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Cited by 154Thermoregulation and physiological responsesElectrolyte and hormonal disordersBody Composition Measurement Techniques

Physiologic basis for understanding quantitative dehydration assessment

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Cheuvront, Samuel N, Kenefick, Robert W, Charkoudian, Nisha, Sawka, Michael N·2013·The American Journal of Clinical Nutrition
DOI 10.3945/ajcn.112.044172
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Abstract

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.

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  • Treatment for low-intake dehydration involves the administration of hypotonic fluids, which will help correct the fluid deficit while diluting down the raised osmolality.

    “Treatment for low-intake dehydration involves the administration of hypotonic fluids (222-224), which will help correct the fluid deficit while diluting down the raised osmolality.”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [222]

    The Introduction (page unavailable) says that fluid acquisition is necessary to restore body-water balance, and the section on AVP and thirst responses says water loading lowers plasma osmolality. The paper does not recommend administering hypotonic fluids as treatment for low-intake dehydration, so it supports the underlying physiology but not the cited treatment claim. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Volume depletion follows medical conditions resulting in excessive losses of fluid and electrolytes, such as excessive blood loss, vomiting, and diarrhea.

    “and following medical conditions resulting in excessive losses of fluid and electrolytes, such as excessive blood loss, vomiting, and diarrhea (221-224).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [222]

    In “Two Critical Caveats to Understanding Osmotic Responses to Dehydration” (pp. 1–4), the paper identifies vomiting and secretory diarrhea as causes of isotonic hypovolemia, also called volume depletion because solute is lost along with water. It discusses blood-volume loss when assessing volume depletion, but does not explicitly identify excessive blood loss as a cause in the same way. (LLM, conf=0.79)

    Experimental — accuracy not yet measured

  • Reduced fluid intake raises the osmolality of serum and plasma.

    “When we take in too little fluid (drink too little) the fluid within and around our cells becomes more concentrated, raising the osmolality of serum and plasma (221)(222)(223)(224).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [222]

  • Volume depletion occurs without raised serum or plasma osmolality.

    “Volume depletion (reduced volume of extracellular fluids only, due to loss of fluids and electrolytes, also called salt loss or extracellular dehydration) occurs without raised serum or plasma osmolality”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [222]

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Authors
Cheuvront, S. N., Kenefick, R. W., Charkoudian, N., & Sawka, M. N.
Affiliations
U.S. Army Research Institute of Environmental Medicine (US)
ORCID
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2013-03
Volume
97
Issue
3
Pages
455-462
ISSN
0002-9165 (ISSN-L)
DOI
10.3945/ajcn.112.044172
OpenAlex
W2168342451
Cited by
154
References
107
Citations by year
2026: 3 · 2025: 10 · 2024: 12 · 2023: 11 · 2022: 9 · 2021: 15 · 2020: 13 · 2019: 16 · 2018: 9 · 2017: 7 · 2016: 16 · 2015: 16 · 2014: 7 · 2013: 9 · 2012: 1
FWCI
1.73
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Defense
  • U.S. Army
  • Medical Research and Materiel Command
Topics
  • Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Keywords
dehydration assessment, plasma osmolality, vasopressin, thirst, hypovolemia, dehydration severity, hydration status
MeSH terms
Blood Volume, Body Water, Dehydration, Humans, Neurophysins, Osmolar Concentration, Protein Precursors, Thirst, Vasopressins, Water-Electrolyte Balance

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