consumption by cumulative urine output for each test beverage at each time point. The BHI for MPS was significantly higher at all time points compared to water (all p < 0.001) and CES (all p ≤ 0.01) but did not differ between CES and water at any time point. Drinking 1 L of MPS resulted in decreased cumulative urine output across the subsequent 4 h compared to water and CES, suggesting that a beverage containing milk permeate is superior to water and a traditional CES at sustaining positive fluid balance post-ingestion.

Permanent tattooing has no impact on local sweat rate, sweat sodium concentration and skin temperature or prediction of whole-body sweat sodium concentration during moderate-intensity cycling in a warm environment

PURPOSES

This study investigated the impact of permanently tattooed skin on local sweat rate, sweat sodium concentration and skin temperature and determined whether tattoos alter the relationship between local and whole-body sweat sodium concentration.

METHODS

Thirteen tattooed men (27 ± 6 years) completed a 1 h (66 ± 4% of [Formula: see text]) cycling trial at 32 °C, 35% relative humidity. Sweat rate and sweat sodium concentration were measured using the whole-body washdown and local absorbent patch techniques. Patches and skin-temperature probes were applied over the right/left thighs and tattooed/non-tattooed (contralateral) regions.

RESULTS

Local sweat rates did not differ (p > 0.05) between the right (1.11 ± 0.38) and left (1.21 ± 0.37) thighs and the permanently tattooed (1.93 ± 0.82) and non-tattooed (1.72 ± 0.81 mg cm^-2 min^-1) regions. There were no differences in local sweat sodium concentration between the right (58.2 ± 19.4) and left (55.4 ± 20.3) thighs and the permanently tattooed (73.0 ± 22.9) and non-tattooed (70.2 ± 18.9 mmol L^-1) regions. Difference in local skin temperature between the right and left thighs (- 0.043) was similar to that between the permanently tattooed and non-tattooed (- 0.023 °C) regions. Prediction of whole-body sweat sodium concentration for the permanently tattooed (41.0 ± 6.7) and the non-tattooed (40.2 ± 5.3 mmol L^-1) regions did not differ.

CONCLUSION

Permanent tattoos do not alter local sweat rate, sweat sodium concentration or local skin temperature during moderate-intensity cycling exercise in a warm environment. Results from a patch placed over a tattooed surface correctly predicts whole-body sweat sodium concentration from an equation developed from a non-tattooed region.

Exercise-Associated Hyponatremia in Endurance and Ultra-Endurance Performance-Aspects of Sex, Race Location, Ambient Temperature, Sports Discipline, and Length of Performance: A Narrative Review

Exercise-associated hyponatremia (EAH) is defined as a plasma sodium concentration of <135 mmol/L during or after endurance and ultra-endurance performance and was first described by Timothy Noakes when observed in ultra-marathoners competing in the Comrades Marathon in South Africa in the mid-1980s. It is well-established that a decrease in plasma sodium concentration <135 mmol/L occurs with excessive fluid intake. Clinically, a mild hyponatremia will lead to no or very unspecific symptoms. A pronounced hyponatremia (<120 mmol/L) will lead to central nervous symptoms due to cerebral edema, and respiratory failure can lead to death when plasma sodium concentration reaches values of <110–115 mmol/L. The objective of this narrative review is to present new findings about the aspects of sex, race location, sports discipline, and length of performance. The prevalence of EAH depends on the duration of an endurance performance (i.e., low in marathon running, high to very high in ultra-marathon running), the sports discipline (i.e., rather rare in cycling, more frequent in running and triathlon, and very frequent in swimming), sex (i.e., increased in women with several reported deaths), the ambient temperature (i.e., very high in hot temperatures) and the country where competition takes place (i.e., very common in the USA, very little in Europe, practically never in Africa, Asia, and Oceania). A possible explanation for the increased prevalence of EAH in women could be the so-called Varon–Ayus syndrome with severe hyponatremia, lung and cerebral edema, which was first observed in marathon runners. Regarding the race location, races in Europe seemed to be held under rather moderate conditions whereas races held in the USA were often performed under thermally stressing conditions (i.e., greater heat or greater cold).

Altered brain structure with preserved cortical motor activity after exertional hypohydration: a MRI study

Hypohydration exceeding 2% body mass can impair endurance capacity. It is postulated that the brain could be perturbed by hypohydration, leading to impaired motor performance. We investigated the neural effects of hypohydration with magnetic resonance imaging (MRI). Ten men were dehydrated to approximately −3% body mass by running on a treadmill at 65% maximal oxygen consumption (V̇o2max) before drinking to replace either 100% [euhydration (EU)] or 0% [hypohydration (HH)] of fluid losses. MRI was performed before start of trial (baseline) and after rehydration phase (post) to evaluate brain structure, cerebral perfusion, and functional activity. Endurance capacity assessed with a time-to-exhaustion run at 75% V̇o2max was reduced with hypohydration (EU: 45.2 ± 9.3 min, HH: 38.4 ± 10.7 min; P = 0.033). Mean heart rates were comparable between trials (EU: 162 ± 5 beats/min, HH: 162 ± 4 beats/min; P = 0.605), but the rate of rise in rectal temperature was higher in HH trials (EU: 0.06 ± 0.01°C/min, HH: 0.07 ± 0.02°C/min; P < 0.01). In HH trials, a reduction in total brain volume (EU: +0.7 ± 0.6%, HH: −0.7 ± 0.9%) with expansion of ventricles (EU: −2.7 ± 1.6%, HH: +3.7 ± 3.3%) was observed, and vice versa in EU trials. Global and regional cerebral perfusion remained unchanged between conditions. Functional activation in the primary motor cortex in left hemisphere during a plantar-flexion task was similar between conditions (EU: +0.10 ± 1.30%, HH: −0.11 ± 0.31%; P = 0.637). Our findings demonstrate that with exertional hypohydration, brain volumes were altered but the motor-related functional activity was unperturbed.

NEW & NOTEWORTHY Dehydration occurs rapidly during prolonged or intensive physical activity, leading to hypohydration if fluid replenishment is insufficient to replace sweat losses. Altered hydration status poses an osmotic challenge for the brain, leading to transient fluctuations in brain tissue and ventricle volumes. Therefore, the amount of fluid ingestion during exercise plays a critical role in preserving the integrity of brain architecture. These structural changes, however, did not translate directly to motor functional deficits in a simple motor task.

[Exercise-Associated Hyponatremia in Endurance Performance]

Exercise-Associated Hyponatremia in Endurance Performance Abstract. Exercise-associated hyponatremia is defined as a plasma sodium concentration of <135 mmol/l and was first described by Timothy Noakes at the Comrades Marathon in South Africa in the mid-1980s. A decrease in plasma sodium <135 mmol/l occurs with excessive fluid intake. Risk factors include long to very long endurance performance, extreme climatic conditions, female gender and competitions in the USA. Regarding its prevalence by sport, exercise-associated hyponatraemia tends to occur while swimming and running, but rarely when cycling. While mild exercise-associated hyponatremia does not lead to clinical symptoms, severe hyponatremia due to cerebral edema can lead to neurological deficits and even death. The best prevention of exercise-associated hyponatremia is the reduction of fluid intake during exercise.

A randomized trial to assess beverage hydration index in healthy older adults

BACKGROUND

The beverage hydration index (BHI) is a composite measure of fluid balance after consuming a test beverage relative to water. BHI is a relatively new measure that has been explored in young, but not yet older, adults.

OBJECTIVE

The aim of this study was to investigate potential differences in BHI between euhydrated younger and older adults after drinking 4 different commercial beverages. We hypothesized that 1) older subjects would remain in positive fluid balance longer than young subjects after ingestion of each test beverage due to decreased urinary excretion rates, 2) glucose (glu)- and amino acid (AA)-based hydration beverages with sodium would have a BHI greater than water in both groups, and 3) the traditional 2-h postingestion BHI may be inappropriate for older adults.

METHODS

On 5 separate visits, 12 young (23 ± 3 yr, 7 M/5F) and 12 older (67 ± 6 yr, 5 M/7F) subjects consumed 1 L of distilled water, G-20 (6% CHO, 20 mmol/L Na+), G-45 (2.5% CHO, 45 mmol/L Na+), AA-30 (5 AAs, 30 mmol/L Na+), or AA-60 (8 AAs, 60 mmol/L Na+) over 30 min. Blood and urine samples were collected before ingestion and at 0, 60, 120, 180, and 240 min postingestion with additional venous blood sampling at 5, 10, 15, and 30 min postingestion.

RESULTS

In young subjects, BHI increased with increasing beverage Na+ concentration, and AA-60 had the highest BHI (AA-60 = 1.24 ± 0.10 compared with water = 1.00, P = 0.01). For older subjects, BHI was highest in AA-30 (AA-30; 1.20 ± 0.13 compared with water, P < 0.01) and was still in flux beyond 2 h in AA-60 (P < 0.05).

CONCLUSIONS

Beverage Na+ content progressively increased BHI in young adults independent of glucose or AA content. For older adults, the AA-30 beverage had the highest BHI. A 4-h BHI may be more appropriate for older adults due to attenuated urine excretion rates. This trial was registered at clinicaltrials.gov as NCT03559101.

Measurement of cations, anions, and acetate in serum, urine, cerebrospinal fluid, and tissue by ion chromatography

Accurate quantification of cations and anions remains a major diagnostic tool in understanding diseased states. The current technologies used for these analyses are either unable to quantify all ions due to sample size/volume, instrument setup/method, or are only able to measure ion concentrations from one physiological sample (liquid or solid). Herein, we adapted a common analytical chemistry technique, ion chromatography and applied it to measure the concentration of cations; sodium, potassium, calcium, and magnesium (Na⁺, K⁺, Ca²⁺, and Mg²⁺) and anions; chloride, and acetate (Cl⁻, ⁻OAc) from physiological samples. Specifically, cations and anions were measured in liquid samples: serum, urine, and cerebrospinal fluid, as well as tissue samples: liver, cortex, hypothalamus, and amygdala. Serum concentrations of Na⁺, K⁺, Ca²⁺, Mg²⁺, Cl⁻, and ⁻OAc (mmol/L): 138.8 ± 4.56, 4.05 ± 0.21, 4.07 ± 0.26, 0.98 ± 0.05, 97.7 ± 3.42, and 0.23 ± 0.04, respectively. Cerebrospinal fluid concentrations of Na⁺, K⁺, Ca²⁺, Mg²⁺, Cl⁻, and ⁻OAc (mmol/L): 145.1 ± 2.81, 2.41 ± 0.26, 2.18 ± 0.38, 1.04 ± 0.11, 120.2 ± 3.75, 0.21 ± 0.05, respectively. Tissue Na⁺, K⁺, Ca²⁺, Mg²⁺, Cl⁻, and ⁻OAc were also measured. Validation of the ion chromatography method was established by comparing chloride concentration between ion chromatography with a known method using an ion selective chloride electrode. These results indicate that ion chromatography is a suitable method for the measurement of cations and anions, including acetate from various physiological samples.

Interactions between body fluid homeostasis and thermoregulation in humans

Humans are unique in their ability to control body temperature with a large amount of skin blood flow and sweat rate while exercising in an upright position. However, cutaneous vasodilation in the body reduces total peripheral resistance and blood pooling in cutaneous veins decreases venous return to the heart and cardiac filling pressure. In addition, hypovolemia by sweating accelerates the reduction in cardiac filling pressure. These may threaten the maintenance of blood pressure if they are not compensated for. To prevent this, cutaneous vasodilation and sweat rate are suppressed by baroreflexes or hyperosmolality with dehydration. These mechanisms suppress heat dissipation, accelerate the increase in body temperature, and sometimes cause heat stroke. As a countermeasure to prevent this, we have recommended glucose electrolyte solutions but recently found that aerobic training with carbohydrate + whey protein supplementation markedly improves heat dissipation mechanisms by plasma volume expansion. In this article, we will discuss the importance of improving body fluid homeostasis for thermoregulation under heat stress in humans and the strategy to attain this.

Fluid intake restores retinal blood flow early after exhaustive exercise in healthy subjects

PURPOSE

It remains unclear whether rehydration restores retinal blood flow reduced by exhaustive exercise. We investigated the effect of fluid intake on retinal blood flow after exhaustive exercise.

METHODS

Blood flow in the inferior (ITRA) and superior temporal retinal arterioles (STRA) was measured before and after incremental cycling exercise until exhaustion in 13 healthy males. After the exercise, the subjects rested without drinking (control condition: CON) or with drinking an electrolyte containing water (rehydrate condition: REH) and were followed up for a period of 120 min. To assess the hydration state, the body mass was measured, and venous blood samples were collected and plasma volume (PV) was calculated.

RESULTS

Body mass decreased in CON after the trial [- 1.1 ± 0.1% (mean ± SE), p < 0.05]. PV was lower in CON than in REH during recovery. The ITRA and STRA blood flows decreased immediately after exercise from the resting baseline (ITRA; - 23 ± 4% in REH and - 30 ± 4% in CON, p < 0.05). The ITRA blood flow recovered baseline level at 15 min of recovery in REH (- 9 ± 3%, p = 0.5), but it remained reduced in CON (-14 ± 3%, p < 0.05). The STRA blood flow was higher in REH than in CON at 15 min (2 ± 3 vs. - 5 ± 3%, p < 0.05).

CONCLUSIONS

The results of this study suggest that the reduction in retinal blood flow induced by exhaustive exercise can be recovered early by rehydration.

Engineering Approaches to Assessing Hydration Status

Dehydration is a common condition characterized by a decrease in total body water. Acute dehydration can cause physical and cognitive impairment, heat stroke and exhaustion, and, if severe and uncorrected, even death. The health effects of chronic mild dehydration are less well studied with urolithiasis (kidney stones) the only condition consistently associated with it. Aside from infants and those with particular medical conditions, athletes, military personnel, manual workers, and older adults are at particular risk of dehydration due to their physical activity, environmental exposure, and/or challenges in maintaining fluid homeostasis. This review describes the different approaches that have been explored for hydration assessment in adults. These include clinical indicators perceived by the patient or detected by a practitioner and routine laboratory analyses of blood and urine. These techniques have variable accuracy and practicality outside of controlled environments, creating a need for simple, portable, and rapid hydration monitoring devices. We review the wide array of devices proposed for hydration assessment based on optical, electromagnetic, chemical, and acoustical properties of tissue and bodily fluids. However, none of these approaches has yet emerged as a reliable indicator in diverse populations across various settings, motivating efforts to develop new methods of hydration assessment.

Do Bodybuilders Use Evidence-Based Nutrition Strategies to Manipulate Physique?

Competitive bodybuilders undergo strict dietary and training practices to achieve an extremely lean and muscular physique. The purpose of this study was to identify and describe different dietary strategies used by bodybuilders, their rationale, and the sources of information from which these strategies are gathered. In-depth interviews were conducted with seven experienced (10.4 ± 3.4 years bodybuilding experience), male, natural bodybuilders. Participants were asked about training, dietary and supplement practices, and information resources for bodybuilding strategies. Interviews were transcribed verbatim and analyzed using qualitative content analysis. During the off-season, energy intake was higher and less restricted than during the in-season to aid in muscle hypertrophy. There was a focus on high protein intake with adequate carbohydrate to permit high training loads. To create an energy deficit and loss of fat mass, energy intake was gradually and progressively reduced during the in-season via a reduction in carbohydrate and fat intake. The rationale for weekly higher carbohydrate refeed days was to offset declines in metabolic rate and fatigue, while in the final “peak week” before competition, the reasoning for fluid and sodium manipulation and carbohydrate loading was to enhance the appearance of leanness and vascularity. Other bodybuilders, coaches and the internet were significant sources of information. Despite the common perception of extreme, non-evidence-based regimens, these bodybuilders reported predominantly using strategies which are recognized as evidence-based, developed over many years of experience. Additionally, novel strategies such as weekly refeed days to enhance fat loss, and sodium and fluid manipulation, warrant further investigation to evaluate their efficacy and safety.

Impact of Carbohydrate-Electrolyte Beverage Ingestion on Heart Rate Response While Climbing Mountain Fuji at ~3000 m

We sought to investigate whether carbohydrate-electrolyte beverage ingestion reduced heart rate (HR) in twenty-three healthy young adults while climbing Mount Fuji at a given exercise intensity. Twenty-three healthy adults were randomly divided into two groups: the tap water (11 males [M] and 1 female [F]) and the carbohydrate-electrolyte group (10 M and 1 F). HR and activity energy expenditure (AEE) were recorded every min. The HRs for the first 30 minutes of climbing were not significantly different between the groups [121 ± 2 beats per min (bpm) in the tap water and 116 ± 3 bpm in the carbohydrate-electrolyte]; however, HR significantly increased with climbing in the tap water group (129 ± 2 bpm) but showed no significant increase in the carbohydrate-electrolyte group (121 ± 3 bpm). In addition, body weight changes throughout two days ascending and descending on Mount Fuji were inversely related to changes in resting HR. Further, individual variation of body weight changes was suppressed by carbohydrate-electrolyte drink. Collectively, carbohydrate-electrolyte beverage intake may attenuate an increase in HR at a given AEE while mountaineering at ~3000 m compared with tap water intake.

Effect of hypohydration on postsynaptic cutaneous vasodilation and sweating in healthy men

Hypohydration decreases cutaneous vasodilation and sweating during heat stress, but it is unknown if these decrements are from postsynaptic (i.e., sweat gland/blood vessel) alterations. The purpose of this study was to determine if hypohydration affects postsynaptic cutaneous vasodilation and sweating responses. Twelve healthy men participated in euhydrated (EU) and hypohydrated (HY) trials, with hypohydration induced via fluid restriction and passive heat stress. Changes in cutaneous vascular conductance (CVC; %max) in response to incremental intradermal infusion of the endothelium-independent vasodilator sodium nitroprusside (SNP) and the endothelium-dependent vasodilator methacholine chloride (MCh) were assessed by laser Doppler flowmetry. Local sweat rate (LSR) was simultaneously assessed at the MCh site via ventilated capsule. At the end of the last dose, maximal CVC was elicited by delivering a maximal dose of SNP (5 × 10−2 M) for 30 min to both sites with simultaneous local heating (~44°C) at the SNP site. The concentration of drug needed to elicit 50% of the maximal response (log EC50) was compared between hydration conditions. The percent body mass loss was greater with HY vs. EU (−2.2 ± 0.7 vs. −0.1 ± 0.7%, P < 0.001). Log EC50 of endothelium-dependent CVC was lower with EU (−3.62 ± 0.22) vs. HY (−2.93 ± 0.08; P = 0.044). Hypohydration did not significantly alter endothelium-independent CVC or LSR (both P > 0.05). In conclusion, hypohydration attenuated endothelium-dependent CVC but did not affect endothelium-independent CVC or LSR responses. These data suggest that reductions in skin blood flow accompanying hypohydration can be partially attributed to altered postsynaptic function.

Potassium Homeostasis, Oxidative Stress, and Human Disease

Potassium is the most abundant cation in the intracellular fluid and it plays a vital role in the maintenance of normal cell functions. Thus, potassium homeostasis across the cell membrane, is very critical because a tilt in this balance can result in different diseases that could be life threatening. Both Oxidative stress (OS) and potassium imbalance can cause life threatening health conditions. OS and abnormalities in potassium channel have been reported in neurodegenerative diseases. This review highlights the major factors involved in potassium homeostasis (dietary, hormonal, genetic, and physiologic influences), and discusses the major diseases and abnormalities associated with potassium imbalance including hypokalemia, hyperkalemia, hypertension, chronic kidney disease, and Gordon's syndrome, Bartter syndrome, and Gitelman syndrome.

Water intake and urinary hydration biomarkers in children

BACKGROUND/OBJECTIVES

The aims of the study were as follows: (1) examine fluid intake and urinary hydration markers of children in Greece, (2) determine the calculated relative risk of hypohydration in children who did not meet the recommendations for daily water intake provided by the Institute of Medicine and the European Food Safety Authority compared with those who did and (3) analyze the efficacy of the recommendations as a method to achieve euhydration in children.

SUBJECTS/METHODS

One hundred and fifty Greek boys and girls (age 9-13) recorded their fluid intake for 2 consecutive days. A 24-h urine collection was obtained during the second day. Fluid intake records were analyzed for total water intake from fluids (TWI-F), and urine samples were analyzed for osmolality, color, specific gravity and volume. Urine osmolality ⩾800 mmol/kg H₂O was defined as hypohydration.

RESULTS

Water intake from fluids was 1729 (1555-1905) and 1550 (1406-1686) ml/d for boys and girls, respectively. Prevalence of hypohydration was 33% (44% of boys, 23% of girls). Children who failed to meet TWI-F recommendations demonstrated a risk of hypohydration that was 1.99-2.12 times higher than those who met recommendations (P⩽0.01). Boys between 9 and 13 years displayed urine osmolality of 777 (725-830) mmol/kg, and urine specific gravity of 1.021 (1.019-1.022), which was higher than those in girls between 9-13 years (P⩽0.015), and >27% were classified as hypohydrated despite meeting water intake recommendations.

CONCLUSIONS

Failure to meet TWI-F guidelines increased calculated relative risk of hypohydration in children. Boys between 9 and 13 years are at greater hazard regardless of meeting guidelines and may require greater water intake to avoid elevated urine concentration and ensure adequate hydration.

Heat stress and dehydration in adapting for performance: Good, bad, both, or neither?

Physiological systems respond acutely to stress to minimize homeostatic disturbance, and typically adapt to chronic stress to enhance tolerance to that or a related stressor. It is legitimate to ask whether dehydration is a valuable stressor in stimulating adaptation per se. While hypoxia has had long-standing interest by athletes and researchers as an ergogenic aid, heat and nutritional stressors have had little interest until the past decade. Heat and dehydration are highly interlinked in their causation and the physiological strain they induce, so their individual roles in adaptation are difficult to delineate. The effectiveness of heat acclimation as an ergogenic aid remains unclear for team sport and endurance athletes despite several recent studies on this topic. Very few studies have examined the potential ergogenic (or ergolytic) adaptations to ecologically-valid dehydration as a stressor in its own right, despite longstanding evidence of relevant fluid-regulatory adaptations from short-term hypohydration. Transient and self-limiting dehydration (e.g., as constrained by thirst), as with most forms of stress, might have a time and a place in physiological or behavioral adaptations independently or by exacerbating other stressors (esp. heat); it cannot be dismissed without the appropriate evidence. The present review did not identify such evidence. Future research should identify how the magnitude and timing of dehydration might augment or interfere with the adaptive processes in behaviorally constrained versus unconstrained humans.

Adaptations and mechanisms of human heat acclimation: Applications for competitive athletes and sports

Exercise heat acclimation induces physiological adaptations that improve thermoregulation, attenuate physiological strain, reduce the risk of serious heat illness, and improve aerobic performance in warm-hot environments and potentially in temperate environments. The adaptations include improved sweating, improved skin blood flow, lowered body temperatures, reduced cardiovascular strain, improved fluid balance, altered metabolism, and enhanced cellular protection. The magnitudes of adaptations are determined by the intensity, duration, frequency, and number of heat exposures, as well as the environmental conditions (i.e., dry or humid heat). Evidence is emerging that controlled hyperthermia regimens where a target core temperature is maintained, enable more rapid and complete adaptations relative to the traditional constant work rate exercise heat acclimation regimens. Furthermore, inducing heat acclimation outdoors in a natural field setting may provide more specific adaptations based on direct exposure to the exact environmental and exercise conditions to be encountered during competition. This review initially examines the physiological adaptations associated with heat acclimation induction regimens, and subsequently emphasizes their application to competitive athletes and sports.

Validation of a urine color scale for assessment of urine osmolality in healthy children

AIM

Urine color (UC) is a practical tool for hydration assessment. The technique has been validated in adults, but has not been tested in children.

PURPOSE

The purpose of the study was to test the validity of the urine color scale in young, healthy boys and girls, as a marker of urine concentration, investigate its diagnostic ability of detecting hypohydration and examine the ability of children to self-assess UC.

METHODS

A total of 210 children participated (age: 8-14 years, body mass: 43.4 ± 12.6 kg, height: 1.49 ± 0.13 m, body fat: 25.2 ± 7.8 %). Data collection included: two single urine samples (first morning and before lunch) and 24-h sampling. Hydration status was assessed via urine osmolality (UOsmo) and UC via the eight-point color scale.

RESULTS

Mean UC was 3 ± 1 and UOsmo 686 ± 223 mmol kg(-1). UC displayed a positive relationship as a predictor of UOsmo (R (2): 0.45, P < 0.001). Based on the receiver operating curve, UC has good overall classification ability for the three samples (area under the curve 85-92 %), with good sensitivity (92-98 %) and specificity (55-68 %) for detecting hypohydration. The overall accuracy of the self-assessment of UC in the morning or the noon samples ranged from 67 to 78 %. Further threshold analysis indicated that the optimal self-assessed UC threshold for hypohydration was ≥4.

CONCLUSIONS

The classical eight-point urine color scale is a valid method to assess hydration in children of age 8-14 years, either by researchers or self-assessment.

Dehydration: physiology, assessment, and performance effects

This article provides a comprehensive review of dehydration assessment and presents a unique evaluation of the dehydration and performance literature. The importance of osmolality and volume are emphasized when discussing the physiology, assessment, and performance effects of dehydration. The underappreciated physiologic distinction between a loss of hypo-osmotic body water (intracellular dehydration) and an iso-osmotic loss of body water (extracellular dehydration) is presented and argued as the single most essential aspect of dehydration assessment. The importance of diagnostic and biological variation analyses to dehydration assessment methods is reviewed and their use in gauging the true potential of any dehydration assessment method highlighted. The necessity for establishing proper baselines is discussed, as is the magnitude of dehydration required to elicit reliable and detectable osmotic or volume-mediated compensatory physiologic responses. The discussion of physiologic responses further helps inform and explain our analysis of the literature suggesting a ≥ 2% dehydration threshold for impaired endurance exercise performance mediated by volume loss. In contrast, no clear threshold or plausible mechanism(s) support the marginal, but potentially important, impairment in strength, and power observed with dehydration. Similarly, the potential for dehydration to impair cognition appears small and related primarily to distraction or discomfort. The impact of dehydration on any particular sport skill or task is therefore likely dependent upon the makeup of the task itself (e.g., endurance, strength, cognitive, and motor skill).

Characterization of the effects of the vasopressin V2 receptor on sweating, fluid balance, and performance during exercise

A regulatory effect of arginine vasopressin (AVP) on sweat water conservation has been hypothesized but not definitively evaluated. AVP-mediated insertion of sweat and salivary gland aquaporin-5 (AQP5) water channels through activation of the vasopressin type 2 receptor (V2R) remains an attractive, yet unexplored, mechanism that could result in a more concentrated sweat with resultant decreased water loss. Ten runners participated in a double-blind randomized control treadmill trial under three separate pharmacological conditions: a placebo, V2R agonist (0.2 mg desmopressin), or V2R antagonist (30 mg tolvaptan). After a familiarization trial, runners ran for 60 min at 60% of peak speed followed by a performance trial to volitional exhaustion. Outcome variables were collected at three exercise time points: baseline, after the steady-state run, and after the performance run. Body weight losses were <2% across all three trials. Significant pharmacological condition effects were noted for urine osmolality [F = 84.98; P < 0.0001] and urine sodium concentration ([Na(+)]) [F = 38.9; P < 0.0001], which verified both pharmacological activation and inhibition of the V2R at the kidney collecting duct. Plasma osmolality and [Na(+)] demonstrated significant exercise (F = 26.0 and F = 11.1; P < 0.0001) and condition (F = 5.1 and F = 3.8; P < 0.05) effects (osmolality and [Na(+)], respectively). No significant exercise or condition effects were noted for either sweat or salivary [Na(+)]. Significant exercise effects were noted for plasma [AVP] (F = 22.3; P < 0.0001), peak core temperature (F = 103.3; P < 0.0001), percent body weight change (F = 6.3; P = 0.02), plasma volume change (F = 21.8; P < 0.0001), and thirst rating (F = 78.2; P < 0.0001). Performance time was not altered between conditions (P = 0.80). In summary, AVP acting at V2R does not appear to regulate water losses from body fluids other than renal excretion during exercise.

The interrelationship of research in the laboratory and the field to assess hydration status and determine mechanisms involved in water regulation during physical activity

Changes in skin blood and sweating are the primary mechanisms for heat loss in humans. A hot, humid environment concomitant with dehydration limits the ability to increase skin blood flow for the purpose of transferring heat from the body core to skin surface and evaporate sweat to maintain core temperature within safe limits during exercise. Adequate hydration improves thermoregulation by maintaining blood volume to support skin blood flow and sweating. Humans rely on fluid intake to maintain total body water and blood volume, and have developed complex mechanisms to sense changes in the amount and composition of fluid in the body. This paper addresses the interrelationship of research in the laboratory and the field to assess hydration status involved in body water and temperature regulation during exercise. In the controlled setting of a research laboratory, investigators are able to investigate the contributions of volume and tonicity of fluid in the plasma to body water and temperature regulation during exercise and recovery. For example, laboratory studies have shown that tonicity in a rehydration beverage maintains the thirst mechanism (and stimulates drinking), and contributes to the ongoing stimulation of renal fluid retention hormones, ultimately leading to a more complete rehydration. Research in the field cannot control the environment precisely, but these studies provide a natural, 'real-life' setting to study fluid and temperature regulation during exercise. The conditions encountered in the field are closest to the environment during competition, and data collected in the field can have an immediate impact on performance and safety during exercise. There is an important synergy between these two methods of collecting data that support performance and protect athletes from harm during training and improve performance during competition.

Whole-body fluid distribution in humans during dehydration and recovery, before and after humid-heat acclimation induced using controlled hyperthermia

AIM

This experiment was designed to test the hypothesis that the plasma volume is not selectively defended during exercise- and heat-induced dehydration following humid-heat acclimation.

METHODS

Eight physically active males were heat acclimated (39.8 °C, relative humidity 59.2%) using 17 days of controlled hyperthermia (core temperature: 38.5 °C). Inter-compartmental fluid losses and movements were tracked (radioisotopes and Evans blue dye) during progressive dehydration (cycling) in these same conditions and also during a resting recovery without fluid replacement (28 °C), before (day 1), during (day 8) and after heat acclimation (day 22).

RESULTS

On days 8 and 22, there were significant increases in total body water, interstitial fluid and plasma volume (P < 0.05), but the intracellular compartments did not change (P > 0.05). The baseline plasma volume remained expanded throughout: 43.4 [±2.6 (day 1)], 49.1 [±2.4 (day 8); P < 0.05] and 48.9 mL kg(-1) [±3.0 (day 22); P < 0.05]. During progressive dehydration, plasma reductions of 9.0% (±0.9: day 1), 12.4% (±1.6: day 8) and 13.6% (±1.2: day 22) were observed, with day 8 and 22 losses significantly exceeding day 1 (P < 0.05). During recovery, plasma volume restoration commenced, with the intracellular fluid contribution becoming more pronounced as acclimation progressed.

CONCLUSION

It is concluded that the plasma volume was not defended more vigorously following humid-heat acclimation. Indeed, a greater fluid loss may well underlie the mechanisms for enhancing plasma volume recovery when heat acclimation is induced using the controlled-hyperthermia technique.

Assessment of extracellular dehydration using saliva osmolality

INTRODUCTION

When substantial solute losses accompany body water an isotonic hypovolemia (extracellular dehydration) results. The potential for using blood or urine to assess extracellular dehydration is generally poor, but saliva is not a simple ultra-filtrate of plasma and the autonomic regulation of salivary gland function suggests the possibility that saliva osmolality (Sosm) may afford detection of extracellular dehydration via the influence of volume-mediated factors.

PURPOSE

This study aimed to evaluate the assessment of extracellular dehydration using Sosm. In addition, two common saliva collection methods and their effects on Sosm were compared.

METHODS

Blood, urine, and saliva samples were collected in 24 healthy volunteers during paired euhydration and dehydration trials. Furosemide administration and 12 h fluid restriction were used to produce extracellular dehydration. Expectoration and salivette collection methods were compared in a separate group of eight euhydrated volunteers. All comparisons were made using paired t-tests. The diagnostic potential of body fluids was additionally evaluated.

RESULTS

Dehydration (3.1 ± 0.5% loss of body mass) decreased PV (-0.49 ± 0.12 L; -15.12 ± 3.94% change), but Sosm changes were marginal (<10 mmol/kg) and weakly correlated with changes in absolute or relative PV losses. Overall diagnostic accuracy was poor (AUC = 0.77-0.78) for all body fluids evaluated. Strong agreement was observed between Sosm methods (Expectoration: 61 ± 10 mmol/kg, Salivette: 61 ± 8 mmol/kg, p > 0.05).

CONCLUSIONS

Extracelluar dehydration was not detectable using plasma, urine, or saliva measures. Salivette and expectoration sampling methods produced similar, consistent results for Sosm, suggesting no methodological influence on Sosm.

Physiologic basis for understanding quantitative dehydration assessment

Dehydration (body water deficit) is a physiologic state that can have profound implications for human health and performance. Unfortunately, dehydration can be difficult to assess, and there is no single, universal gold standard for decision making. In this article, we review the physiologic basis for understanding quantitative dehydration assessment. We highlight how phenomenologic interpretations of dehydration depend critically on the type (dehydration compared with volume depletion) and magnitude (moderate compared with severe) of dehydration, which in turn influence the osmotic (plasma osmolality) and blood volume-dependent compensatory thresholds for antidiuretic and thirst responses. In particular, we review new findings regarding the biological variation in osmotic responses to dehydration and discuss how this variation can help provide a quantitative and clinically relevant link between the physiology and phenomenology of dehydration. Practical measures with empirical thresholds are provided as a starting point for improving the practice of dehydration assessment.

Water-deficit equation: systematic analysis and improvement

BACKGROUND

The water-deficit equation {WD(1) = 0.6 × B(m) × [1 - (140 ÷ Na(+))]; B(m) denotes body mass} is used in medicine and nutrition to estimate the volume (L) of water required to correct dehydration during the initial stages of fluid-replacement therapy. Several equation assumptions may limit its accuracy, but none have been systematically tested.

OBJECTIVES

We quantified the potential error in WD(1) for the estimation of free water (FW) and total body water (TBW) losses and systematically evaluated its assumptions.

DESIGN

Thirty-six euhydrated volunteers were dehydrated (2.2-5.8% B(m)) via thermoregulatory sweating. Assumptions within WD(1) were tested by substituting measured euhydrated values for assumed or unknown values. These included the known (premorbid) B(m) (WD(2)), a proposed correction for unknown B(m) (WD(3)), the TBW estimated from body composition (WD(4)), the actual plasma sodium (WD(5)), the substitution of plasma osmolality (Posm) for sodium (WD(6)), and actual Posm (WD(7)).

RESULTS

Dehydration reduced TBW by 3.49 ± 0.91 L, 57% of which (2.02 ± 0.96 L) was FW loss, and increased plasma sodium from 139 (range: 135-143 mmol/L) to 143 (range: 141-148 mmol/L) mmol/L. Calculations for WD(1) through WD(7) all underestimated TBW loss by 1.5-2.5 L (P < 0.05). WD(1) through WD(5) underestimated FW by 0.5 L to 1.0 L (P < 0.05), but WD(6) and WD(7) estimated FW loss to within 0.06-0.16 L (P > 0.05).

CONCLUSIONS

WD(1) grossly underestimates TBW and FW losses. Corrections for unknowns and assumptions (WD(2) through WD(5)) improved estimates little. The use of WD(6) = 0.6 × B(m) × [1 - (290 ÷ Posm)] accurately estimates FW but still underestimates TBW losses by >40%.