Daily Fluid Intake Research Articles

Oral hydration in children with cerebral palsy

AIM: To investigate whether oral motor performance is determinant for the hydration status and the effect of a supplemental oral fluid supply on salivary osmolality. METHODS: The sample consisted of 99 children with cerebral palsy aged 6 to 13 years old. In this study, children participated in 2-day evaluations: 1st day - baseline: saliva collection, caries experience and oral motor performance evaluations; and 2nd day: saliva collection after supplemental fluid supply. Prior to each evaluation, the participants were trained for saliva collection. Unstimulated whole saliva was collected using cotton roll at baseline, with the amount of fluid usually offered by caregivers, and 48 h after baseline, with as much as twice the normal daily fluid intake previously offered. Salivary osmolality was measured using a freezing point depression osmometer. Caries experience index for decayed, missed and filled teeth (DMFT) was evaluated. According to the Oral Motor Assessment Scale, the children were classified into subfunctional or functional groups. Chi-square, Student's t test and Pearson's correlation coefficient were used. RESULTS: The subfunctional group presented a higher percentage of quadriplegic children (p<0.001), with significantly higher values for caries experience (p<0.001) and salivary osmolality (p<0.001), which did not diminish when supplemental fluid supply was offered, compared with the functional group (p=0.001). CONCLUSIONS: The effectiveness of oral motor performance plays an important role in the hydration status of children with cerebral palsy and those with worse oral motor performance may be at higher risk of oral diseases.

Fluid intake and all-cause mortality, cardiovascular mortality and kidney function: a population-based longitudinal cohort study

Drinking eight glasses of fluid or water each day is widely believed to improve health, but evidence is sparse and conflicting. We aimed to investigate the association between fluid consumption and long-term mortality and kidney function. We conducted a longitudinal analysis within a prospective, population-based cohort study of 3858 men and women aged 49 years or older residing in Australia. Daily fluid intake from food and beverages not including water was measured using a food frequency questionnaire. We did multivariable adjusted Cox proportional hazard models for all-cause and cardiovascular mortality and a boot-strapping procedure for estimated glomerular filtration rate (eGFR). Upper and lower quartiles of daily fluid intake corresponded to >3 L and <2 L, respectively. During a median follow-up of 13.1 years (total 43 093 years at risk), 1127 deaths (26.1 per 1000 years at risk) including 580 cardiovascular deaths (13.5 per 1000 years at risk) occurred. Daily fluid intake (per 250 mL increase) was not associated with all-cause [adjusted hazard ratio (HR) 0.99 (95% CI 0.98-1.01)] or cardiovascular mortality [HR 0.98 (95% CI 0.95-1.01)]. Overall, eGFR reduced by 2.2 mL/min per 1.73 m(2) (SD 10.9) in the 1207 (31%) participants who had repeat creatinine measurements and this was not associated with fluid intake [adjusted regression coefficient 0.06 mL/min/1.73 m(2) per 250 mL increase (95% CI -0.03 to 0.14)]. Fluid intake from food and beverages excluding water is not associated with improved kidney function or reduced mortality.

Evaluation of the antidepressant, anxiolytic and memory-improving efficacy of aripiprazole and fluoxetine in ethanol-treated rats

Some study results indicate a positive effect of aripiprazole (ARI) on impaired cognitive functions caused by brain damage resulting from chronic EtOH abuse. However, other research shows that to manifest itself, an ARI antidepressant effect requires a combined therapy with another selective serotonin reuptake inhibitor antidepressant, namely, fluoxetine (FLX). The aim of this article was to assess antidepressant and anxiolytic effects of ARI as well as its effect on spatial memory in ethanol-treated (alcoholized) rats. On the basis of alcohol consumption pattern, groups of (1) ethanol-preferring rats, with mean ethanol intake above 50%, and (2) ethanol-nonpreferring rats (EtNPRs), with mean ethanol intake below 50% of total daily fluid intake, were formed. The group of EtNPRs was used for this study, subdivided further into three groups administered ARI, FLX and a combination of both, respectively. Behavioral tests such as Porsolt’s forced swimming test, the Morris water maze test and the two-compartment exploratory test were employed. Behavioral test results demonstrated (1) no antidepressant effect of ARI in EtNPRs in subchronic treatment and (2) no procognitive effect of ARI and FLX in EtNPRs in combined single administration. Combined administration of both drugs led to an anxiogenic effect and spatial memory deterioration in study animals. ARI had no antidepressant effect and failed to improve spatial memory in rats. However, potential antidepressant, anxiolytic and procognitive properties of the drug resulting from its mechanism of action encourage further research aimed at developing a dose of both ARI and FLX that will prove such effects in alcoholized EtNPRs.

The suitability of caffeinated drinks for children: a systematic review of randomised controlled trials, observational studies and expert panel guidelines.

The increased availability of caffeinated drinks raises questions about the level of caffeine that is appropriate for children, as well as the benefits and risks associated with their consumption. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this systematic review evaluates evidence from randomised controlled trials investigating the effects of caffeine on cognition, behaviour, mood and exercise performance in children. Observational studies and expert panel guidelines are also discussed. One hundred and nine studies were found, with 11 randomised controlled trials and 13 observational studies meeting the criteria. High caffeine intakes (e.g. >5 mg kg(-1) body weight day(-1)) were associated with an increased risk of anxiety and withdrawal symptoms. However, smaller amounts were not linked with such effects and may benefit cognitive function and sports performance based on adult studies. The evidence suggests that children and adolescents should limit daily caffeine consumption to 2.5 mg kg(-1) body weight day(-1), equating to one or two cups of tea or one small cup of coffee. Lower contributors of caffeine, such as tea, may be more appropriate for children because they contribute to daily fluid intakes and provide flavonoids. By contrast, caffeinated soft drinks may be less suitable options for children as a result of their acidity, higher caffeine content, presence of added sugar (in some cases) and absence of bioactive compounds. More studies are needed to determine the intakes that represent a risk and whether there may be benefits for alertness and sports performance with moderate intakes of caffeine.

Fluoride intake from fluids and urinary fluoride excretion by young children in Kuwait: a non‐fluoridated community

To determine the pattern of fluid consumption, fluoride intake from the fluids and urinary fluoride excretion by children aged 1-9 years in Kuwait, a nonfluoridated community. Using the cluster sampling technique, children aged 1-9 years were chosen from 2000 randomly selected households in Kuwait. Questionnaires were then administered to their mothers to determine the children's daily fluid intake. Fluoride concentrations in tap water as well as all brands of bottled water and beverages consumed by the children were measured, using the fluoride ion-specific electrode. Fluoride excretion was determined in 400 randomly selected children, based on fluoride/creatinine ratio. The mean daily fluid consumption by the children was high, being 1115-1545 ml. About 40% of the fluid intake was plain (tap and bottled) water and approximately 10% of the children drank bottled water exclusively. Fluoride concentration in tap water was low (0.04±SD 0.02 ppm), but was higher in bottled water (0.28±SD 0.40 ppm). Mean daily fluoride ingestion from fluids was 0.013-0.018 mg/kg body weight (bw). Even after allowing for fluoride ingestion from other sources, mean daily fluoride ingestion was still below 0.1 mg/kg bw set by the United States of America Institute of Medicine as the lowest-observed-adverse-effect level for moderate enamel fluorosis in children aged up to 8 years. Furthermore, the mean daily urinary fluoride excretion of 128-220 μg was below the provisional standard of 360-480 μg for optimal fluoride usage by children aged 3-5 years. Fluoride ingestion from fluids and urinary fluoride excretion by the children were below the recommendations for optimal fluoride usage. Thus, there is room for an upward adjustment of fluoride level in public drinking water supplies in Kuwait, as a caries preventive measure.

Switching Habitual Small and Large Volume Drinkers

Normal human water intake spans a large range owing to the body’s ability to excrete large volumes of water in times of excess and conserve in times of scarcity. Recently, chronic intakes of either large volumes (HIGH) or small volumes (LOW) of water have been investigated. Adaptations within the renal regulation of water through the secretion and reabsorptive actions of the hormone arginine vasopressin and the thirst mechanism have been observed to differentiate these 2 groups during normal living. Increases or decreases in daily fluid intake in LOW and HIGH resulted in appropriate arginine vasopressin and perception of thirst changes, which enabled fluid balance in both of these populations. However, future research should establish if the chronic adaptive mechanisms, by which fluid is regulated have long-term negative outcomes.

The effect of work location on urolithiasis in health care professionals

The objective of this study is to compare the prevalence and risks factors for urolithiasis among health care professionals who work in the operating room (OR) versus other locations. Electronic surveys, focusing on a history of urolithiasis, were sent to 3,921 randomly selected employees at our institution, 34% (1,340) of which worked in an OR. Additional information regarding potential risk factors such as quantity of daily fluid intake, stress level, activity level, body mass index, relevant medical conditions and family history of urolithiasis were obtained and analyzed. Of those surveyed, 46% (1,802/3,921) responded. The prevalence of urolithiasis for all responders was 10.9% (196/1,802). Those individuals working in an OR had a higher prevalence of stone disease compared to those who work elsewhere [14.6% (64/439) versus 9.7% (132/1,363); p=0.004]. Specifically, physicians that work in an OR had the highest prevalence of urolithiasis [17.4% (20/115) versus 9.7% (132/1,363); p=0.009). Additionally, physicians that work in an OR reported significantly less fluid intake (p=0.04) and higher stress levels (p<0.0001) compared to employees not working in an OR. On multivariate analysis, working in an OR remained associated with a significantly increased risk stone formation (HR 1.43; p=0.04). Our survey found that health care professionals working in an OR setting, and physicians in particular, are at higher risk of urolithiasis.

Relation between urinary hydration biomarkers and total fluid intake in healthy adults

Background/objectives:In sedentary adults, hydration is mostly influenced by total fluid intake and not by sweat losses; moreover, low daily fluid intake is associated with adverse health outcomes. This study aimed to model the relation between total fluid intake and urinary hydration biomarkers.Subjects/methods:During 4 consecutive weekdays, 82 adults (age, 31.6±4.3 years; body mass index, 23.2±2.7 kg/m2; 52% female) recorded food and fluid consumed, collected one first morning urine (FMU) void and three 24-h (24hU) samples. The strength of linear association between urinary hydration biomarkers and fluid intake volume was evaluated using simple linear regression and Pearson's correlation. Multivariate partial least squares (PLS) modeled the association between fluid intake and 24hU hydration biomarkers.Results:Strong associations (|r|⩾0.6; P<0.001) were found between total fluid intake volume and 24hU osmolality, color, specific gravity (USG), volume and solute concentrations. Many 24hU biomarkers were collinear (osmolality versus color: r=0.49–0.76; USG versus color: r=0.46–0.78; osmolality versus USG: 0.86–0.97; P<0.001). Measures in FMU were not strongly correlated to intake. Multivariate PLS and simple linear regression using urine volume explained >50% of the variance in fluid intake volume (r2=0.59 and 0.52, respectively); however the error in both models was high and the limits of agreement very large.Conclusions:Hydration biomarkers in 24hU are strongly correlated with daily total fluid intake volume in sedentary adults in free-living conditions; however, the margin of error in the present models limits the applicability of estimating fluid intake from urinary biomarkers.

Challenges in oral administration of metronidazole dissolved in drinking water to rhesus monkeys (Macaca mulatta)

Intestinal pathogens such as Entamoeba spp. and Giardia spp. protozoans are not uncommon among rhesus macaques (Macaca mulatta) in research facilities. These infections affect the health of the macaques, potentially causing severe diarrhea, and also pose a risk of zoonotic transmission to human caretakers. Infections must therefore be treated, but no standard treatment for intestinal protozoans in macaques has been developed. Metronidazole is commonly used to treat infections with Giardia spp. and Entamoeba spp. in veterinary medicine, but evidence-based information on effectiveness and dosages for nonhuman primates is lacking, and administration of drugs to nonhuman primates is challenging. The authors designed a study to determine whether oral administration of metronidazole dissolved in drinking water would be successful in rhesus macaques. They monitored daily fluid intake of macaques given water with or without metronidazole and with or without flavored syrup. Metronidazole addition, with or without flavored syrup, resulted in a decrease in fluid intake. Although it was possible to administer metronidazole in drinking water to some macaques, the authors conclude that this strategy is not a practical clinical method because of variation in the amount of water and metronidazole ingested by the macaques.

Increased Fluid Intake Is Associated With Bothersome Bowel Symptoms Among Women With Urinary Incontinence

To determine the association between the type and volume of fluid intake and bowel symptoms in women with urinary incontinence. We hypothesize that a lower volume of fluid intake would be associated with greater straining with bowel movements in women with urinary incontinence. We performed a cross-sectional study of 256 women presenting with complaints of urinary incontinence from 2009 to 2010. Data on fluid intake, fluid intake behavior, urinary and bowel symptoms were collected using validated questionnaires. The relationship between quartiles of total daily fluid intake and bowel symptoms was analyzed. The behavior of restricting fluid intake was reported by 32% of the women. Increasing quartiles of total daily fluid intake was significantly associated with greater bother from straining with bowel movements (P = 0.04). Women with no bother from straining with bowel movements had significantly lower median daily fluid intake (2839 mL) than women with quite a bit of bother (3312 mL; P = 0.01). The association between the volume of fluid intake and straining with bowel movements persisted after controlling for age, body mass index, history of prolapse or incontinence surgery, and stage of prolapse (P < 0.05). There was no association between caffeinated fluid intake and any bowel symptom or between the behavior of restricting fluid intake and any bowel symptom. In women with urinary incontinence, higher volume of total fluid intake is reported by women with greater straining with bowel movements. The behavior of fluid restriction is not associated with bothersome bowel symptoms.

Pathophysiology of Leptospirosis

Leptospirosis is an acute septicemic illness that affects humans in all parts of the world. Approximately 10% of patients with leptospirosis develop severe disease, the Weil syndrome, with jaundice, acute kidney injury (AKI), and pulmonary hemorrhage. Leptospirosis-induced AKI is typically nonoliguric with a high frequency of hypokalemia. Experimental and clinical studies demonstrated that tubular function alterations precede a drop in the glomerular filtration rate and are mainly in the proximal tubule. Studies in humans and animals have demonstrated a decrease in the expression of proximal sodium (NHE3) and water tubular transporter, aquaporin 1 (AQP1) together with higher renal expression of the Na-K-2Cl cotransporter NKCC2. In an experimental model, at the initial phase of the disease, the expression of AQP2, the water transport of the collecting duct, is decreased, which explains the higher incidence of nonoliguric AKI. During the recovery phase of AKI, AQP2 expression increased in human and animals as a compensatory mechanism. Alveolar hemorrhage, pulmonary edema, acute respiratory distress syndrome, or a combination of these features may accompany AKI and is associated with high mortality. Studies with hamsters demonstrated that in leptospirosis a noncardiogenic pulmonary edema occurs consequently to a decrease in the clearance of alveolar fluid, due to a decrease in sodium transporter in the luminal membrane (ENaC) and an increase in the NKCC1 basolateral membrane transporter. Antibiotic treatment is efficient in the early and late/severe phases and revert all kidney transporters. Early and daily hemodialysis, low daily net fluid intake, and lung-protective strategies are recommended for critically ill patients with leptospirosis.

Radiological remission and recovery of thirst appreciation after infliximab therapy in adipsic diabetes insipidus secondary to neurosarcoidosis

Neurosarcoidosis is a rare and aggressive variant of systemic sarcoidosis which may result in hypothalamic-pituitary dysfunction. We report a case of hypothalamic hypopituitarism secondary to neurosarcoidosis complicated by adipsic diabetes insipidus (ADI). Initiation of anti-tumour necrosis factor-α (TNF-α) therapy resulted in both radiological disease remission and recovery of osmoregulated thirst appreciation after 3 months. A 22-year-old man was referred to the endocrinology service with profound weight gain, polyuria and lethargy. Biochemical testing confirmed anterior hypopituitarism while posterior pituitary failure was confirmed by hypotonic polyuria responding to desmopressin. Magnetic resonance imaging (MRI) demonstrated extensive hypothalamic infiltration; neurosarcoidosis was confirmed histologically after excisional cervical lymph node biopsy. Osmoregulated thirst appreciation was normal early in the disease course despite severe hypotonic polyuria. However, subsequent subjective loss of thirst appreciation and development of severe hypernatraemia in the setting of normal cognitive function indicated onset of ADI. Clinical management involved daily weighing, regular plasma sodium measurement, fixed daily fluid intake and oral desmopressin. We initiated immunosuppressive therapy with pulsed intravenous anti-TNF-α therapy (infliximab) after multidisciplinary team consultation. Infliximab therapy resulted in successful radiological disease remission and complete recovery of osmoregulated thirst appreciation. This was confirmed by subjective return of thirst response and maintenance of plasma sodium in the normal range in the absence of close biochemical monitoring.

A Study on Fluid Intake Measurements

Purpose: The purpose of this study was to compared two methods for measuring fluid intake and to assess the most effective method. Methods: Data from 44 hospitalized patients with chronic kidney disease was analyzed. Two methods were used. The liquid method is to measure the daily intake of water in the form of pure water or some other beverage and IV fluid, the liquid-solid method is to measure the daily intake of water which enters by the oral route and IV fluid. Results: The daily intake of fluid was 1483.10mL and 2245.99mL respectively. The fluid output was 1883.72 mL. The Intra-Class Correlation (ICC) between the liquid method and the liquid-solid method and fluid output was 0.64 and 0.69, respectively. The correlation between differences of fluid in two methods and body weight change was r=.47 (p<.001) and r=.56 (p<.001), respectively. Conclusion: The results of this study suggest that there are no difference between the two measuring methods as to reflecting the most close value to fluid output. And the difference between intake and output by two methods is correlated with body weight change. Therefore, it can be suggested that the either method could be useful as patients' fluid intake measurement.

Fluid intake of adults in four Chinese cities

To investigate the fluid intake and knowledge on water and health in Chinese adults, and to provide a scientific basis for the development of adequate water intake values for people in China. A total of 1,483 adults aged 18-60 years were selected from four provincial capital cities using a multiple-stage random sampling method. The information on the amounts and types of daily fluid intake was collected using a 24-h fluid intake record for 7 consecutive days. Trained interviewers used a questionnaire to assess knowledge on water. The median of daily total fluid intake was 1,488 mL, with a wide range from 86 mL to 7,036 mL. Significant differences were found for fluid intake among the four cities. The medians of daily intakes of plain water, tea, and beverages were 786 mL, 109 mL, and 186 mL, respectively. Approximately 32% of the subjects drank less water than the amount recommended by the Chinese Nutrition Society (1,200 mL/day) and 71.6% of participants lacked knowledge of these recommendations. Moreover, 48.3% of them drank water only when they felt thirsty.

1880 Fluid, Calorie and Protein Intake in Infants Born at < 32 Weeks Gestation - Are we Meeting the Standards?

BackgroundIn premature infants optimal nutrition should be maintained and weight loss limited. Guidelines recommend incremental fluid/calorie intake to achieve 150mls/kg/day of fluid; 90kcal/kg/day calorie intake and 3.54g/kg/day of protein intake...

Increased Water Intake as a Prevention Strategy for Recurrent Urolithiasis: Major Impact of Compliance on Cost-Effectiveness

We evaluated the economic impact of preventing recurrent stones using a strategy of increased water intake and determined the impact of compliance on cost-effectiveness for the French health care system. A Markov model was constructed to compare costs and outcomes for recurrent kidney stone formers with less than 2 L vs 2 L or more daily fluid intake. Model assumptions included an annual prevalence of 120,000 stone episodes in France, 14.4% annual risk of stone recurrence and a 55% risk reduction in subjects with adequate water intake. Costs were based on resource use as estimated by a panel of experts and official national price lists. Outcomes were from the perspective of the public health payer, and encompassed direct and indirect costs. The total cost of an episode of urolithiasis was estimated at €4,267 including the cost of treatment and complications. This corresponds to an annual budget impact of €88 million for recurrent stones based on 21,000 stone events. Assuming 100% compliance with fluid intake recommendations of 2 L daily, 11,572 new stones might be prevented, resulting in a cost savings of €49 million. Compliance with water intake in only 25% of patients would still result in 2,893 fewer stones and a cost savings of €10 million. Varying the costs of managing stones had a smaller impact on outcomes since in many patients stones do not form. Varying the incidence of complications did not change the incidence of stones and had a negligible effect on overall cost. Preventing recurrent urolithiasis has a significant cost savings potential for a payer as a result of a reduced stone burden. However, compliance is an important factor in determining cost-effectiveness.

The Effects of a Fluid Intake Intervention for Elders in Long-term Care Hospitals

Purpose: This study was done to evaluate the effects of a fluid intake intervention on increasing fluid intake and ameliorating dehydration status in elders admitted to long-term care hospitals. Methods: A nonequivalent control group, pretest and posttest design was used. The experimental group of 39 participants received the 4-week intervention while the control group of 38 participants received routine care. Outcome variables were daily fluid intake and physiological indexes such as blood urea nitrogen and creatinine ratio (BUN/Cr), urine specific gravity (USG), and urine color. Results: After the intervention to increase fluid intake, there were statistically significant increases in daily fluid intake, normal BUN/Cr, and USG in the experimental group. However, a statistically significant improvement in normal urine color was not found for either group. Conclusion: The findings of this study demonstrated that the fluid intake intervention improved hydration status of the experimental group participants. Consequently, it was confirmed that the intervention is considered to be effective in preventing dehydration which occurs frequently in older adults in long-term care facilities and, thus this intervention may contribute to preventing various health issues resulting from dehydration.

Hydration biomarkers in free-living adults with different levels of habitual fluid consumption

Little is known about the impact of habitual fluid intake on physiology. Specifically, biomarkers of hydration status and body water regulation have not been adequately explored in adults who consume different fluid volumes in everyday conditions, without prolonged exercise or environmental exposure. The purpose of the present study was to compare adults with habitually different fluid intakes with respect to biomarkers implicated in the assessment of hydration status, the regulation of total body water and the risk of kidney pathologies. In the present cross-sectional study, seventy-one adults (thirty-two men, thirty-nine women, age 25–40 years) were classified according to daily fluid intake: thirty-nine low drinkers (LD; ≤ 1·2 litres/d) and thirty-two high drinkers (HD; 2–4 litres/d). During four consecutive days, urinary parameters (first morning urine (FMU) on day 1 and subsequent 24 h urine (24hU) collections), blood parameters, and food and beverage intake were assessed. ANOVA and non-parametric comparisons revealed significant differences between the LD and HD groups in 24hU volume (1·0 (se 0·1) v. 2·4 (se 0·1) litres), specific gravity (median 1·023 v. 1·010), osmolality (767 (se 27) v. 371 (se 33) mOsm/kg) and colour (3·1 (se 0·2) v. 1·8 (se 0·2)). Similarly, in the FMU, the LD group produced a smaller amount of more concentrated urine. Plasma cortisol, creatinine and arginine vasopressin concentrations were significantly higher among the LD. Plasma osmolality was similar between the groups, suggesting physiological adaptations to preserve plasma osmolality despite low fluid intake. The long-term impact of adaptations to preserve plasma osmolality must be examined, particularly in the context of renal health.

Promoting hydration

A learning zone article helped Diane Taylor ensure patients achieve adequate daily fluid intake

Index of Suspicion

Index of Suspicion