Inadequate Hydration Research Articles

Hypertonic Saline Is Effective in the Prevention and Treatment of Mucus Obstruction, but Not Airway Inflammation, in Mice with Chronic Obstructive Lung Disease

Recent evidence suggests that inadequate hydration of airway surfaces is a common mechanism in the pathogenesis of airway mucus obstruction. Inhaled hypertonic saline (HS) induces osmotic water flux, improving hydration of airway surfaces. However, trials in patients with obstructive lung diseases are limited. The aim of this study was to investigate effects of HS on mucus obstruction and airway inflammation in the prevention and treatment of obstructive lung disease in vivo. We, therefore, used the β-epithelial Na(+) channel (βENaC)-overexpressing mouse as a model of chronic obstructive lung disease and determined effects of preventive and late therapy with 3% HS and 7% HS on pulmonary mortality, airway mucus obstruction, and inflammation. We found that preventive treatment with 3% HS and 7% HS improved growth, reduced mortality, and reduced mucus obstruction in neonatal βENaC-overexpressing mice. In adult βENaC-overexpressing mice with chronic lung disease, mucus obstruction was significantly reduced by 7% HS, but not by 3% HS. Treatment with HS triggered airway inflammation with elevated keratinocyte chemoattractant levels and neutrophils in airways from wild-type mice, but reduced keratinocyte chemoattractant in chronic neutrophilic inflammation in adult βENaC-overexpressing mice. Our data demonstrate that airway surface rehydration with HS provides an effective preventive and late therapy of mucus obstruction with no consistent effects on inflammation in chronic lung disease. These results suggest that, through mucokinetic effects, HS may be beneficial for patients with a spectrum of obstructive lung diseases, and that additional strategies are required for effective treatment of associated airway inflammation.

Acute Splenic Syndrome in an African-American Male with Sickle Cell Trait on a Commercial Airplane Flight

BackgroundPatients with sickle cell trait (SCT) generally suffer few effects of sickle cell disease. Acute splenic syndrome is a rare but well-documented complication of SCT that can present in the setting of low oxygen tension that occurs with major changes in altitude, either by unpressurized air flight or ground travel such as mountain climbing. ObjectiveOur objective was to increase emergency physician awareness of the rare diagnosis of altitude-induced splenic infarction in patients with SCT by presenting and reviewing recorded literature. Case ReportThis is an unusual case of a man with SCT who suffered acute splenic syndrome while on a pressurized airplane flight subsequently requiring splenectomy. ConclusionsAlthough it is a rare phenomenon, patients with SCT who are exposed to high altitudes can be subject to splenic syndrome. There are many patients who are unaware that they have SCT, which makes the diagnosis challenging for emergency physicians. In addition, because patients with SCT generally do not have complications related to their disease, diagnosing splenic syndrome might be delayed, potentially resulting in inadequate hydration, pain management, and other supportive treatment, which ultimately leads to worsening splenic syndrome and splenectomy.

Cerebellar hemorrhage after resection of frontal meningioma. Case report

Abstract Introduction: Remote cerebellar hemorrhage is an infrequent complication, potentially harmful with an unclear etiologic mechanism. There may be incriminated multiple risk factors: arterial hypertension, use of antiplatelet medication (Aspenter), CSF aspiration or drainage associated with intracranial hypotension. Material and methods: We present a 69 year old woman with remote intracerebral hemorrhage that occurred after frontal parasagittal meningioma resection. Results: An inadequate oral hydration was responsible for decreased level of consciousness, cerebellar and parietaloccipital cortical-sub-cortical contra-lateral hemorrhages. Close monitoring of water balance and adequate hydration is related to clinical improvement and resolution of brain imaging. Conclusion: Retraction of the brain due to intracranial hypotension led to some small vessels rupture and development of remote cerebellar hemorrhage.

Troubles mictionnels de l’enfant : de la symptomatologie au diagnostic

The new definitions of voiding disorders in children should be used in clinical practice. Two major kinds of voiding disorders are identified: 1) isolated primary enuresis as a disorder occurring exclusively during sleep with no daytime leakage; 2) urinary dysfunctions that include uninhibited detrusor contraction, sphincter hypertonicity, and urethral instability. These dysfunctions may be primary or secondary. Constipation as an underlying cause is frequent and usually underestimated. The diagnostic process requires one (or more) long consultations. After ruling out a urine leak without a voiding disorder and secondary causes (constipation, inadequate hydration, poor voiding hygiene, crystalluria, etc.), the aim is to distinguish isolated sleep-time disorders (primary enuresis) from daytime ± sleep-time symptoms (primary urinary dysfunctions). Anamnesis, long and accurate, can be sensitized by a questionnaire completed at home. The physical examination focuses on the exclusion of anatomic abnormalities and local inflammation (vulvitis, balanitis, etc.). Diagnostic tests are rarely required at the beginning. Urodynamic exploration may be indicated, never at the first consultation, in case of primary urinary dysfunction. This diagnostic approach provides an appropriate therapeutic decision.

Hydration campaign.

Inadequate hydration affects about one in five people admitted to hospital as an emergency; many are older people.

The Diagnostic Test Accuracy of Clinical Swallow Assessment for Oropharyngeal Aspiration: A Systematic Review.

Review question/objective The objective of this systematic review is to synthesise the best available evidence on the diagnostic test accuracy (sensitivity and specificity) of Clinical Swallow Assessment (CSA) compared with Video Fluoroscopic Swallow Study (VFSS) in diagnosing oropharyngeal aspiration in children and adults with dysphagia. In this review, VFSS will be the 'Gold Standard' or, reference test and CSA will be the index test. VFSS is the radiographic assessment of swallow function usually performed by a Speech Pathologist and Radiologist. CSA is defined as a non-invasive, non-instrumental assessment of swallow function. It is usually performed by a Speech Pathologist and includes a thorough case history and assessment of oro-motor function. For example, tongue, jaw movement, cough reflex and review of swallow function with a range of food and fluids. A rating is usually provided to describe the level of function and likely presence or absence of aspiration. Based on the CSA findings the Speech Pathologist recommends specific diet and fluid modifications, feeding techniques and positioning techniques to enable safe oral feeding. Inclusion criteria Types of participants Studies will be considered in this review if they include: infants, children or adults with dysphagia. The following definitions will be used within this review: - infant will be defined as < 36 months; - children will be defined as 36 months – 18 years; - adults will be defined as 18 years and over; - dysphagia will be defined as 'a swallowing disorder' 6. The definition uses 36 months as the cut off between infants and children as this is the stage when the infant transitions from sucking patterns used for bottle feeding and early solids and begins to chew solids, self feed and drink from a range of cups consistent with an older child 4. There will be no exclusion of studies based on age or gender. Studies will be excluded that include the population of head and neck cancer (HNC) patients, patients with a tracheostomy in situ and patients with craniofacial anomalies. The primary treatment for HNC patients includes surgery and radiotherapy . Radiotherapy can have a specific impact on swallowing , not necessarily seen in other populations and surgical resections can result in predictable swallowing difficulties . Patients with a tracheostomy in situ and patients with craniofacial anomalies also have known anatomical changes that have a specific impact on swallow function. The clinician undertaking the clinical swallow assessment has access to any anatomical changes following surgery. This is different to other populations whereby information regarding specific neurological and anatomical information is not necessarily available. Focus of the review The focus of this review will be on diagnostic test accuracy (sensitivity and specificity) of Clinical Swallow Assessment (CSA) compared with Video Fluoroscopic Swallow Study (VFSS) in diagnosing oropharyngeal aspiration in children and adults with dysphagia. In this review, VFSS will be the 'Gold Standard' or, reference test and CSA will be the index test. The terms VFSS and Modified Barium Swallow (MBS) refer to the same study. Although this review will use the term VFSS defined as the radiographic assessment of the oral and pharyngeal swallow, MBS studies will also be included. The terms Clinical Swallow Assessment and Bedside Swallow Evaluation also refer to the same diagnostic tool . Clinical Swallow Assessment (CSA) will be used within this review, defined as the non-instrumental, non-radiologic assessment of swallow function by a Speech Pathologist, however studies of Bedside Swallow Evaluation will also be included. Studies that do not use CSA as the index test or do not use VFSS as the reference test will be excluded. In addition, studies of effectiveness, experience or comparison of treatment interventions will be excluded. The diagnostic test accuracy of CSA and VFSS will be compared using: sensitivity and specificity. Where possible, positive and negative predictive values will also be analysed and reported. Sensitivity of a diagnostic test is defined as 'the ability of the test to identify correctly those who have the disease'34. Specificity of a diagnostic test is defined as 'the ability of the test to identify correctly those who do not have the disease' Positive predictive value is defined as the proportion of patients who test positive and actually have the disease in question . Negative predictive value is defined as the proportion of patients who test negative and actually do not have the disease in question .

Spontaneous hemoperitoneum in cats: 65 cases (1994–2006)

To describe the clinical signs, physical examination findings, clinical laboratory abnormalities, etiology, and outcome in cats with spontaneous hemoperitoneum. Retrospective case series. 65 client-owned cats with spontaneous hemoperitoneum. Medical records of cats with spontaneous hemoperitoneum at 7 large referral clinics were reviewed. Cats were included if a definitive diagnosis of spontaneous hemoperitoneum could be obtained from review of the medical records. 65 cats met inclusion criteria. The most common historical findings were lethargy, anorexia, and vomiting. Common findings on physical examination included inadequate hydration status and hypothermia. The most common clinicopathologic abnormalities were high serum AST activity, anemia, prolonged prothrombin time, and prolonged partial thromboplastin time. Forty-six percent (30/65) of cats had abdominal neoplasia, and 54% (35/65) had nonneoplastic conditions. Hemangiosarcoma was the most often diagnosed neoplasm (18/30; 60%), and the spleen was the most common location for neoplasia (11/30; 37%). Eight cats survived to be discharged from the hospital. Cats with neoplasia were significantly older and had significantly lower PCVs than cats with non-neoplastic disease. Spontaneous hemoperitoneum in cats often results in debilitating clinical consequences. In contrast to dogs with hemoperitoneum, the cause of hemoperitoneum in cats is approximately evenly distributed between neoplastic and nonneoplastic diseases. Although only a few cats were treated in this study, the prognosis appears poor.

Thermoregulatory Responses and Hydration Practices in Heat-Acclimatized Adolescents During Preseason High School Football

Previous researchers have not investigated the thermoregulatory responses to multiple consecutive days of American football in adolescents. To examine the thermoregulatory and hydration responses of high school players during formal preseason football practices. Observational study. Players practiced outdoors in late August once per day on days 1 through 5, twice per day on days 6 and 7, and once per day on days 8 through 10. Maximum wet bulb globe temperature averaged 23 +/- 4 degrees C. Twenty-five heat-acclimatized adolescent boys (age = 15 +/- 1 years, height = 180 +/- 8 cm, mass = 81.4 +/- 15.8 kg, body fat = 12 +/- 5%, Tanner stage = 4 +/- 1). We observed participants within and across preseason practices of football. Measures included gastrointestinal temperature (T(GI)), urine osmolality, sweat rate, forearm sweat composition, fluid consumption, testosterone to cortisol ratio, perceptual measures of thirst, perceptual measures of thermal sensation, a modified Environmental Symptoms Questionnaire, and knowledge questionnaires assessing the participants' understanding of heat illnesses and hydration. Results were analyzed for differences across time and were compared between younger (14-15 years, n = 13) and older (16-17 years, n = 12) participants. Maximum daily T(GI) values remained less than 40 degrees C and were correlated with maximum wet bulb globe temperature (r = 0.59, P = .009). Average urine osmolality indicated that participants generally experienced minimal to moderate hypohydration before (881 +/- 285 mOsmol/kg) and after (856 +/- 259 mOsmol/kg) each practice as a result of replacing approximately two-thirds of their sweat losses during exercise but inadequately rehydrating between practices. Age did not affect most variables; however, sweat rate was lower in younger participants (0.6 +/- 0.2 L/h) than in older participants (0.8 +/- 0.1 L/h) (F(1,18) = 8.774, P = .008). Previously heat-acclimatized adolescent boys (T(GI) < 40 degrees C) can safely complete the initial days of preseason football practice in moderate environmental conditions using well-designed practice guidelines. Adolescent boys replaced most sweat lost during practice but remained mildly hypohydrated throughout data collection, indicating inadequate hydration habits when they were not at practice.

Hydration Status of Expatriate Manual Workers During Summer in the Middle East

Implicit in all indices used for risk assessment in the prevention of heat stress is the assumption that workers are healthy and well hydrated; studies in Australian mine workers have shown that this is not the case. Where workers are poorly hydrated, the level of protection offered by management strategies based primarily on environmental monitoring is compromised. To investigate the hydration status of expatriate workers during summer in a range of work environments in the Middle East as large numbers of expatriate workers are employed as manual labourers in construction and other industries under extreme heat stress conditions where heat illness is a significant concern. The aim was to ascertain whether the generally inadequate hydration status, previously documented in Australian workers, is also an issue in these workers and make practical recommendations for control. Studies were carried out at four sites to document the hydration status of exposed workers in different workplaces using urine specific gravity at three time points over two different work shifts. Although the workers were found in general to be better hydrated than their Australian counterparts, a high proportion were still found to be inadequately hydrated both on presentation for work and throughout the shift. Hydration status did not alter greatly over the course of the day at individual or group level. Interventions are required to ensure that workers in extreme heat stress conditions maintain adequate levels of hydration. Failure to do so reduces the protection afforded by heat stress indices based on environmental monitoring.

High Mortality in a Cholera Outbreak in Western Kenya after Post-Election Violence in 2008

In 2008, a cholera outbreak with unusually high mortality occurred in western Kenya during civil unrest after disputed presidential elections. Through active case finding, we found a 200% increase in fatal cases and a 37% increase in surviving cases over passively reported cases; the case-fatality ratio increased from 5.5% to 11.4%. In conditional logistic regression of a matched case-control study of fatal versus non-fatal cholera infection, home antibiotic treatment (odds ratio [OR] 0.049; 95% CI: < 0.001-0.43), hospitalization (OR, 0.066; 95% CI, 0.001-0.54), treatment in government-operated health facilities (OR, 0.15; 95% CI, 0.015-0.73), and receiving education about cholera by health workers (OR, 0.19; 95% CI, 0.018-0.96) were protective against death. Among 13 hospitalized fatal cases, chart review showed inadequate intravenous and oral hydration and substantial staff and supply shortages at the time of admission. Cholera mortality was under-reported and very high, in part because of factors exacerbated by widespread post-election violence.

Hydration Status of Air Force Military Basic Trainees After Implementation of the Back-Mounted Hydration System

The Air Force makes an extraordinary effort to prevent heat-related illnesses associated with basic military training (BMT) in south Texas. However, inadequate hydration can still contribute to lost training time and qualified trainees leaving military service without completing BMT. The purpose of the present study was to determine whether equipping BMTs with back-mounted hydration systems (BM) is better than the standard-issue (SI) canteens with respect to hydration status. Male BMTs were randomly assigned to either BM (n = 40) or SI (n = 38) groups. Baseline values were assessed at week 0 before any physical readiness training (PRT). Subsequent data collection took place in the a.m. before PRT and in the p.m. before dinner the first 3 weeks, and during the 5 weeks of training. BMT total body water (TBW) and body composition were assessed by bioelectrical impedance. Saliva osmolality and total protein concentration were also determined. Hydration status increased daily in BM and SI and was well maintained over the duration of BMT. A significant hydration effect (p < 0.05) was observed for average daily increases in TBW and body weight with BM gaining more compared to SI. Average a.m. TBW was 0.3-0.8 L greater in SI versus BM (p < 0.05). Our findings demonstrate that adequate hydration status is maintained during Air Force BMT in a hot environment using either hydration mode and therefore do not support widespread issuance of the BM system on the premise of improved hydration during USAF BMT military training.

Fluid replacement and heat stress during exercise alter post‐exercise cardiac haemodynamics in endurance exercise‐trained men

It has been reported that endurance exercise-trained men have decreases in cardiac output with no change in systemic vascular conductance during post-exercise hypotension, which differs from sedentary and normally active populations. As inadequate hydration may explain these differences, we tested the hypothesis that fluid replacement prevents this post-exercise fall in cardiac output, and further, exercise in a warm environment would cause greater decreases in cardiac output. We studied 14 trained men (VO2,peak 4.66 +/- 0.62 l min(-1)) before and to 90 min after cycling at 60% VO2,peak for 60 min under three conditions: Control (no water was consumed during exercise in a thermoneutral environment), Fluid (water was consumed to match sweat loss during exercise in a thermoneutral environment) and Warm (no water was consumed during exercise in a warm environment). Arterial pressure and cardiac output were measured pre- and post-exercise in a thermoneutral environment. The fall in mean arterial pressure following exercise was not different between conditions (P = 0.453). Higher post-exercise cardiac output (Delta 0.41 +/- 0.17 l min(-1); P = 0.027), systemic vascular conductance (Delta 6.0 +/- 2.2 ml min(-1) mmHg(-1); P = 0.001) and stroke volume (Delta 9.1 +/- 2.1 ml beat(-1); P < 0.001) were seen in Fluid compared to Control, but there was no difference between Fluid and Warm (all P > 0.05). These data suggest that fluid replacement mitigates the post-exercise decrease in cardiac output in endurance-exercise trained men. Surprisingly, exercise in a warm environment also mitigates the post-exercise fall in cardiac output.

Case Study: Asphyxia Caused by Inspissated Oral and Nasopharyngeal Secretions

Case Study: Asphyxia Caused by Inspissated Oral and Nasopharyngeal Secretions

Sudden Death and Sickle Cell Trait

Sickle cell trait, which affects approximately 8% of American blacks, is generally felt to be a benign condition. Exercise-related collapse in persons with sickle cell trait is a rare but serious complication. It occurs most often in military recruits and deconditioned athletes undergoing intense physical training, but can also occur in other situations in which an individual exerts himself beyond his limits of endurance. Local hypoxia causes intravascular sickling, in turn causing vascular occlusion and organ and tissue damage. This can result in rhabdomyolysis, myocardial ischemia, arrhythmias and sudden death. Risk factors include poor physical conditioning, inadequate hydration, excess heat and/or altitude, heat-retaining clothing and febrile illness. Seven cases are presented, and the implications of the diagnosis of sickle trait-associated collapse and sudden death are discussed.

Fluid Replacement And Heat Stress During Exercise Alters Postexercise Cardiac Hemodynamics In Endurance Trained Men

Endurance exercise-trained men have decreases in cardiac output with no change in systemic vascular conductance during postexercise hypotension, which differs from sedentary and normally active populations. PURPOSE: As inadequate hydration may explain these differences, we tested the hypothesis that fluid replacement prevents this postexercise fall in cardiac output, and further, exercise in a warm condition would cause greater decreases in cardiac output. METHODS: We studied 14 trained men (63.5 ± 4.7 ml.kg-1·min-1) before and through 90 min after cycling at 60% VO2peak for 60 min under three conditions: (1) fluid replacement and thermoneutral, (2) no fluid replacement and thermoneutral, and (3) no fluid replacement and exercise in a warm environment. Arterial pressure and cardiac output were measured pre and postexercise in a thermoneutral environment. RESULTS: The fall in mean arterial pressure following exercise was not different between conditions (P=0.453). Postexercise cardiac output (P=0.027), systemic vascular conductance (P=0.001), stroke volume (P < 0.001), and heart rate (P < 0.001) were different between conditions, as higher cardiac output (D 0.4 ± 1.6 l/min; P=0.023), systemic vascular conductance (D 6.0 ± 2.2 ml· min-1· mmHg-1; P=0.008), and stroke volumes (D 9.1 ± 2.1 ml/beat; P=0.002) were seen in the fluid condition compared to the no fluid condition, but there was no difference between the fluid condition versus the no fluid and warm condition (all P > 0.05). CONCLUSION: These data suggest that fluid replacement mitigates the postexercise decrease in cardiac output in endurance-exercise trained men. Surprisingly, exercise in a warm environment also mitigates the fall in cardiac output postexercise. Funding by AHA 555623Z and The Evonuk Foundation.

Survival and growth of drought hardened Eucalyptus pilularis Sm. seedlings and vegetative cuttings

Forestry requires low mortality of transplanted seedlings. Mortality shortly after planting is often associated with inadequate hydration of transplants. Seedlings can be hardened to the drought conditions they may experience after transplanting by exposing them to controlled drought conditions in the nursery. Eucalyptus pilularis Sm. seedlings were drought hardened by providing nil (severe treatment) or half (mild treatment) the daily irrigation routinely received (control treatment) for up to two non-consecutive days per week during the last 4 weeks of growth in the nursery. Drought hardening reduced stem diameter, seedling leaf area, leaf area per root biomass and seedling quality measured by the Dickson quality index, but increased root:shoot ratio. Hardened seedlings had lower stomatal conductance and leaf water potential on the days they received less irrigation that the control treatment. Hardened seedlings had greater stomatal conductance and were less water stressed than seedlings experiencing drought for the first time indicating hardened seedlings had adjusted physiologically to drought. Survival after transplanting in the controlled drought environment in a glasshouse was enhanced by the hardening treatments. Non hardened seedlings that had had their upper leaves manually removed immediately prior to transplanting to reduce leaf area (top-clipped) had similar survival to hardened seedlings. Stomatal conductance and leaf water potential after transplanting were higher in hardened and top-clipped seedlings than unhardened control seedlings or vegetative cuttings. Survival in the field trial was over 95% for all treatments, possibly as rain fell within 4 days of planting and follow-up rain occurred in the subsequent weeks. Neither the hardened or top-clipped seedlings planted in the field trial had reduced growth, increased propensity to form double leaders or worse stem form than control seedlings when measured at age 3 years.

INO-4995 therapeutic efficacy is enhanced with repeat dosing in cystic fibrosis knockout mice and human epithelia.

Progressive lung damage in cystic fibrosis (CF) has been linked to inadequate airway mucosal hydration. We previously demonstrated that an inositol tetrakisphosphate analog, 1-O-octyl-2-O-butyryl-myo-inositol 3,4,5,6-tetrakisphosphate octakis(propionoxymethyl)ester (INO-4995), regulates airway secretory and absorptive processes, affecting mucosal hydration by prolonged (24 h) inhibition of Na(+) and fluid absorption in CF human nasal epithelia (CFHNE). The objectives of this study were to further assess clinical potential of INO-4995 in CF through ascertaining in vivo activity in mice with CF, determining the effects of repeated administration on potency and determining cytoplasmic half-life. Uptake and metabolism of [(3)H]INO-4995 was monitored with HPLC to calculate intracellular half-life. INO-4995 was administered in vitro repeatedly over 4 to 8 days to CFHNE. Fluid absorption was assessed by blue dextran exclusion, and basal short-circuit current was measured in Ussing chambers. INO-4995 (1-100 microg/kg) was dosed intranasally either as a single dose or once per day over 4 days to gut-corrected CF mice. [(3)H]INO-4995 was rapidly taken up by epithelial cultures and converted to the active drug, which had a half-life of 40 hours. Repeated daily application of INO-4995 to CFHNE lowered the effective concentration for inhibition of fluid absorption and amiloride-sensitive short-circuit current in cultured CFHNE, and reduced nasal potential difference to nearly control levels in gut-corrected CF mice. Ca(2+)-activated Cl(-) channel activity was also boosted in cultures. Mouse nasal levels fell from abnormal levels to within 2 muA of normal with repeated exposure to 0.8 microg/kg over 4 days. These data support further development of INO-4995 for the treatment of CF.

Scintigraphic evaluation of colon targeting pectin–HPMC tablets in healthy volunteers

The in vivo evaluation of colon-targeting tablets was conducted in six healthy male volunteers. A pectin–hydroxypropyl methylcellulose coating was compressed onto core tablets labelled with 4 MBq 99mTc-DTPA. The tablets released in the colon in all subjects; three in the ascending colon (AC) and three in the transverse colon (TC). Tablets that released in the TC had reached the AC before or just after food (Group A). The other three tablets released immediately upon AC entry at least 1.5 h post-meal (Group B). Release onset for Group B was earlier than Group A (343 min vs 448 min). Group B tablets exhibited a clear residence period at the ileocaecal junction (ICJ) which was not observed in Group A. Prolonged residence at the ICJ is assumed to have increased hydration of the hydrogel layer surrounding the core tablet. Forces applied as the tablets progressed through the ICJ may have disrupted the hydrogel layer sufficiently to initiate radiolabel release. Conversely, Group A tablets moved rapidly through the AC to the TC, possibly minimising contact times with water pockets. Inadequate prior hydration of the hydrogel layer preventing access of pectinolytic enzymes and reduced fluid availability in the TC may have retarded tablet disintegration and radiolabel diffusion.

Why does the plasma urea concentration increase in acute dehydration?

Acute dehydration biochemically manifests itself with mild uremia and a normal creatinine concentration. The reason for this, as quoted in popular medical textbooks, is that there is increased reabsorption of urea by the kidneys ([1][1]). This explanation is rarely taken further by clinical tutors

An exploration of factors that influence the regular consumption of water by Irish primary school children

Inadequate hydration has been linked to many factors that may impact on children's education and health. Teachers play an important role in the education and behaviour of children. Previous research has demonstrated low water intake amongst children and negative teachers' attitudes to water in the classroom. The present study aimed to explore teachers' knowledge about water and the perceived barriers to allowing children access to water during lesson time. In-depth interviews were conducted with 12 teachers from primary schools in the Midlands of Ireland. Interviews were continued until there was saturation of the data. Thematic analysis of the data was conducted. Participants had a poor knowledge of hydration requirements and the associated health benefits and effect on concentration. Low water intake amongst teachers and pupils, and barriers such as disruption to class and increased need to urinate, were reported. Teachers identified the hydration effect on learning as the education message most likely to influence the decision to allow water in the classroom. The issues, opinions and perceived barriers raised by teachers as part of this qualitative research provide a basis for future health promotion around water.