Thirst and drugs: A study in the World Health Organization's pharmacovigilance database.

Thirst is a complex physiological compensatory mechanism but could also be associated with drugs. This association was poorly investigated previously. Using the WHO global pharmacovigilance database, Vigibase®, disproportionality analyses potential associations between exposure to drugs and thirst reports were performed. All reports of thirst in adults between 01/01/2000 and 31/12/2023 were included. Results are expressed as reporting odds ratio (ROR). Analysis of the 3186 reports of thirst (978 'serious') allowed, first, to confirm the association between thirst and exposure to vasopressin antagonists (tolvaptan), lithium, gliflozins (dapagliflozin, empagliflozin), pregabalin and antimuscarinic drugs (glycopyronium, oxybutynin, tiotropium). Second, new safety signals were described with monoamine reuptake inhibitors (antidepressants: duloxetine, venlafaxine; anti-obesity agent: sibutramine), antipsychotic (olanzapine), glucocorticoid (prednisolone), diuretic (furosemide) drugs as well with ribavirin or sodium oxybate. This study is the first to offer a list of drugs associated with thirst in humans.

Stereotyped goal-directed manifold dynamics in the insular cortex.

The insular cortex is involved in diverse processes, including bodily homeostasis, emotions, and cognition. However, we lack a comprehensive understanding of how it processes information at the level of neuronal populations. We leveraged recent advances in unsupervised machine learning to study insular cortex population activity patterns (i.e., neuronal manifold) in mice performing goal-directed behaviors. We find that the insular cortex activity manifold is remarkably consistent across different animals and under different motivational states. Activity dynamics within the neuronal manifold are highly stereotyped during rewarded trials, enabling robust prediction of single-trial outcomes across different mice and across various natural and artificial motivational states. Comparing goal-directed behavior with self-paced free consumption, we find that the stereotyped activity patterns reflect task-dependent goal-directed reward anticipation, and not licking, taste, or positive valence. These findings reveal a core computation in insular cortex that could explain its involvement in pathologies involving aberrant motivations.

The Effect of Cold Oral Applications in the Management of Postoperative Thirst: A Systematic Review.

PURPOSE: Thirst is one of the most bothersome symptoms experienced by surgical patients. Effective thirst intervention and management in the Post Anesthesia Care Unit (PACU) and hospital wards is critical because patients are less sedated and more aware than in the past. There is a need to review the literature on the identification and management of thirst in the inpatient and PACU settings. The aim of this systematic review was to examine the available evidence on the effectiveness of oral cold applications on thirst in postoperative patients. DESIGN: This was a systematic review study. Articles in PUBMED, Web of Science, ScienceDirect, TÜBITAK-ULAKBIM, and TRDizin databases between January 2008 and January 2023 that included oral cold applications to relieve the thirst of patients in the postoperative period were included. METHODS: The PICOT-SD (Patients Interventions Comparison Outcome Time-Study Design) method was used as an eligibility criterion for inclusion in the study. The eligibility criteria included that the articles were written in English-Turkish and within the target dates, the studies included nursing interventions, the primary outcome of the studies was thirst, and the study sample included postoperative patients. The risk of bias was assessed using the RoB2 tool developed by Cochrane. FINDINGS: A total of 254 articles were retrieved from the databases using the specified keywords. 244 articles did not meet the study criteria: 30 were excluded because they were not interventional studies, 61 were not conducted in a postoperative population, 56 were duplicates, and 79 were not on a related topic. A total of 10 studies consisting of randomized controlled trials and quasi-experimental articles met the criteria for our review. Oral cold applications effectively reduced the thirst rate of postoperative patients and improved their health-related quality of life. The intervention has also been shown to reduce other anesthesia-related complications. CONCLUSIONS: This systematic review concluded that cold oral applications have promising effects on thirst, dry mouth, and health-related quality of life. Cold oral applications are cost-effective and suitable for large-scale health care applications.

Brain sodium sensing for regulation of thirst, salt appetite, and blood pressure.

The brain possesses intricate mechanisms for monitoring sodium (Na) levels in body fluids. During prolonged dehydration, the brain detects variations in body fluids and produces sensations of thirst and aversions to salty tastes. At the core of these processes Nax , the brain's Na sensor, exists. Specialized neural nuclei, namely the subfornical organ (SFO) and organum vasculosum of the lamina terminalis (OVLT), which lack the blood-brain barrier, play pivotal roles. Within the glia enveloping the neurons in these regions, Nax collaborates with Na+ /K+ -ATPase and glycolytic enzymes to drive glycolysis in response to elevated Na levels. Lactate released from these glia cells activates nearby inhibitory neurons. The SFO hosts distinct types of angiotensin II-sensitive neurons encoding thirst and salt appetite, respectively. During dehydration, Nax -activated inhibitory neurons suppress salt-appetite neuron's activity, whereas salt deficiency reduces thirst neuron's activity through cholecystokinin. Prolonged dehydration increases the Na sensitivity of Nax via increased endothelin expression in the SFO. So far, patients with essential hypernatremia have been reported to lose thirst and antidiuretic hormone release due to Nax -targeting autoantibodies. Inflammation in the SFO underlies the symptoms. Furthermore, Nax activation in the OVLT, driven by Na retention, stimulates the sympathetic nervous system via acid-sensing ion channels, contributing to a blood pressure elevation.

The effect of ice-cold water spray following the model for symptom management on postoperative thirst in patients admitted to intensive care unit: A randomized controlled study.

BACKGROUND: Postoperative thirst is common in patients admitted to the intensive care unit. Existing methods like wet cotton swabs or oral care prove ineffectual or operationally intricate. Currently, an efficacious postoperative thirst alleviation method remains elusive. Exploring a prompt, safe, and efficacious solution is of paramount importance. OBJECTIVE: To assess the effect of ice-cold water spray applied following a symptom management model on postoperative thirst and to establish a framework for mitigating thirst in intensive care unit patients. RESEARCH DESIGN: Single-center randomized controlled study. SETTING: Surgical intensive care unit in a university-affiliated hospital. MAIN OUTCOME MEASURES: 56 intensive care unit patients were selected and equally randomized. The experimental group received ice-cold water spray in conjunction with eight symptom management strategies, while the control group underwent standard care involving wet cotton swabs. Thirst intervention was initiated 0.5 hours after postoperative extubation, followed by subsequent interventions at 2-hour, 4-hour, and 6-hour intervals post-extubation. Thirst intensity, oral comfort, and the duration of relief from thirst were assessed and compared between groups before and 0.5 hours after each thirst intervention. RESULTS: Across different interventions, the experimental group exhibited superior scores in thirst intensity and oral comfort compared to the control group. Additionally, the nursing time required to alleviate thirst in the experimental group was significantly shorter than that in the control group (P < 0.01). CONCLUSION: Ice-cold water spray following the model for symptom management can effectively mitigate the postoperative thirst intensity in intensive care unit patients, improve oral comfort, and reduce the nursing time for relieving thirst. IMPLICATIONS FOR CLINICAL PRACTICE: Clinical nurses can employ ice-cold water spray following the model for symptom management to ameliorate postoperative thirst intensity in ICU patients while enhancing oral comfort. Furthermore, the utilization of ice-cold water spray can reduce the nursing time required for relieving postoperative thirst in intensive care unit patients.

Parent-offspring similarity in hunger and thirst sensations.

The internal (i.e., interoceptive) sensations that characterise hunger vary between people, and this may also be the case for thirst, although it has not been so well explored. There are probably both heritable and learning-based causes for this interoceptive variability. Consequently, it would seem plausible that parents and their offspring would have more similar patterns of hunger and thirst than pairs of strangers. We tested this idea, in addition to exploring its potential moderating variables, by studying the similarity of self-reported hunger and thirst sensations in 170 students and their primary caregivers from childhood. Both students and caregivers completed the same online-survey, covering hunger and thirst sensations, beliefs about the causes of hunger and thirst, the Three Factor Eating Questionnaire (revised) and demographic data. We find evidence of robust student-caregiver similarity in interoceptive hunger and thirst sensations (medium effect sizes), with these being moderated by caregiver beliefs about the homeostatic nature of each state (medium effect sizes). This suggests a potential role for caregivers in the development of their offspring's interoceptive cues for hunger and for thirst. In addition, thirst, like hunger, appears to be multidimensional, and varies between people. The implications of these findings are discussed.

Is increased subjective thirst associated with greater interdialytic weight gains, extracellular fluid and dietary sodium intake?

BACKGROUND: Some previous studies have reported an effect of increasing subjective thirst and interdialytic weight gains (IDWG), and that this may be influenced by nonadherence to dietary sodium restrictions, whereas others reported no such association. As such we wished to review the effect of self-reported thirst on IDWGs and dietary sodium intake. METHODS: Dialysis patients were asked to complete visual analogues thirst, distress thermometer (DT) scores and complete a sodium food frequency questionnaire (SFFQ). IDWG and pre and post dialysis volumes were measured with multifrequency bioelectrical impedance. RESULTS: One hundred and eleven patients completed the questionnaires and had bioimpedance measurements: 63% male, mean age 63.8 ± 16.1 years, 33% diabetic with a median thirst score 3 (0-5) and SFFQ 52.0 ± 18, and IDWG 2.1 ± 1.3%. Thirst was associated with DT (r = 0.28, p = 0.004) and negatively with age (r = -0.31, p < 0.001), but not SFFQ, IDWG, extracellular water, or dialysate sodium, or dialysate to plasma gradient. Patients with higher thirst scores were younger (58.0 ± 15.2 vs. 69.4 ± 15.0 years, p < 0.001) with higher DT scores (5 [2-7] vs. 2 [0-5], p < 0.001). On multivariate logistic analysis, only age was associated with self-reported thirst (odds ratio 0.95, 95% confidence limits 0.92-0.98, p < 0.001). CONCLUSION: We found that subjective thirst was greater for younger patients and those who reported higher levels of distress, but no association with IDWGs, dietary sodium intake, or dialysate sodium. However, most of our patients followed the dietary advice, as evidenced by the low SFFQ scores and % IDWGs. Whether thirst increases distress or distress increases subjective thirst remains to be determined.

Evaluation of thirst severity, death anxiety, and complementary and supportive therapy use as predictors of urinary incontinence-related quality of life in older adults.

PURPOSE: This correlational survey study aimed to evaluate thirst severity, death anxiety, and the use of complementary and supportive therapy as predictors of urinary incontinence-related quality of life in older adults. METHODS: The study included 368 participants aged 60 or older. Data were collected by face-to-face interviews using a participant information form, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Visual Analog Scale for thirst severity, Death Anxiety Scale, a modified version of the Mini Mental State Examination, and questions about their use of complementary and supportive therapies. RESULTS: The participants had a mean age of 70.5 ± 6.9 years (54.9% female). Mean ICIQ-SF score was significantly correlated with daytime frequency of urine leakage and thirst severity score. Multiple linear regression analysis indicated that thirst severity was a significant predictor of urinary incontinence-related quality of life. Most of the older adults said they had never used complementary or supportive therapies for urinary incontinence. CONCLUSION: Thirst severity should be assessed in older adults with urinary incontinence in addition to other factors that may affect ICIQ-SF scores.

Two parabrachial Cck neurons involved in the feedback control of thirst or salt appetite.

Thirst and salt appetite are temporarily suppressed after water and salt ingestion, respectively, before absorption; however, the underlying neural mechanisms remain unclear. The parabrachial nucleus (PBN) is the relay center of ingestion signals from the digestive organs. We herein identify two distinct neuronal populations expressing cholecystokinin (Cck) mRNA in the lateral PBN that are activated in response to water and salt intake, respectively. The two Cck neurons in the dorsal-lateral compartment of the PBN project to the median preoptic nucleus and ventral part of the bed nucleus of the stria terminalis, respectively. The optogenetic stimulation of respective Cck neurons suppresses thirst or salt appetite under water- or salt-depleted conditions. The combination of optogenetics and in vivo Ca2+ imaging during ingestion reveals that both Cck neurons control GABAergic neurons in their target nuclei. These findings provide the feedback mechanisms for the suppression of thirst and salt appetite after ingestion.

Clinical significance and correlation of compliance to thirst in maintenance hemodialysis patients.

BACKGROUND: The main treatment method for end-stage renal disease (ESRD) is maintenance hemodialysis (MHD). With the continuous improvement of dialysis technology, the survival period of MHD patients has been effectively prolonged, but dialysis technology still cannot completely replace renal function. OBJECTIVE: To study the dietary compliance and its correlation with thirst in MHD patients and to provide guidance for clinical development of corresponding intervention countermeasures. METHODS: A total of 90 patients who received MHD treatment from March 2021 to March 2022 were selected as objects. The Renal Adherence Attitudes Questionnaire (RAAQ) and the Renal Adherence Behaviour Questionnaire (RABQ) were used to analyze the dietary compliance and thirst status of patients. Pearson correlation analysis was used to analyze the correlation between diet compliance and thirst. RESULTS: Positive correlations were found between VAS and DTI, SXI and TDS (P< 0.05). Social restrictive attitude was positively correlated with VAS, DTI, SXI, TDS, acceptance attitude and compliance in facing difficulties (P< 0.05), and negatively correlated with self-care compliance (r=-0.35, P< 0.05). Health attitude was positively correlated with VAS, DTI and SXI (P< 0.05). Acceptance attitude was positively correlated with DTI, SXI and TDS (P< 0.05). High RAAQ was associated with high VAS (b= 0.11, 95% CI: 0.05, 0.18), DTI (b= 0.28, 95% CI: 0.17, 0.38), SXI (b= 0.24, 95% CI: 0.14, 0.34) and TDS (b= 0.26, 95% CI: 0.13, 0.4). CONCLUSION: The overall performance of dietary compliance in patients with MHD is at a moderate level, and dietary compliance is negatively correlated with disease perception.

Validación clínica de la propuesta diagnóstica de enfermería de sed perioperatoria / Clinical validation of the nursing diagnostic proposition perioperative thirst / Validação clínica da proposição diagnóstica de enfermagem sede perioperatória

Objetivo: verificar la validez clínica de la proposición de un nuevo diagnóstico de enfermería denominado sed perioperatoria, basado en la precisión diagnóstica de sus indicadores clínicos, incluyendo la magnitud del efecto de sus factores etiológicos. Método: estudio de validación clínica diagnóstica con 150 pacientes quirúrgicos en un hospital universitario. Se recogieron variables sociodemográficas e indicadores clínicos relacionados con la sed. Se utilizó la técnica de análisis de clases latentes. Resultados: se propusieron dos modelos de clases latentes para las características definitorias. El modelo ajustado en el preoperatorio incluía: labios resecos, saliva espesa, lengua espesa, ganas de beber agua, informe del cuidador, garganta seca y deglución constante de saliva. En el postoperatorio: sequedad de garganta, saliva espesa, lengua espesa, constante deglución de saliva, ganas de beber agua, mal gusto en la boca. Los factores relacionados "temperatura ambiente elevada" y "sequedad de boca" se asocian a la presencia de sed, así como las condiciones asociadas "uso de anticolinérgicos" e "intubación". La prevalencia de sed fue del 62,6% en el preoperatorio y del 50,2% en el postoperatorio inmediato. Conclusión: la proposición diagnóstica de la sed perioperatoria mostró buenos parámetros de precisión de sus indicadores clínicos y efectos etiológicos. Esta propuesta en una taxonomía de enfermería permitirá una mayor visibilidad, apreciación y tratamiento de este síntoma.

Objective: to verify the clinical validity of the proposition of a new nursing diagnosis called perioperative thirst, based on the diagnostic accuracy of its clinical indicators, including the magnitude of effect of its etiological factors. Method: clinical diagnostic validation study with a total of 150 surgical patients at a university hospital. Sociodemographic variables and clinical indicators related to thirst were collected. The latent class analysis technique was used. Results: two models of latent classes were proposed for the defining characteristics. The model adjusted preoperatively included: dry lips, thick saliva, thick tongue, desire to drink water, caregiver report, dry throat and constant swallowing of saliva. In the postoperative period: dry throat, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth. The factors related to "high ambient temperature" and "dry mouth" are associated with the presence of thirst, as well as the associated conditions "use of anticholinergics" and "intubation". The prevalence of thirst was 62.6% in the pre and 50.2% in the immediate postoperative period. Conclusion: the diagnostic proposition of perioperative thirst showed good accuracy parameters for its clinical indicators and etiological effects. This proposition in a nursing taxonomy will allow greater visibility, appreciation and treatment of this symptom.

Objetivo: verificar a validade clínica da proposição de um novo diagnóstico de enfermagem denominado sede perioperatória, com base na acurácia diagnóstica de seus indicadores clínicos, incluindo a magnitude de efeito de seus fatores etiológicos. Método: estudo de validação clínica diagnóstica com 150 pacientes cirúrgicos em um hospital universitário. Foram coletadas variáveis sociodemográficas e indicadores clínicos relacionados à sede. Empregou-se a técnica de análise de classe latente. Resultados: dois modelos de classes latentes foram propostos para as características definidoras. O modelo ajustado no pré-operatório incluiu: lábios ressecados, saliva grossa, língua grossa, vontade de beber água, relato do cuidador, garganta seca e constante deglutição de saliva. No pós-operatório: garganta seca, saliva grossa, língua grossa, constante deglutição de saliva, vontade de beber água, gosto ruim na boca. Os fatores relacionados Temperatura do ambiente elevada e Boca seca estão associados à presença de sede, assim como as condições associadas Utilização de anticolinérgicos e Intubação. A prevalência de sede foi de 62,6% no pré-operatório e 50,2% no pós-operatório imediato. Conclusão: a proposição diagnóstica de sede perioperatória apresentou bons parâmetros de acurácia de seus indicadores clínicos e efeitos etiológicos. Essa proposição em uma taxonomia de enfermagem permitirá maior visibilidade, valorização e tratamento desse sintoma.

The responsibility to quench thirst by providing drinks when a relative is dying spouses' experience in specialist palliative home care.

BACKGROUND: Thirst and dry mouth are common symptoms in terminally ill patients. It is known that family members usually request drips for their dying relative. Few studies have focused on thirst in terminally ill patients and their spouses' experience of this, leading to a knowledge gap in this area. AIM: The aim of this study was to explore spouses' experiences of observing and managing thirst in a dying relative admitted to specialist palliative home care. METHODS: A qualitative interview study with an inductive approach was conducted. Eighteen spouses caring for their husband or wife admitted to specialist palliative home care in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. RESULTS: Three main themes emerged regarding spouses' experiences of patients' thirst: Knowledge and views of thirst; Control of fluid intake provides vital information; and Taking charge of their drinking is a life and death responsibility. CONCLUSIONS: Spouses experience a responsibility to serve the dying person with fluids so that they will not get thirsty. It is so obvious and commonplace to them. To be able to fulfil this responsibility, they need to keep track of the patient's fluid intake and know what quenches thirst. There is a need for research in this area to assist carers and patients in identifying which drinks best quench the patient's thirst. Interventions are also needed to help provide/make available knowledge on suitable thirst-quenching drinks.

Use of a menthol popsicle in managing postoperative thirst in patients undergoing radical prostatectomy: A randomized clinical trial.

Background and aim: Thirst is a real bother that most patients feel in the immediate postoperative period when they still need to fast. Many approaches regarding symptomatic relief strategies have been described in the literature, but strategies with cold water and/or menthol are effective in quenching thirst, as they act on pre-absorptive mechanisms. This study aims to evaluate the effectiveness of using menthol popsicles in relieving postoperative thirst in patients undergoing radical prostatectomy. Material and methods: This is a randomized controlled clinical trial with a quantitative approach. In all, 44 patients were evaluated in the immediate postoperative period of radical prostatectomy, with the intensity and discomfort of thirst being evaluated initially and subsequently. The study consisted of two groups: (1) the placebo group, popsicles without the addition of menthol substrates and (2) the experimental group, popsicles with the addition of 0.05% minty substrates. Results: The results demonstrate that the sociodemographic and clinical characteristics were homogeneous at the α = 5% significance level, except the occupation variable. The test detected changes in the intensity and discomfort of thirst in relation to the pre- and post-intervention times for the primary outcome when the groups were analyzed separately and for the interaction of the group versus time, there was no statistical difference between the groups. Conclusion: It was possible to prove that both the menthol popsicle and the popsicle without the addition of menthol were effective in relieving postoperative thirst in patients undergoing radical prostatectomy, but there was no statistically significant difference when comparing the two groups. Trial registration: The Brazilian Registry of Clinical Trials (RBR-8c3chr7).

Serum Activity of Proteolytic Enzyme Trypsin in Rats under Conditions of Water and Food Deprivation.

Trypsin is mainly regarded as a digestive enzyme, but there is evidence that activation of protease-activated receptor-2 (PAR-2) leads to behavioral changes. There are no data on trypsin activity in the serum of animals under conditions of thirst and starvation in the available literature. In our experiments, water deprivation led to a significant (p⩽0.05) increase in trypsin activity in rats, and food deprivation led to its decrease in comparison with controls (free access to water and food). After deprived rats received water and food, a decrease in trypsin activity was observed in both experimental groups. Changes in trypsin activity under conditions of water or food deprivation and after satiation were accompanied by shifts in some biochemical parameters of the bloods. Under conditions of metabolic stress (starvation and thirst), opposite changes in trypsin activity seem to indicate its participation in the mechanisms of adequate restructuring of metabolism and maintenance of vital processes in the body.

Effects of a low carbohydrate diet on heart failure symptoms and quality of life in patients with diabetic cardiomyopathy: A randomised controlled trial pilot study.

BACKGROUND AND AIMS: Heart failure, insulin resistance and/or type 2 diabetes mellitus coexist in the syndrome that is diabetic cardiomyopathy. Patients with diabetic cardiomyopathy experience high symptom burden and poor quality of life. We tested the hypothesis that a low carbohydrate diet improves heart failure symptoms and quality of life in patients with diabetic cardiomyopathy. METHODS AND RESULTS: We conducted a 16-week randomised controlled pilot trial comparing the effects of a low carbohydrate diet (LC) to usual care (UC) in 17 adult patients with diabetic cardiomyopathy. New York Heart Association classification, weight, thirst distress and quality of life scores as well as blood pressure and biochemical data were assessed at baseline and at 16 weeks. Thirteen (n = 8 LC; n = 5 UC) patients completed the trial. The low carbohydrate diet induced significant weight loss in completers (p = 0.004). There was a large between-group difference in systolic blood pressure at the end of the study (Hedges's g 0.99[-014,2.08]). There were no significant differences in thirst or quality of life between groups. CONCLUSION: This is the first clinical trial utilising the low carbohydrate dietary approach in patients with diabetic cardiomyopathy in an outpatient setting. A low carbohydrate diet can lead to significant weight loss in patients with diabetic cardiomyopathy. Future clinical trials with larger samples and that focus on fluid and sodium requirements of patients with diabetic cardiomyopathy who engage in a low carbohydrate diet are warranted. CLINICAL TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trial Registry (ANZCTR): ACTRN12620001278921. DATE OF REGISTRATION: 26th November 2020.

Behavioral responses of free-flying Drosophila melanogaster to shiny, reflecting surfaces.

Active locomotion plays an important role in the life of many animals, permitting them to explore the environment, find vital resources, and escape predators. Most insect species rely on a combination of visual cues such as celestial bodies, landmarks, or linearly polarized light to navigate or orient themselves in their surroundings. In nature, linearly polarized light can arise either from atmospheric scattering or from reflections off shiny non-metallic surfaces like water. Multiple reports have described different behavioral responses of various insects to such shiny surfaces. Our goal was to test whether free-flying Drosophila melanogaster, a molecular genetic model organism and behavioral generalist, also manifests specific behavioral responses when confronted with such polarized reflections. Fruit flies were placed in a custom-built arena with controlled environmental parameters (temperature, humidity, and light intensity). Flight detections and landings were quantified for three different stimuli: a diffusely reflecting matt plate, a small patch of shiny acetate film, and real water. We compared hydrated and dehydrated fly populations, since the state of hydration may change the motivation of flies to seek or avoid water. Our analysis reveals for the first time that flying fruit flies indeed use vision to avoid flying over shiny surfaces.

Assistant nurses' experiences of thirst and ethical dilemmas in dying patients in specialized palliative care-A qualitative study.

AIMS: To describe assistant nurses' experiences of thirst and ethical challenges in relation to thirst in terminally ill patients in specialized palliative care (PC) units. DESIGN: A qualitative, reflexive thematic design with an inductive analysis was used. METHODS: Data were collected during November 2021-January 2023. Twelve qualitative interviews with assistant nurses working in five different specialized PC units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. The study was guided by the Standards for Reporting Qualitative Research (SRQR). RESULTS: Two main themes were found in this study. (1) 'A world of practice for thirst relief' where assistant nurses present a task-oriented world where the knowledge of thirst is an experience-based unspoken knowledge where mainly routines rule. (2) Ethical challenges presents different ethical problems that they meet in their practice, such as when patients express thirst towards the end of their life but are too severely ill to drink or when they watch lack of knowledge in the area among other health professionals. CONCLUSION: Thirst in dying patients is a neglected area that assistant nurses work with, without communicating it. Their knowledge of thirst and thirst relief are not expressed, seldom discussed, there are no policy documents nor is thirst documented in the patient's record. There is a need for nurses to take the lead in changing nursing practice regarding thirst. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPACT: In palliative care, previous studies have shown that dying patients might be thirsty. Assistant nurses recognize thirst in dying patients, but thirst is not discussed in the team. Nurses must consider the patient's fundamental care needs and address thirst, for example in the nursing process to ensure patients quality of life in the last days of life. REPORTING METHOD: The study was guided by the SRQR. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Thirst is a distressing symptom for all humans. However, when a patient is dying, he or she loses several functions and can no longer drink independently. The knowledge from this article contributes to our understanding of current practice and shows an area that requires immediate attention for the improvement of fundamental palliative care delivery.

The organum vasculosum of the lamina terminalis and subfornical organ: regulation of thirst.

Thirst and water intake are regulated by the organum vasculosum of the lamina terminalis (OVLT) and subfornical organ (SFO), located around the anteroventral third ventricle, which plays a critical role in sensing dynamic changes in sodium and water balance in body fluids. Meanwhile, neural circuits involved in thirst regulation and intracellular mechanisms underlying the osmosensitive function of OVLT and SFO are reviewed. Having specific Nax channels in the glial cells and other channels (such as TRPV1 and TRPV4), the OVLT and SFO detect the increased Na+ concentration or hyperosmolality to orchestrate osmotic stimuli to the insular and cingulate cortex to evoke thirst. Meanwhile, the osmotic stimuli are relayed to the supraoptic nucleus (SON) and paraventricular nucleus of the hypothalamus (PVN) via direct neural projections or the median preoptic nucleus (MnPO) to promote the secretion of vasopressin which plays a vital role in the regulation of body fluid homeostasis. Importantly, the vital role of OVLT in sleep-arousal regulation is discussed, where vasopressin is proposed as the mediator in the regulation when OVLT senses osmotic stimuli.

Hunger- and thirst-sensing neurons modulate a neuroendocrine network to coordinate sugar and water ingestion.

Consumption of food and water is tightly regulated by the nervous system to maintain internal nutrient homeostasis. Although generally considered independently, interactions between hunger and thirst drives are important to coordinate competing needs. In Drosophila, four neurons called the interoceptive subesophageal zone neurons (ISNs) respond to intrinsic hunger and thirst signals to oppositely regulate sucrose and water ingestion. Here, we investigate the neural circuit downstream of the ISNs to examine how ingestion is regulated based on internal needs. Utilizing the recently available fly brain connectome, we find that the ISNs synapse with a novel cell-type bilateral T-shaped neuron (BiT) that projects to neuroendocrine centers. In vivo neural manipulations revealed that BiT oppositely regulates sugar and water ingestion. Neuroendocrine cells downstream of ISNs include several peptide-releasing and peptide-sensing neurons, including insulin producing cells (IPCs), crustacean cardioactive peptide (CCAP) neurons, and CCHamide-2 receptor isoform RA (CCHa2R-RA) neurons. These neurons contribute differentially to ingestion of sugar and water, with IPCs and CCAP neurons oppositely regulating sugar and water ingestion, and CCHa2R-RA neurons modulating only water ingestion. Thus, the decision to consume sugar or water occurs via regulation of a broad peptidergic network that integrates internal signals of nutritional state to generate nutrient-specific ingestion.

Exercise-induced hypohydration impairs 3 km treadmill-running performance in temperate conditions.

Research assessing exercise-induced hypohydration on running performance in a temperate environment is scarce. Given the weight-bearing nature of running, the negative effects of hypohydration might be offset by the weight-loss associated with a negative fluid balance. Therefore, this study investigated the effect of exercise-induced hypohydration on running performance in temperate conditions. Seventeen intermittent games players (age 22 ± 1 y; VO2peak 52.5 ± 4.1 mL∙kg-1∙min-1) completed preliminary and familiarisation trials, and two experimental trials consisting of 12 blocks of 6 min of running (65% VO2peak; preload) with 1 min passive rest in-between, followed by a 3 km time trial (TT). During the preload, subjects consumed minimal fluid (60 mL) to induce hypohydration (HYP) or water to replace 95% sweat losses (1622 ± 343 mL; EUH). Body mass loss (EUH -0.5 ± 0.3%; HYP -2.2 ± 0.4%; P < 0.001), and other changes indicative of hypohydration, including increased serum osmolality, heart rate, thirst sensation, and decreased plasma volume (P ≤ 0.022), were apparent in HYP by the end of the preload. TT performance was ~6% slower in HYP (EUH 900 ± 87 s; HYP 955 ± 110 s; P < 0.001). Exercise-induced hypohydration of ~2% body mass impaired 3 km running TT performance in a temperate environment.