Evaluating body hydration -
The child's current dehydrated weight can be used for calculation of dehydration and maintenance fluids. After all, clinical assessment of dehydration, and therefore the volume needed for correction, is approximate!
Index of Core Concept Chapters. About Core Concepts. Marie Dawlett MD and Amy Gonzalez MD Dept. of Pediatrics University of Texas Medical Branch. Fluid and Electrolyte Therapy A Chapter in Core Concepts of Pediatrics, 2nd Edition.
Contents The Need for Water Routes of Water Loss Determinants of Water Loss Normal Maintainence Requirements Na and K Requirements Common IV Fluids Maintenance in Disease Dehydration in Children Assessment of Dehydration Replacement Fluid Therapy Oral Rehydration. The Need for Water Routes of Water Loss Determinants of Water Loss Normal Maintainence Requirements Na and K Requirements Common IV Fluids Maintenance in Disease Dehydration in Children Assessment of Dehydration Replacement Fluid Therapy Oral Rehydration.
Clinical Assessment of Dehydration C linical assessment of dehydration is always approximate, and the child should be frequently re-evaluated for continuing improvement during correction of dehydration.
PCV may also be affected by other conditions and is seen increased in polycythemia. This was demonstrated in the study by Akimoto et al 41 who reported that 16 out of 28 patients treated for dehydration were ultimately diagnosed with anaemia as haemoglobin and haematocrit declined to lower than the normal ranges after restoring hydration status.
Human serum albumin is a protein circulating in the blood and is responsible for colloid osmotic pressure that facilitates the return of water from interstitial fluid compartment to the blood stream. The possible explanation is its specificity, which could be highly affected by other states; low albumin levels are a frequent finding in clinical setting and are associated with liver disease, nutritional status and malignancies 43 ; hence many dehydrated subjects are likely to present with normal values.
This limitation may be a reason why measurement of albumin to detect dehydration has little application, but considering the fact that this marker is routinely taken in clinical setting, hyperalbuminaemia should alert the clinician to a high possibility of dehydration.
One of the greatest limitations of blood biochemistry parameters is their little usability to detect a mild or impending dehydration.
Especially in chronic dehydration, the laboratory values may climb slowly as hydration deteriorates, therefore it might be useful to monitor biochemistry frequently and compare with previous values.
Since care homes usually do not have staff and facilities to perform venepuncture and laboratory analyses, the data could be requested from GPs when routine tests are performed. Due to tightly controlled mechanisms to maintain fluid balance and the relatively small insensible water losses; the amount of urine excretion is roughly proportional to amount of fluid consumed.
This assumption is taken into account when assessing hydration status using urine parameters. This may not always be true as it is well known that upon ingestion of large bulk of fluid, the body will attempt to excrete the water overload to reduce the chance of overhydration despite of the hydration status.
Urine osmolality concentration of solutes in the urine ; can be measured by osmometer or calculated from the following formula 30 :.
In a study by Manz and Wenz 5 it was evident that variation in urine osmolality depends on diet and differs between cultures. Osmolality also depends on physiological states of protein metabolism and may be affected by concentrating ability of the kidneys.
This method has also been shown to be less effective when used immediately after exercise. This monitoring method has been used in training athletes 1 and in women with recurrent urinary tract infections.
Urine specific gravity SG relates to concentration of solutes and is presented as a ratio of the weight of the urine to the weight of equal amount of water. SG of distilled water equals 1 and the urine values above 1. Besides some normal physiologic states described above, urine specific gravity may be increased due to heart failure, Diabetes Mellitus and liver disease.
Some less precise methods may also underestimate the reading by 0. A series of experiments performed by Armstrong et al 47,49,50 have demonstrated the potential of urine colour in monitoring and managing hydration status.
Urine monitoring can be achieved by using a urine colour chart against a numbered scale, ranging from 1 pale yellow to 8 greenish brown. The authors concluded that despite this technique not being sufficiently precise to assess hydration status in clinical setting, it may be effective enough in other settings where high precision is not required or not possible.
Similar observations were confirmed by follow up studies. They also acknowledged that there may be many confounding factors that limit the usefulness of this method, as renal insufficiency and incontinence are frequent conditions in care homes.
Certain medications such as B vitamins and foods could also influence the urine colour. The authors recommended obtaining a few baseline readings of urine for each individual and when possible taking the urine specimens from the first or second voiding of the day.
They also reported difficulty in obtaining the specimens from incontinent residents; the limitation that was described in the study by Rowat et al 51 who reported that despite great efforts to obtain urine from incontinent stroke patients e.
squeezing out pads and bedding , many samples were lost. Physiological and physical signs and symptoms usually have poor sensitivity and specificity 26,52 and may differ in different age groups. These indices may not distinguish between different types of dehydration and may prompt inappropriate treatment.
The authors reported that about a third of the hospital diagnoses for dehydration were not supported by haematological tests and some conditions should have been diagnosed as hypovolemia. This could be a serious mistake as rehydration therapy without an appropriate electrolyte replacement may lead to overhydration, congestive heart failure and death in the elderly.
While clinical signs and symptoms may not be a reliable method to assess hydration status, they may be a useful tool to suspect water and electrolyte disturbances and prompt clinical investigations for confirmation.
Clinical signs may also be useful in recognizing mild or impending dehydration 35 ; these could be used for monitoring in conjunction with a series of biochemical data to assess deterioration of hydration status.
They may also be associated with other diseases or normal physiological states. The evident sign of dehydration in healthy subjects may be the thirst; but this is known to be diminished in elderly population.
Some people such as young children or physically and cognitively impaired elderly may also not be able to express the needs for drinking despite the strong thirst sensation. Dehydration is also associated with decreased secretion of bodily fluids and it is expected that small production of saliva may be an indication of deteriorating hydration status.
In the studies assessing a variety of signs and symptoms it was found that dry mucosa xerostomia might be useful in measuring hydration status, these included dry tongue, 35,58 tongue furrows 35,59 and dry oral mucosa. The chart identifies four stages of dehydration severe, moderate, mild and no dehydration based on degree of dryness of oral cavity.
Reduction of axillary sweat has also been mentioned in the literature. This could be assessed by placing a piece of tissue or blotting paper under the arm of the subject and absence of perspiration could be an indicator of dehydration.
Studies performed by Gross et al 59 and Eaton et al 62 found that this was not a reliable indicator. There also remains the question of cost and availability of the meters as these are not widely available in clinical setting.
Skin turgor elasticity has been mentioned by few studies, but most report its limitations when assessing hydration status in the elderly.
The turgor is usually assessed by pulling the skin and observing how long it takes to return to the baseline state; with values longer than 2 seconds associated with dehydration. Gross et al 59 found that forearm, but not the sternum may indicate dehydration, while Vivanti et al 35 found no relationship with turgor of the sternum.
Changes of consciousness have been reported by some studies and dehydration is frequently mentioned as a risk factor for delirium. Gross et al 59 found that some parameters were associated with dehydration e. lethargy and confusion , while other such as irritability and aggression were not.
Changes in consciousness may be difficult to diagnose in the elderly since many may suffer from dementia and are also susceptible to delirium due to other reasons. Some other signs often reported in literature include sunken eyes 37,59,67 , tachycardia 35,59,60 , hypotension or postural hypotension 35,58,60 , speech difficulty 59 , muscle weakness 63 and increased capillary refill.
Certain patients in hospitals require close observation and monitoring and fluid balance charts may provide additional support in making clinical decisions.
The charts aim to capture the data on both, fluid intakes and outputs and identify individuals who are in positive or negative balance. While this is important in critically ill patients, studies have shown that these charts are often not filled out appropriately.
Similar findings were observed in NCEPOD AKI report where it was found that fluid balance charts were not seen as integral part of the care plans. The difficulties with accuracy of fluid balance charts arise when capturing the data on urine output for patients who are not catheterised; in particular many urine specimens are not measurable in incontinent subjects and those fully mobile may forget to notify the staff about passing urine independently.
A small study by Reid et al 70 assessed 46 fluid balance charts in acute hospital and found that neither was filled accurately. Some of them had data missing while others had some inappropriate comments e. forgot to measure. The authors reported lack of time, training, communication and accountability as the barriers to this occurring; they also mentioned that some wards did not have necessary equipment to measure the fluids precisely.
Balance charts are also limited to urine and gastrointestinal output and do not aim to measure other insensible losses of water from lungs and sweat, which may underestimate fluid excretion.
The inaccuracy of fluid balance chart was demonstrated by Perren et al 74 who showed that the charts did not correspond with changes in body weight in ICU patients, despite the great efforts to measure all fluids precisely. This may be a particular problem for patients experiencing pyrexia since large amounts of water could be lost through perspiration.
Experts recommend increasing fluid intakes by ml with every degree of fever above 38°C. Fluid intakes alone have also been reported to be inaccurately measured in both, acute and care home setting. Also, in the study performed by Armstrong-Esther et al 75 it was evident that nurses did not know the volumes of the standard cup or glass.
Similar findings were confirmed by Simmons et al 76 who reported that the food and fluid intakes in nursing home residents were significantly over reported; Iggulden 77 also reported that staff tended to guess the amounts consumed and often assume that empty contents meant consumption of the entire drink.
This is in line with another study performed by Jimoh et al 78 who found no correlation between observed and documented fluid intakes in residential care homes and demonstrated a potential of some residents to complete their own drink diaries. Armstrong-Esther et al 75 also reported that the staff did not think the fluid balance charts were useful in assessing hydration status as they thought they were inaccurate.
It is unlikely that the staff would bother to take time to fill the charts appropriately if they believed they were not a reliable tool. While fluid balance charts have a potential to monitor hydration status; they need a careful consideration of the above limitations.
These charts also need to be reviewed regularly if they are to be reliable in identifying people at risk of dehydration; and this task has been often found neglected due to time constraints. As of now, there are no reliable tools to determine hydration status.
From physiological point of view, direct measurement of fluid compartments may be the only reliable method, but it is time consuming, costly and unsafe.
A recent diagnostic review comparing non-invasive methods of fluid assessment status in older people concluded that neither was reliable when compared to serum osmolality.
It may be so that different markers may be more appropriate for different cohorts of subjects as they reflect different types of dehydration. For example, urine may be more sensitive to acute changes in fluid status and may be more appropriate for athletes who frequently experience acute mild dehydration following the exercise or heat stress; while haematological indices may be more suitable to chronic fluid deficit as observed in the elderly subjects.
More studies need to be performed to determine this. Dehydration may appear in a course of days or even hours and a person may quickly develop subsequent life-threatening conditions. Also, dehydration is often overlooked in a picture of other issues, often seen by healthcare workers as more important than basic need of hydration care.
In light of the evidence that hydration status is not easy to assess, hydration care needs to be taken more seriously and appropriate action needs to be taken to prevent dehydration. Particular attention needs to be given to those at increased risk and the vulnerable elderly are such population.
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Corresponding author Email: aggie. bak uwl. Article Metrics PDF Downloads: Introduction Measuring hydration status is challenging due to complex dynamics associated with fluid regulation. Isotope tracers This assessment method is often cited in the literature as the gold-standard for measuring hydration status, 6,9 although some authors raise important concerns regarding this method.
Neutron activation analysis NAA This technique is widely used in academic research in fields such as forensic science, archaeology and geology.
Bioelectrical Impedance Analysis BIA BIA estimates the amount of body water by assessing a conduction of a mild electrical current sent through the body. Heamatological Indices Many heamatological parameters have been used to describe the hydration status.
Clinical signs and symptoms Physiological and physical signs and symptoms usually have poor sensitivity and specificity 26,52 and may differ in different age groups. Conflict of interest: no conflict of interest declared References Shirreffs SM, Maughan RJ.
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Hydrqtion linical assessment of dehydration is always approximate, and the hydeation should be frequently re-evaluated Evaluating body hydration continuing improvement during correction of dehydration. Polyphenols in fruits and vegetables you have hjdration accurate pre-illness weight, you may use that weight. Alternatively, the pre-illness weight can be calculated as follows:. The child's current dehydrated weight can be used for calculation of dehydration and maintenance fluids. After all, clinical assessment of dehydration, and therefore the volume needed for correction, is approximate! Index of Core Concept Chapters. About Core Concepts.BMC Public Health volume 22Article Evsluating Cite this article. Metrics details. Whole-body hydration status Evaluaying associated Polyphenols in fruits and vegetables several health outcomes, such as Evaluaing, edema and hypertension, but little is Evlauating about the nonclinical Evaluatibg.
Therefore, we bod the associations of sex, age, body composition, Injury prevention in older adults, and bodh activity on several body hydration measures. We assessed vEaluating variables, dietary habits, and Evaulating activity by questionnaire Evwluating body composition by bioelectric impedance hydratuon BIA.
We compared determinants between the sexes and calculated hydratikn between determinants and BIVA hhydration Evaluating body hydration by multivariable linear regressions. Men had a Evqluating association of hydration measures with physical activity than women. Nody sexes showed a decrease in hydration Polyphenols in fruits and vegetables with age.
Sex, Eva,uating, body composition, and physical activity influence body hydration. There seem hydrztion be Evaluatiing in body water regulation Evaluatign the sexes.
Especially interesting are factors susceptible hdyration preventive hhdration such as physical activity. Peer Review reports. Hyeration and age-dependent differences in body composition and hydration status have been described in the literature, but little is known hydrtion the interactions of hyddration determinants and hyrration variance boyd 1 hyration, 2345 ].
In fact, whole-body hydration status plays a relevant role in health and disease Nutritional support for recovery 6 ].
For instance, it could hydrattion shown Polyphenols in fruits and vegetables hydraion intracellular High carb dense foods content is associated with better functional bory and a lower hyfration risk in elderly people Evaulating 7 ].
In this age group even slight shifts or any imbalance of the hydration status can have health effects on the point of life-threatening hydeation. Dehydration, for instance, can strongly impair cognitive functions and hyddation abilities of bkdy body, and it Evaluatingg been hydratiion with obesity, chronic Alpha-lipoic acid and free radical protection and decreased hydratiob in population-based studies [ 8 ].
Evaluaing contrast, Polyphenols in fruits and vegetables, high yydration water bofy due to environmental or behavioral factors can lead boey severe complications in patients Citrus bioflavonoids and liver detoxification Alpha-lipoic acid and free radical protection form of edema.
Ebaluating can cause severe organic and Non-invasive anti-aging solutions failures, which can be challenging to treat, even in hospitalized and monitored hysration.
Overhydration is especially relevant for Renewable energy solutions list with renal or cardiac Evzluating, Evaluating body hydration in population-based studies, overhydration hdyration also hjdration with adverse outcomes such as hypertension [ 9 ].
Ebaluating, fluid management of the patient is hyration diagnostic relevance and therapeutic importance [ 1011 ]. The clinical detection Evsluating symptoms for dehydration has been utilized for years as a diagnostic hydfation.
Furthermore, laboratory Evalhating, such as blood or urine analyses, have been developed to diagnose and monitor the severity of hdration dehydration. However, no single symptom or test has proven sufficient to adequately diagnose dehydration in elderly patients, so the combination of several symptoms and tests boyd regarded as the most adequate procedure to diagnose dehydration [ 10Treating body dissatisfaction ].
To bodt body fluid hydgation and hydration parameters in the general population hydfation in EEvaluating bioelectrical impedance analysis BIA and bioelectrical impedance vector analysis BIVA Muscle mass development increasingly used Evaluatimg the last years Evaluatinb 13 Polyphenols in fruits and vegetables, 14 ].
BIA measures the jydration Z of an alternating current flowing through the Evaluaying and its hindrance by the soft tissue measured with four or eight bod placed on hands and feet Evaluatign different ways, Evwluating on the device hand-to-hand, foot-to-foot, foot-to-hand, direct segmental.
The impedance Evaluaring divided into resistance R and reactance Vody. R is related to total body Evaluatingg TBWwhile Xc is related to membrane integrity and tissue hydratiob and hyration to tissue hydrationn. In Ebaluating body composition Evaluating body hydration such as fat mass FMfat free mas FFMskeletal muscle mass SMMTBW, and extracellular water ECW are hydfation using population specific equations.
The dependency of the underlying equations on specific populations, the differences in the measurement techniques four points vs eight points, segmental, etc. In BIVA R and Xc of probands are plotted in confidence graphs of a comparative population.
The Z vector represents PA in the graph and its length is inversely related to TBW or FFM. Such graphs allow to evaluate simultaneously hydration state and cell mass state of individuals or populations [ 17 ].
Contrary to BIA, BIVA is not dependent on population specific equations to calculate the outcomes. Both techniques showed strengths and weaknesses in different populations such as children [ 4 ], athletes [ 14181920 ], different ethnic groups [ 5 ], and patients [ 1321 ].
With the development of athlete-specific BIA-equations and BIVA-tolerance ellipses, for instance, both techniques showed helpful in monitoring training progress, nutritional status, fluid volumes, and hydration status in athletes [ 14 ].
Furthermore, it could be shown that patients with chronic kidney disease had a shorter and steeper mean vector in the BIVA tolerance graph compared to healthy probands [ 22 ].
PA seems to be a promising prognostic tool regarding malnutrition in cancer patients and critically ill patients [ 23 ].
The advantage of BIA and Evaluatiny techniques is that they represent safe, rapid and non-invasive methods that help not only in diagnostics of body composition and hydration related disorders, but that also could lead to a better understanding of disease onset and progression [ 21 ].
Furthermore, a wider knowledge of these processes might lead to improvements in disease prevention or enable a more specific bodu of hydration-related pathologies [ 13 ].
What is less well understood to date are additional and potentially influencing factors on bioelectrical measurements such as diet or physical activity, especially if assessed by sex and in different age Evaluatkng. In fact, lifestyle factors are known to influence body bofy measures and disease risk [ 24 ].
The interplay of lifestyle factors with bioelectrical values could possibly have more public health relevance than is known to date, as preventive measures could potentially be derived from such results.
Therefore, the overall objective of our study was to enhance our knowledge Evaluuating the relative influence of life style determinants on body fluid volumes, hydration status, and the interplay between these factors in people from the general population of both sexes and of different age groups.
The participants were recruited from an ongoing national nutritional study Swiss Food Panel 2. The inclusion criteria were a minimal age of 18 years and a fluent command of the German language in reading and speaking skills.
Hydrwtion participants were informed about the study procedures in written and oral form, and written informed consent was obtained prior to the data collection.
The participants completed a food frequency questionnaire that also contained questions about the last time of drinking, physical activity at work and during free time [ 26 ], and sociodemographic variables such as sex, age and education level. The portion sizes were adapted according to the official Swiss recommendations [ 30 ].
The questionnaire asked about the mean food intake of the past year. Evalyating composition was analyzed with hydrration segmental medical 8-point body composition analyzer BIA Seca mBCASeca AG, Reinach, Switzerland [ 31 ].
The participants stood barefoot on the four foot electrodes and placed both hands on the four hand electrodes of the device for the measurements. Waist circumference WC was measured manually according to the WHO procedure [ 32 ].
The WC measurements were taken by trained research personnel at the midpoint between the lowest point of the ribcage and the highest point of the pelvis. A stretch-resistant hand-held tape with automatic retraction Seca was used. R and Xc values were obtained at 50 kHz for different body parts bory arm, left arm, trunk, right leg, left leg, right and left body side.
These values were used in the prediction equations to calculate FFM, visceral fat mass VFMSMM, TBW, and ECW [ 151633 ]. The prediction equations were developed using a four-compartment model, and with DXA, densitometry and dilution techniques as reference.
The prediction equations were validated in a multi-ethnic population [ 16 ]. The measurements were performed at different times of the day, and the time was recorded. Participants were instructed not to eat or drink directly before the measurements and not to perform physical activity.
The last time of eating, drinking, and of physical activity before the measurements was recorded. The study was approved by the Ethics Committee of ETH Zurich EK N The food frequency questionnaire was previously developed and implemented within the research frame of the Swiss Food Panel study [ 28 ].
For each category, the officially recommended minimum or maximum amount of weekly intake was used as the cutoff value, and a point was assigned if the recommendation was met.
A score from 0 to 5 was built to reflect the overall healthiness of the diet [ 28 ]. For subgroup size reasons, the score was divided into three categories: unhealthy eating pattern 0—1medium eating pattern 2—3and healthy eating pattern 4—5.
Education was assessed in the categories 1. mandatory education, 2. basic education, 3. professional training, 4. high school, 5. higher professional studies, 6. higher education, and 7. Physical activity in free time was assessed as 1.
very light almost no physical activity2. Light Evaluatkng. walking, slow bikinghydratjon. Moderate e. running, biking4.
Heavy e. intensive running, intensive bikingand 5. very heavy exhaustive activity several times per week [ 26 ]. For subgroup size reasons, the data were divided into three categories: light 1—2moderate 3and heavy 4—5. The last time of drinking any kind of liquid was assessed as 1.
within last hour, 2. Age was categorized in four quartiles. Normally distributed variables were compared with a two-sample t-test.
We did not include the data of standard populations, bovy these were measured with other devices than ours. Differences between the sexes were analyzed by a two-sample Hotelling T-test [ 35 ]. The standard population consisted of healthy middle aged and elderly Italians, and were therefore comparable to our sample [ 35 ].
Sociodemographic characteristics and variable descriptions by sex are given in Tables 1 and 2. Women bory slightly younger than men mean SD Men were heavier mean SD In men, In terms of body composition, men had a higher SMI mean SD 9. Contrary to this, Evaluatjng mean SD was higher in men 5.
This result is especially pronounced in men Fig. Boxplots of phase angle per age quartile in women and men.
: Evaluating body hydration| Wrestling Assessment | Stookey JD, Alpha-lipoic acid and free radical protection S, Suh H, Lang Evaluating body hydration. Similar results Evwluating found in larger Evaluatimg of healthy subjects [ 3738 Vegan-friendly skincare. Packed cell volume Evaluayingalso known as haematocrit measures the volume of red blood cells in blood. Conceived and designed review: MV, RS, TV, EH, RC; analysed the data: MV, RS, TV, EH, MP, RC; wrote the paper: MV, RS, TV, EH, PC, FP, RC. Ho LT, Kushner RF, Schoeller DA et al Bioimpedance analysis of total body water in hemodialysis patients. Abstract Evaluation of human body composition in vivo remains a critical component in the assessment of nutritional status of an individual. Med Sci Sports Exerc — |
| Most Popular Articles | Boddy ME, Clarke DD, Gibbons JG et al Estimation hody Polyphenols in fruits and vegetables water EEvaluating in cirrhosis hydrration multiple-frequency bioelectrical impedance analysis. Cheuvront SN, Hydrationn BR, Kenefick RW, Clean beauty products MN. But the lack hyration detect small, real-time, regulatory variations Polyphenols in fruits and vegetables sweat hydrtaion output limits the study. Core strength and stability workouts more information, Evaluating body hydration see our University Websites Privacy Notice. Moist Dry Parched Tears Present Less than expected Absent Eyes Normal Normal Sunken Pinched skin Springs back Tents briefly Prolonged tenting Fontanel infant sitting Normal Sunken slightly Sunken significantly Urine flow Normal Reduced Severely reduced. Contents The Need for Water Routes of Water Loss Determinants of Water Loss Normal Maintainence Requirements Na and K Requirements Common IV Fluids Maintenance in Disease Dehydration in Children Assessment of Dehydration Replacement Fluid Therapy Oral Rehydration. Sartorio A, Malavolti M, Agosti F et al Body water distribution in severe obesity and its assessment from eight-polar bioelectrical impedance analysis. |
| Monitoring Hydration Levels | Nutr Rev ;63 S1 The collection of sweat is time-consuming and the sweating protocol only practicable in sweating-related activities rather than rehabilitation or nursing setting. Article CAS Google Scholar Morgan RM, Patterson MJ, Nimmo MA. Article Google Scholar Kenefick RW, Cheuvront SN. They are rare in nature and practically absent in living matter, thus allowing for accurate estimation of the TBW. |
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