Biological variation and diagnostic accuracy of dehydration assessment markers
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Background Well-recognized markers for static (one time) or dynamic (monitoring over time) dehydration assessment have not been rigorously tested for their usefulness in clinical, military, and sports medicine communities. Objective This study evaluated the components of biological variation and the accuracy of potential markers in plasma, urine, saliva, and body mass (B(m)) for static and dynamic dehydration assessment. Design We studied 18 healthy volunteers (13 men and 5 women) while carefully controlling hydration and numerous preanalytic factors. Biological variation was determined over 3 consecutive days by using published methods. Atypical values based on statistical deviations from a homeostatic set point were examined. Measured deviations in body fluid were produced by using a separate, prospective dehydration experiment and evaluated by receiver operating characteristic (ROC) analysis to quantify diagnostic accuracy. Results All dehydration markers displayed substantial individuality and one-half of the dehydration markers displayed marked heterogeneity of intraindividual variation. Decision levels for all dehydration markers were within one SD of the ROC criterion values, and most levels were nearly identical to the prospective group means after volunteers were dehydrated by 1.8-7.0% of B(m). However, only plasma osmolality (P(osm)) showed statistical promise for use in the static dehydration assessment. A diagnostic decision level of 301 plusmn 5 mmol/kg was propo…
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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 [221]
Cheuvront et al.'s suggested threshold is that serum or plasma osmolality >300 mOsm/kg is classified as dehydrated.
“Their suggested threshold is that serum or plasma osmolality >300 mOsm/kg is classified as dehydrated.”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [221]
Cheuvront et al. assessed the range of plasma osmolality in hydrated younger adults and then in the same persons when dehydrated, identifying the cut-off that best separated the two states.
“They assessed the range of plasma osmolality in hydrated younger adults, then in the same persons who had been dehydrated, identifying the cut-off that best separated the two states.”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [221]
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 [221]
Cheuvront et al. (221) appear to have developed the most rigorous assessment of threshold values of serum osmolality.
“Threshold values of serum osmolality have been assessed in varied ways, but Cheuvront et al. (221) appear to have developed these most rigorously.”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [221]
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 [221]
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Self-citation
- Authors
- Cheuvront, S. N., Ely, B. R., Kenefick, R. W., & Sawka, M. N.
- Affiliations
- U.S. Army Research Institute of Environmental Medicine (US)
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 92
- Issue
- 3
- Pages
- 565-573
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W1997497052
- Cited by
- 367
- References
- 62
- Citations by year
- 2026: 12 · 2025: 20 · 2024: 26 · 2023: 21 · 2022: 18 · 2021: 29 · 2020: 28 · 2019: 34 · 2018: 26 · 2017: 20 · 2016: 29 · 2015: 28 · 2014: 20 · 2013: 21 · 2012: 23
- FWCI
- 11.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Keywords
- dehydration assessment, biological variation, plasma osmolality, urine specific gravity, body mass, reference change value, diagnostic accuracy, within-person variability, fluid balance, military medicine, sports medicine
- MeSH terms
- Adult, Body Weight, Dehydration, Female, Humans, Male, Osmolar Concentration, Prospective Studies, Reference Values, ROC Curve, Saliva, Specific Gravity, Biomarkers, Young Adult
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