Influence of Sodium Citrate Supplementation after Dehydrating Exercise on Responses of Stress Hormones to Subsequent Endurance Cycling Time-Trial in the Heat.

Background and objectives: In temperate environments, acute orally induced metabolic alkalosis alleviates exercise stress, as reflected in attenuated stress hormone responses to relatively short-duration exercise bouts. However, it is unknown whether the same phenomenon occurs during prolonged exercise in the heat. This study was undertaken with aim to test the hypothesis that ingestion of an alkalizing substance (sodium citrate; CIT) after dehydrating exercise would decrease blood levels of stress hormones during subsequent 40 km cycling time-trial (TT) in the heat. Materials and Methods: Male non-heat-acclimated athletes (n = 20) lost 4% of body mass by exercising in the heat. Then, during a 16 h recovery period prior to TT in a warm environment (32 °C), participants ate the prescribed food and ingested CIT (600 mg·kg-1) or placebo (PLC) in a double-blind, randomized, crossover manner with 7 days between the two trials. Blood aldosterone, cortisol, prolactin and growth hormone concentrations were measured before and after TT. Results: Total work performed during TT was similar in the two trials (p = 0.716). In CIT compared to PLC trial, lower levels of aldosterone occurred before (72%) and after (39%) TT (p ˂ 0.001), and acute response of aldosterone to TT was blunted (29%, p ˂ 0.001). Lower cortisol levels in CIT than in PLC trial occurred before (13%, p = 0.039) and after TT (14%, p = 0.001), but there were no between-trial differences in the acute responses of cortisol, prolactin or growth hormone to TT, or in concentrations of prolactin and growth hormone before or after TT (in all cases p > 0.05). Conclusions: Reduced aldosterone and cortisol levels after TT and blunted acute response of aldosterone to TT indicate that CIT ingestion during recovery after dehydrating exercise may alleviate stress during the next hard endurance cycling bout in the heat.

Estudio del estado de hidratación de futbolistas profesionales mediante diferentes métodos de evaluación de la composición corporal / Evaluation of the hydration status in professional football players through different body composition assessment techniques

Introducción: El estado de hidratación del individuo durante la práctica deportiva, es uno de los temas más importantes en la actualidad en relación a la práctica de ejercicio físico, sobre todo, en ambientes calurosos y de duración prolongada (>1h). En el presente estudio, se analiza el estado de hidratación de jugadores profesionales de fútbol, integrantes del Real Valladolid B, durante una sesión de entrenamiento en diferentes épocas del año, con el fin de, además de comprobar su estado de hidratación, poder observar de qué manera influye el clima en dicho estado. Dado que una alteración en el estado de hidratación, será perjudicial para el deportista, afectando tanto a su rendimiento físico, como a su salud, el cumplimiento de una serie de normas y pautas existentes será imprescindible para mantener un estado óptimo de hidratación. Métodos: Se usaron distintos métodos de evaluación de la hidratación. Un registro de doble pesada, una bioimpedanciometría pre y post entrenamiento, una cineantropometría pre y post entrenamiento y la medición de la densidad de orina únicamente post entrenamiento. Resultados: Los resultados mostraron diferencias significativas en cuanto a la diferencia de peso entre el pre y post entrenamiento, y en el% de variación de peso entre enero y mayo. La densidad de orina indicó también la aparición de un estado de deshidratación postejercicio. La bioimpedancia y la antropometría mostraron diferencias significativas y una concordancia baja entre ellas, siendo la antropometría la más sensible. Conclusiones: La diversidad de resultados obtenidos, relacionados con la aparición de un estado de deshidratación en los jugadores en el momento postejercicio, sugiere la necesidad de aconsejar y concienciar a los deportistas sobre el cumplimiento de estrategias de reposición hidroelectrolítica individualizadas, teniendo en cuenta las características propias del individuo, así como las externas a este

Introduction: The hydration status of the individual during sports is currently one of the most important issues in relation to the practice of physical exercise, especially in hot and long-lasting environments (>1h). In the present study, the hydration status of professional football players, members of Real Valladolid B, is analysed during a training session at different times of the year in order to check their hydration status, as well as to observe in which way the climate influences the aforesaid state. Since a variation in the hydration status, whether dehydration or overhydration, is harmful for the athlete, affecting both his physical performance and health. Thus, in order to maintain an ideal hydration status throughout the physical effort, it will be essential to accomplish a set of regulations and guidelines. Methods: For this purpose, different hydration assessment techniques are used. These techniques comprise a double weight recording, a bioimpedance analysis before and after training, a cineantropometry before and after training, and, only after training, the measurement of the density of the urine. Results: the results showed differences regarding the different weight obtained before and after training, as well as a variation in the weight percentage between january and may. Urine density also pointed out the manifestation of a state of post-exercise dehydration. Furthermore, the bioimpedance and anthropometry reflected significant differences and low consistency between them, being anthropometry the most accurate method. Conclusions: the diversity of results obtained, related to the appearance of a state of dehydration in players at the postexercise moment, suggests the necessity of advising and raising awareness among the athletes about the compliance of the individualized strategies of hydroelectricity replacement, taking into account the personal characteristics of the individual, as well as those that are external to him

Inadequate fluid intake in long term care residents: prevalence and determinants.

Dehydration is estimated to be present in half of long term care residents, as many do not consume the recommended levels of fluid intake. This study aims to describe fluid intake in long term care residents and identify the factors associated with fluid intake. Data were collected from 622 long term care residents, with a mean age of 86.8 ± 7.8. Total fluid intake was estimated over three non-consecutive days. Potential resident and unit-level variables risk factors for low fluid intake were collected, such as dementia status, activities of daily living, and eating challenges. Average daily fluid intake ranged from 311-2390 mL (1104.1 ± 379.3). Hierarchical regression analysis revealed that fluid intake was negatively associated with increased age, cognitive impairment, eating challenges and increased dining room staffing. Being male and requiring more physical assistance were positively associated with intake. Variables identified to predict intake could help inform strategies and targeted interventions to improve fluid intake.

Potential prevention by oral DHEA of superficial tears in elderly atrophic skin.

Oral DHEA improves skin hydration and sebum production as well as bone mineral density in older patients while limiting progression of their skin atrophy. Topical DHEA cream stimulates local collagen production. Trials of oral DHEA should be undertaken to examin their potential for preventing tears in fragile aging skin.

Fluid Retention and Utility of Practical Hydration Markers to Detect Three Levels of Recovery Fluid Intake in Male Runners.

Runners are unlikely to consume fluid during training bouts increasing the importance of recovery rehydration efforts. This study assessed urine specific gravity (USG) responses following runs in the heat with different recovery fluid intake volumes. Thirteen male runners completed 3 evening running sessions resulting in approximately 2,200 ± 300 ml of sweat loss (3.1 ± 0.4% body mass) followed by a standardized dinner and breakfast. Beverage fluid intake (pre/postbreakfast) equaled 1,565/2,093 ml (low; L), 2,065/2,593 ml (moderate; M) and 2,565/3,356 mL (high; H). Voids were collected in separate containers. Increased urine output resulted in no differences (p > .05) in absolute mean fluid retention for waking or first postbreakfast voids. Night void averages excluding the first void postrun (1.025 ± 0.008; 1.013 ± 0.008; 1.006 ± 0.003), first morning (1.024 ± 0.004; 1.015 ± 0.005; 1.014 ± 0.005), and postbreakfast (1.022 ± 0.007; 1.014 ± 0.007; 1.008 ± 0.003) USG were higher (p < .05) for L versus M and H respectively and more clearly differentiated fluid intake volume between L and M than color or thirst sensation. Waking (r = -0.66) and postbreakfast (r = -0.71) USG were both significantly correlated (p < .001) with fluid replacement percentage, but not absolute fluid retention. Fluid intake M was reported as most similar to normal consumption (5.6 ± 1.0 on 0-10 scale) after breakfast and equaled 122 ± 16% of sweat losses. Retention data suggests consumption above this level is not warranted or actually practiced by most runners drinking ad libitum, but that periodic prerun USG assessment may be useful for coaches to detect runners that habitually consume low levels of fluids between training bouts in warm seasons.

Food protein-induced enterocolitis syndrome

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-, cell-mediated food allergy of unknown prevalence and pathophysiology. Onset is typically during the first year of life; seafood-induced FPIES may start in adulthood. Acute FPIES manifests within 1-4 hours after ingestion with repetitive emesis, pallor, and lethargy progressing to dehydration and hypovolemic shock in 15% of cases. Chronic FPIES manifests with intermittent emesis, watery diarrhea, and poor growth progressing to dehydration and hypovolemic shock over a period of days to weeks. Chronic FPIES has been only reported in infants aged less than 3 months fed with cow milk (CM) or soy formula. The most common triggers are CM, soy, rice, and oat. Diagnosis of FPIES relies on recognition of a pattern of clinical symptoms and may be missed owing to the absence of typical allergic symptoms (eg, urticaria, wheezing) and delayed onset in relation to food ingestion. Physician-supervised food challenge is recommended if diagnosis or the trigger food is not clear and to evaluate for resolution. Testing for food-specific IgE is usually negative, although a subset of patients, usually with CM-induced FPIES may develop sensitization to foods. Such atypical FPIES tends to have a more prolonged course. Despite the potential severity of the reactions, no fatalities have been reported, and FPIES has a favorable prognosis. In most cases, FPIES resolves by age 3-5 years, although persistence of CM-induced FPIES and soy FPIES into adulthood has been reported. The first international consensus guidelines on diagnosis and management of FPIES were published in 2017. Given that the pathophysiology of FPIES is poorly understood, there are no diagnostic biomarkers and no therapies to accelerate resolution. These unmet needs warrant future investigations to improve the care of patients with FPIES (AU)

SEIOA es una alergia alimentaria con patofisiología y prevalencia desconocidas, que típicamente comienza en el primer año de vida, mientras que la producida por pescado suelo tener su comienzo en adultos. La forma aguda se manifiesta entre la hora y 4 horas tras la ingesta del alimento con emesis, palidez, letargia progresiva por deshidratación y shock hipovolémico en el 15% de los casos. La forma crónica se manifiesta con emesis intermitente, diarreas y crecimiento pobre con progresión hacia la deshidratación y shock hipovolémico en un periodo de días o semanas. La forma crónica se ha podido observar únicamente en niños menores de 3 años alimentados con leche de vaca o fórmula de soja. Los desencadenantes más frecuentes son la leche de vaca, la soja, el arroz y avena. El diagnóstico es clínico y puede ser difícil debido a la ausencia de síntomas alérgicos típicos (urticaria, asma…) y a la relación retardada con la ingesta. Es recomendable la provocación controlada si el diagnóstico clínico o el alimento implicado no son claros y también para evaluar la evolución. La IgE específica suele ser negativa, aunque una parte de los pacientes puede desarrollar alergia mediada por IgE. Estos pacientes manifiestan un curso más prolongado. A pesar de la potencial severidad de las reacciones, no se han reportado casos fatales y tiene un pronóstico favorable. La mayoría de los niños consiguen la resolución entre los 3 y 5 años aunque existen casos de persistencia en adultos. Las guías del primer consenso internacional sobre el diagnóstico y tratamiento de esta enfermedad se publicarán en el 2017. Debido a la poco conocida patofisiología, no existen biomarcadores ni terapia que acelere su resolución. Son necesarios estudios que permitan investigar y mejorar la clínica de estos pacientes (AU)

Effect of electrolyzed high-pH alkaline water on blood viscosity in healthy adults.

BACKGROUND: Previous research has shown fluid replacement beverages ingested after exercise can affect hydration biomarkers. No specific hydration marker is universally accepted as an ideal rehydration parameter following strenuous exercise. Currently, changes in body mass are used as a parameter during post-exercise hydration. Additional parameters are needed to fully appreciate and better understand rehydration following strenuous exercise. This randomized, double-blind, parallel-arm trial assessed the effect of high-pH water on four biomarkers after exercise-induced dehydration. METHODS: One hundred healthy adults (50 M/50 F, 31 ± 6 years of age) were enrolled at a single clinical research center in Camden, NJ and completed this study with no adverse events. All individuals exercised in a warm environment (30 °C, 70% relative humidity) until their weight was reduced by a normally accepted level of 2.0 ± 0.2% due to perspiration, reflecting the effects of exercise in producing mild dehydration. Participants were randomized to rehydrate with an electrolyzed, high-pH (alkaline) water or standard water of equal volume (2% body weight) and assessed for an additional 2-h recovery period following exercise in order to assess any potential variations in measured parameters. The following biomarkers were assessed at baseline and during their recovery period: blood viscosity at high and low shear rates, plasma osmolality, bioimpedance, and body mass, as well as monitoring vital signs. Furthermore, a mixed model analysis was performed for additional validation. RESULTS: After exercise-induced dehydration, consumption of the electrolyzed, high-pH water reduced high-shear viscosity by an average of 6.30% compared to 3.36% with standard purified water (p = 0.03). Other measured biomarkers (plasma osmolality, bioimpedance, and body mass change) revealed no significant difference between the two types of water for rehydration. However, a mixed model analysis validated the effect of high-pH water on high-shear viscosity when compared to standard purified water (p = 0.0213) after controlling for covariates such as age and baseline values. CONCLUSIONS: A significant difference in whole blood viscosity was detected in this study when assessing a high-pH, electrolyte water versus an acceptable standard purified water during the recovery phase following strenuous exercise-induced dehydration.

Increased Milk Protein Concentration in a Rehydration Drink Enhances Fluid Retention Caused by Water Reabsorption in Rats.

A fluid-retention effect is required for beverages that are designed to prevent dehydration. That is, fluid absorbed from the intestines should not be excreted quickly; long-term retention is desirable. Here, we focused on the effect of milk protein on fluid retention, and propose a new effective oral rehydration method that can be used daily for preventing dehydration. We first evaluated the effects of different concentrations of milk protein on fluid retention by measuring the urinary volumes of rats fed fluid containing milk protein at concentrations of 1, 5, and 10%. We next compared the fluid-retention effect of milk protein-enriched drink (MPD) with those of distilled water (DW) and a sports drink (SD) by the same method. Third, to investigate the mechanism of fluid retention, we measured plasma insulin changes in rats after ingesting these three drinks. We found that the addition of milk protein at 5 or 10% reduced urinary volume in a dose-dependent manner. Ingestion of the MPD containing 4.6% milk protein resulted in lower urinary volumes than DW and SD. MPD also showed a higher water reabsorption rate in the kidneys and higher concentrations of plasma insulin than DW and SD. These results suggest that increasing milk protein concentration in a beverage enhances fluid retention, which may allow the possibility to develop rehydration beverages that are more effective than SDs. In addition, insulin-modifying renal water reabsorption may contribute to the fluid-retention effect of MPD.

Hydration Status and Sodium Balance of Endurance Runners Consuming Postexercise Supplements of Varying Nutrient Content.

Postexercise protein and sodium supplementation may aid recovery and rehydration. Preserved beef provides protein and contains high quantities of sodium that may alter performance related variables in runners. The purpose of this study was to determine the effects of consuming a commercial beef product postexercise on sodium and water balance. A secondary objective was to characterize effects of the supplementation protocols on hydration, blood pressure, body mass, and running economy. Eight trained males (age = 22 ± 3 y, VO2max = 66.4 ± 4.2 ml·kg-1·min-1) completed three identical weeks of run training (6 run·wk-1, 45 ± 6 min·run-1, 74 ± 5% HRR). After exercise, subjects consumed either, a beef nutritional supplement (beef jerky; [B]), a standard recovery drink (SRD), or SRD+B in a randomized counterbalanced design. Hydration status was assessed via urinary biomarkers and body mass. No main effects of treatment were observed for 24 hr urine volume (SRD, 1.7 ± 0.5; B, 1.8 ± 0.6; SRD+B, 1.4 ± 0.4 L·d-1), urine specific gravity (1.016 ± 0.005, 1.018 ± 0.006, 1.017 ± 0.006) or body mass (68.4 ± 8.2, 68.3 ± 7.7, 68.2 ± 8.1 kg). No main effect of treatment existed for sodium intake-loss (-713 ± 1486; -973 ± 1123; -980 ± 1220 mg·d-1). Mean arterial pressure (81.0 ± 4.6, 81.1 ± 7.3, 83.8 ± 5.4 mm Hg) and average exercise running economy (VO2: SRD, 47.9 ± 3.2; B, 47.2 ± 2.6; SRD+B, 46.2 ± 3.4 ml·kg-1·min-1) was not affected. Urinary sodium excretion accounted for the daily sodium intake due to the beef nutritional supplement. Findings suggest the commercial beef snack is a viable recovery supplement following endurance exercise without concern for hydration status, performance decrements, or cardiovascular consequences.

Electrolyte and plasma responses after pickle juice, mustard, and deionized water ingestion in dehydrated humans.

CONTEXT: Some athletes ingest pickle juice (PJ) or mustard to treat exercise-associated muscle cramps (EAMCs). Clinicians warn against this because they are concerned it will exacerbate exercise-induced hypertonicity or cause hyperkalemia. Few researchers have examined plasma responses after PJ or mustard ingestion in dehydrated, exercised individuals. OBJECTIVE: To determine if ingesting PJ, mustard, or deionized water (DIW) while hypohydrated affects plasma sodium (Na(+)) concentration ([Na(+)]p), plasma potassium (K(+)) concentration ([K(+)]p), plasma osmolality (OSMp), or percentage changes in plasma volume or Na(+) content. DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 9 physically active, nonacclimated individuals (age = 25 ± 2 years, height = 175.5 ± 9.0 cm, mass = 78.6 ± 13.8 kg). INTERVENTION(S): Participants exercised vigorously for 2 hours (temperature = 37°C ± 1°C, relative humidity = 24% ± 4%). After a 30-minute rest, a baseline blood sample was collected, and they ingested 1 mL/kg body mass of PJ or DIW. For the mustard trial, participants ingested a mass of mustard containing a similar amount of Na(+) as for the PJ trial. Postingestion blood samples were collected at 5, 15, 30, and 60 minutes. MAIN OUTCOME MEASURE(S): The dependent variables were [Na(+)]p, [K(+)]p, OSMp, and percentage change in plasma Na(+) content and plasma volume. RESULTS: Participants became 2.9% ± 0.6% hypohydrated and lost 96.8 ± 27.1 mmol (conventional unit = 96.8 ± 27.1 mEq) of Na(+), 8.4 ± 2 mmol (conventional unit = 8.4 ± 2 mEq) of K(+), and 2.03 ± 0.44 L of fluid due to exercise-induced sweating. They ingested approximately 79 mL of PJ or DIW or 135.24 ± 22.8 g of mustard. Despite ingesting approximately 1.5 g of Na(+) in the PJ and mustard trials, no changes occurred within 60 minutes postingestion for [Na(+)]p, [K(+)]p, OSMp, or percentage changes in plasma volume or Na(+) content (P > .05). CONCLUSIONS: Ingesting a small bolus of PJ or large mass of mustard after dehydration did not exacerbate exercise-induced hypertonicity or cause hyperkalemia. Consuming small volumes of PJ or mustard did not fully replenish electrolytes and fluid losses. Additional research on plasma responses pre-ingestion and postingestion to these treatments in individuals experiencing acute EAMCs is needed.

Adequate hydration status promotes a lower concentration of proinflammatory cytikines in healthy adults / Una adecuada hidratación promueve una menor concentración de citoquinas proinflamatorias en adultos sanos

Background: Good hydration status (HS) is necessary for an adequate homeostasis of the organism. Cytokines are secreted mainly by inflammatory leukocytes and act as intercellular mediators. Objetive: Assessing pro and anti-inflammatory cytokines concentration in serum and in the aqueous phase of stools (APhS) from healthy adults in function of their HS. Methods: HS data were obtained from 86 healthy adults of 45-65 years old and BMI ≥18.5-<40 kg/m2. HS was measured by bioelectrical impedance (BIA) with a standardized protocol. Cytokines serum concentrations were determined by multiple ELISAs. Stools were recollected by the participants, frozen, and carefully transported to the laboratory where they were stored at -80°C until their determination. Stools were ultra-centrifuged and cytokines were measured in APhS with an ultra-sensible cytokines array. All samples were analyzed in duplicate. Results: Mean age was 51.2 ± 4.9 years old and BMI was 28.2 ± 4.7 kg/m2. The average intake of water from foods and beverages was not adequate enough (1,411.6 ± 427.4 ml/day; 81% consumed less than two-thirds of the recommended intake) however only 89.5% showed an adequate HS and only 10.5% showed clearly dehydration measured by BIA. Volunteers who had good HS had lower values of IFN(2.7 ± 2.4 vs 6.4 ± 4.3 pg/ml; p < 0.05) and IL6 serum (5.5 ± 13.3 vs 6.4 ± 16.3 pg/ml; p < 0.01) than those who had a dehydration status. IL1 from AphS showed lower values in adults with good hydration than those dehydrated (648.3 ± 615 vs 1,194 ± 561.2 pg/ml; p < 0.05). Conclusions: Adults with an appropriate HS have a minor concentration of pro-inflammatory cytokines in serum and in APhS than adults who showed a dehydration status. More studies are needed in order to corroborate these results (AU)

Introducción: Un adecuado estado de hidratación (EH) es necesario para mantener la homesostasis del organismo. Las citoquinas son mediadores intercelulares que son secretadas principalmente por leucocitos. Objetivo: Valorar la concentración de citoquinas pro y antiinflamatorias en suero y la fase acuosa de las heces (FAH) de adultos sanos en función de su EH. Métodos: Se obtuvo información sobre el EH de 86 adultos sanos de 45-65 años y un IMC de 18,5-<40 kg/m2. El EH fue medido por Impedancia Bioeléctrica (BIA) siguiendo el protocolo estándar. La concentración de citoquinas en suero fue determinada por múltiples ELISAs. Las heces fueron recolectadas por los participantes, congeladas y transportadas al laboratorio donde fueron almacenadas a -80°C hasta su determinación. Posteriormente las heces fueron ultracentrifugadas y las citoquinas fueron medidas en la FAH con un array ultrasensible. Resultados: La edad media fue de 51,2 ± 4,9 años y el IMC fue de 28,2 ± 4,7 kg/m2. El consumo medio de agua proveniente de los alimentos y las bebidas realizado por los participantes no fué suficiente (1.411,6 ± 427,4 ml/día; el 81% consumió menos de dos tercios de la ingesta recomendada), sin embargo, el 89,5% presentó un adecuado EH y solo el 10,5% estuvo en rango de deshidratación. Los participantes con un adecuado EH tuvieron valores de IFN(2,7 ± 2,4 vs 6,4 ± 4,3 pg/ml; p < 0,05) e IL6 séricos (5,5 ± 13,3 vs 6,4 ± 16,3 pg/ml; p < 0,01) inferiores a las personas deshidratadas. La IL1 medida en la FAH mostró una concentración más baja en personas bien hidratadas que en aquellas deshidratadas (648,3 ± 615 vs 1194,0 ± 561,2 pg/ml; p < 0,05). Conclusiones: Los adultos de nuestro estudio con un adecuado EH presentan una concentración inferior de citoquinas proinflamatorias en suero y en la FAH que aquellos que estaban deshidratados. Se necesitan más estudios que confirmen estos resultados (AU)

Hydration protocol of the University Hospital La Paz: an initiative to prevent and treat dehydration and hyperhydration in hospitalized patients / Protocolo de hidratación en el Hospital Universitario La Paz: una iniciativa para prevenir y tratar la deshidratación e hiperhidratación en los pacientes hospitalizados

Introduction: There is a high prevalence of hydration disorders in the hospitalized population. Objectives: In addition to promoting the prevention of dehydration and its early diagnosis, we intend to standardize fluid therapy practices with the aim of reducing complications and improving the prognosis of our patients. Material and methods: A multidisciplinary workgroup consisting of members from the Nutrition Quality Committee was formed, all interested in the subject, and whose area of expertise was relevant to the group. The issues were distributed amongst the team members based on their knowledge area, and a literature review was conducted. They held monthly meetings throughout 2013, and they developed this protocol upon the clinical experience accumulated. Results: A Hydration Protocol was developed that starts with the identification of patients and clinical situations at risk of dehydration and subsequently identifies the clinical signs and symptoms of risk. Other laboratory tests are subsequently performed, such as hematocrit, serum and urinary electrolytes, renal function and acid-base balance tests. All of these parameters allow us to make the diagnosis of the hydration state, classifying patients as hyper-hydrated, well-hydrated or dehydrated and defining the severity of the process. The protocol establishes the most appropriate way to calculate, individually, the daily water, sodium, potassium and chloride requirements; it tries to ensure a supply of at least 125 grams per day of glucose. We reviewed different oral and intravenous rehydration patterns, depending on the plasma sodium level and its follow-up. Finally, we proposed a new guideline of standard fluid therapy. Conclusions: We consider that this protocol is very important for our hospital clinical practice, and once implemented, the results will be evaluated and new modifications or other corrective measures will be established (AU)

Introducción: Existe una alta prevalencia de desórdenes de la hidratación en la población hospitalizada. Objetivos: Además de promover la prevención de la deshidratación y su diagnóstico precoz, se pretende estandarizar las prácticas de fluidoterapia con la intención de disminuir complicaciones y mejorar el pronóstico de nuestros pacientes. Materiales y métodos: Se formó un grupo de trabajo multidisciplinar constituido por miembros de la Comisión de Calidad de Nutrición, interesados en el tema y cuya área de especialización era relevante para el grupo. Se distribuyeron los temas entre todos en función del área del conocimiento y se realizó una revisión bibliográfica. Se mantuvieron reuniones mensuales durante todo el año 2013, e igualmente basados en la experiencia clínica acumulada, se elaboró el presente protocolo. Resultados: Se elaboró un protocolo de Hidratación que se inicia con la identificación de los pacientes y las situaciones clínicas de riesgo de deshidratación y posteriormente se identifican los signos y síntomas clínicos de riesgo. Se revisan posteriormente otras pruebas a realizar, incluyendo las de laboratorio como hematocrito, electrolitos séricos y urinarios, pruebas de función renal y del equilibrio ácido-base. Con todos estos parámetros podemos ya hacer el diagnóstico del estado de hidratación clasificando a los pacientes como hiperhidratados, normohidratados o deshidratados y definiendo la severidad del proceso. Se establece la forma más adecuada para calcular de forma individualizada los requerimientos diarios de agua, sodio, potasio, cloro e intentar garantizar un aporte de al menos 125 gramos de glucosa al día. Finalmente se revisan diferentes pautas de rehidratación oral e intravenosa, en función de los niveles de sodio plasmático y su seguimiento. Y para acabar se propone una nueva pauta de sueroterapia estándar. Conclusiones: Consideramos que la elaboración de este protocolo es muy importante para la práctica clínica de nuestro hospital y una vez implementado , valoraremos los resultados obtenidos por si se deben establecer modificaciones u otras nuevas medidas correctoras (AU)

Association between sodium intake and hydration status amongst community-dwelling elderly people / Asociación entre la ingesta de sodio y el estado de hidratación en personas mayores que viven en centros comunitarios

Dehydration is a common condition in older people and it has been associated with the development of many diseases. The aim of this study was to assess the association between hydration status in community-dwelling elderly people. Data were gathered in 74 community-dwelling elderly individuals (28 males) and included the collection of 24-h urine samples, which were screened for validity using 24-h urinary creatinine excretion in relation to body weight, anthropometric, physical activity, and sociodemographic variables. Hydration status was assessed using urinary indicators (24-h volume, osmolality and urine specific gravity) and sodium intake was assessed by 24-h urinary sodium excretion. Linear regression analysis was performed to quantify the association between sodium excretion (independent variables) and hydration biomarkers (dependent variables). No significant differences were found between males and females in 24-h urine volume (1,982.5 ± 654.5 mL vs 1,832.0 ± 655.8 mL, p = 0.341), 24-h urine osmolality (454.0 ± 158.5 mOsm/kg vs 402.7 ± 149.4 mOsm/kg, p = 0.204) and 24-h urine specific gravity (1.015 ± 0.006 vs 1.013 ± 0.005, p = 0.131). Urine volume and osmolality showed a positive and significant association with sodium excretion (= 0.314, 95%CI: 0.095,0.562 and = 0.390, 95%CI: 0.195,0.679, respectively), even after adjusting for confounders (age, sex, body mass index, and physical activity). Our findings showed that community-dwelling elderly individuals with a higher level of sodium intake had a higher 24-h urine volume and a higher 24-h urine osmolality. These findings suggest that a higher sodium intake is associated with a poorer hydration status in this elderly population, assessed by urine osmolality (AU)

La deshidratación es un problema común en las personas mayores y ha sido asociado con el desarrollo de muchas enfermedades. El objetivo de este estudio consiste en la evaluación de la asociación entre la ingesta de socio y el estado de hidratación en personas mayores que viven en centros comunitarios. Los datos fueron recopilados a partir de 74 personas mayores que vivían en centros comunitarios (28 varones) e incluyeron tomas de muestras de orina de 24h, que fueron examinadas para determinar su validez empleando excreción urinaria de creatinina de 24h en relación con variables de peso corporal, antropometría, actividad física y variables sociodemográficas. El estado de hidratación fue evaluado empleando indicadores urinarios (volumen en 24h, osmolalidad y gravedad específica de la orina) y la ingesta de sodio fue evaluada mediante excreción urinaria de sodio de 24h. Se realizó un análisis de regresión lineal para cuantificar la asociación entre excreción de sodio (variables independientes) y biomarcadores de hidratación (variables dependientes). No se encontraron diferencias significativas entre varones y mujeres en el volumen de orina de 24h (1.982,5 ± 654,5 mL vs 1.832,0 ± 655,8 mL, p = 0,341), 24-h orina osmolalidad (454,0 ± 158,5 mOsm/kg vs 402,7 ± 149,4 mOsm/kg, p= 0,204) y gravedad específica de la orina en 24h (1,015 ±0,006 vs 1,013 ± 0,005, p = 0,131). El volumen de orina y la osmolalidad mostraron una asociación positiva y significativa con la excreción de sodio (= 0,314, 95% CI: 0,095, 0,562 y = 0,390, 95% CI: 0,195, 0,679, respectivamente), incluso después de ajustar factores de distorsión (edad, sexo, índice de masa corporal y actividad física). Nuestros resultados demostraron que las personas mayores en centros comunitarios, con un mayor nivel de ingesta de sodio, tenían un mayor volumen de orina de 24h y una mayor osmolalidad de la orina de 24-h. Estos resultados sugieren que una mayor ingesta de sodio estaría asociada a un peor estado de hidratación en esta población de mayores, evaluado mediante la osmolalidad de la orina (AU)

Effect of varying the concentrations of carbohydrate and milk protein in rehydration solutions ingested after exercise in the heat.

The present study investigated the relationship between the milk protein content of a rehydration solution and fluid balance after exercise-induced dehydration. On three occasions, eight healthy males were dehydrated to an identical degree of body mass loss (BML, approximately 1·8%) by intermittent cycling in the heat, rehydrating with 150% of their BML over 1 h with either a 60 g/l carbohydrate solution (C), a 40 g/l carbohydrate, 20 g/l milk protein solution (CP20) or a 20 g/l carbohydrate, 40 g/l milk protein solution (CP40). Urine samples were collected pre-exercise, post-exercise, post-rehydration and for a further 4 h. Subjects produced less urine after ingesting the CP20 or CP40 drink compared with the C drink (P<0·01), and at the end of the study, more of the CP20 (59 (SD 12)%) and CP40 (64 (SD 6)%) drinks had been retained compared with the C drink (46 (SD 9)%) (P<0·01). At the end of the study, whole-body net fluid balance was more negative for trial C (- 470 (SD 154) ml) compared with both trials CP20 (- 181 (SD 280) ml) and CP40 (2107 (SD 126) ml) (P<0·01). At 2 and 3 h after drink ingestion, urine osmolality was greater for trials CP20 and CP40 compared with trial C (P<0·05). The present study further demonstrates that after exercise-induced dehydration, a carbohydrate--milk protein solution is better retained than a carbohydrate solution. The results also suggest that high concentrations of milk protein are not more beneficial in terms of fluid retention than low concentrations of milk protein following exercise-induced dehydration.

Effect of preexercise soup ingestion on water intake and fluid balance during exercise in the heat.

PURPOSE: To determine whether chicken noodle soup before exercise increases ad libitum water intake, fluid balance, and physical and cognitive performance compared with water. METHODS: Nine trained men (age 25 ± 3 yr, VO2peak 54.2 ± 5.1 ml · kg-1 · min-1; M ± SD) performed cycle exercise in the heat (wet bulb globe temperature = 25.9 ± 0.4 °C) for 90 min at 50% VO2peak, 45 min after ingesting 355 ml of either commercially available bottled water (WATER) or chicken noodle soup (SOUP). The same bottled water was allowed ad libitum throughout both trials. Participants then completed a time trial to finish a given amount of work (10 min at 90% VO2peak; n = 8). Cognitive performance was evaluated by the Stroop color-word task before, every 30 min during, and immediately after the time trial. RESULTS: Ad libitum water intake throughout steady-state exercise was greater in SOUP than with WATER (1,435 ± 593 vs. 1,163 ± 427 g, respectively; p < .03). Total urine volume was similar in both trials (p = .13), resulting in a trend for greater water retention in SOUP than in WATER (87.7% ± 7.6% vs. 74.9% ± 21.7%, respectively; p = .09), possibly due to a change in free water clearance (-0.32 ± 1.22 vs. 0.51 ± 1.06 ml/min, respectively; p = .07). Fluid balance tended to be improved with SOUP (-106 ± 603 vs. -478 ± 594 g, p = .05). Likewise, change in plasma volume tended to be reduced in SOUP compared with WATER (p = .06). Only mild dehydration was achieved (<1%), and physical performance was not different between treatments (p = .77). The number of errors in the Stroop color-word task was lower in SOUP throughout the entire trial (treatment effect; p = .04). CONCLUSION: SOUP before exercise increased ad libitum water intake and may alter kidney function.

Adequate oral fluid intake in hospitalized stroke patients: does viscosity matter?

PURPOSE: Sufficient intake of oral fluids to meet hydration needs is a critical recovery issue for patients hospitalized post stroke. Concerns for adequate oral fluid intake are generally focused on dysphagic patients restricted to thickened liquids; however, fluid intake patterns in stroke patients receiving thin liquids are unknown. METHOD: This study examines the oral fluid intake patterns of three groups over 72 hours: community dwelling individuals, patients hospitalized post stroke receiving thin liquids and patients hospitalized post stroke receiving thickened liquids. RESULTS: Mean oral fluid intake differed significantly between the two hospitalized groups (p = .04), with individuals receiving thickened liquids consuming less. Less than 1% of patients hospitalized post stroke met a minimum standard of 1500 mL/day, regardless of liquid viscosity. Conversely, community dwelling participants consumed significantly more fluids on average than their hospitalized counterparts. CONCLUSION: Compliance with beverage preference, frequency of beverage offering, and inaccurate preparation of thickened beverages were identified as factors potentially influencing fluid intake.

Estrategias nutricionales ante el estreñimiento y la deshidratación en las personas mayores / Nutritional strategies towards constipation and dehydration in older people

El estreñimiento puede ser definido por defecación infrecuente y esfuerzo defecatorio excesivo. Las causas más habituales son la deshidratación, la dieta pobre en fibra, el consumo de determinados fármacos y las enfermedades debilitantes, circunstancias especialmente frecuentes en la edad geriátrica. El estreñimiento en anciano puede asociarse a complicaciones derivadas de la impactación fecal y otras derivadas del excesivo esfuerzo para conseguir la defecación. Para que se produzca deshidratación, virtualmente en todos los casos, debe existir una alteración en la percepción de la sed o en la capacidad de ingerir agua. Cuando el déficit de agua supera al de sodio el paciente desarrolla un síndrome clínico de hipernatremia/hiperosmolaridad que siempre está asociada a un aumento de la osmolaridad plasmática efectiva y, por tanto, con una disminución del volumen intracelular. Las causas desencadenantes en el anciano son la infección, el uso excesivo de diuréticos, el ictus, tratamiento con corticoides, situación de postoperatorio, la suspensión de un tratamiento antidiabético o la diabetes insípida. El tratamiento de rehidratación debe realizarse preferiblemente por vía oral y de forma lenta para evitar el daño neurológico. La corrección debe incluir agua y electrolitos (sales de sodio y potasio) y obliga a un cálculo preciso del aporte, sobre todo cuando está alterado el estado de conciencia y precisamos de tratamiento intravenoso, para evitar la sobrehidratación y las alteraciones electrolíticas. El tratamiento del estreñimiento incluye, además de la rehidratación, la educación del paciente en un patrón horario, postural y de ejercicio físico para reforzar la prensa abdominal. Un cambio en los hábitos alimentarios para aumentar el contenido en fibra alimentaria en la dieta aumenta el tamaño del bolo fecal, mejora la consistencia de las heces y disminuye las molestias abdominales. Así mismo, el uso de prebióticos, complementado con fibra fermentable, logra aumentar la masa fecal. Los alimentos de uso común ricos en fibra son el salvado de trigo, legumbres, harinas integrales, frutas y verduras. Las recomendaciones sobre el consumo de fibra son de 10 a 13 g/1.000 kcal siendo el 70-75% de fibra insoluble y un 25-30% de fibra soluble. El uso juicioso de fármacos con efecto laxante tiene un papel en el tratamiento del estreñimiento cuando éste no responde a las medidas higiénico-dietéticas. Existen cuatro grupos farmacológicos de uso habitual: laxantes con efecto osmótico, estimulantes del peristaltismo, emolientes y aumentadores del bolo fecal con distintas indicaciones. En el paciente de edad avanzada, podemos iniciar el tratamiento con lactulosa o lactitiol o recurrir directamente a fármacos estimulantes como bisacodilo, picosulfato sódico o senósidos. Los azúcares osmóticos serán los laxantes recomendados para el uso crónico. Debemos usar con precaución los laxantes estimuladores del peristaltismo, ya que la secreción de agua y electrolitos a la luz intestinal es responsable de episodios de hipotensión ortostática que pueden ocasionar caídas en el paciente anciano (AU)

Constipation can be defined as infrequent defecation and straining at stool. The most common causes are dehydration, low-fiber diet, use of certain drugs and debilitating disease, particularly common conditions in geriatric patients. Constipation in the elderly may be associated with fecal impaction and other complications deriving from excessive straining to pass stools. Dehydration occurs, in virtually all cases, with an alteration in the perception of thirst or water intake capacity. When the water deficit exceeds that of sodium, the patient develops clinical signs and symptoms of hypernatremia/hyperosmolality, always associated with an increase in effective plasma osmolality and consequent decrease in intracellular volume. Precipitating causes in the elderly are infection, excessive use of diuretics, stroke, treatment with corticosteroids, postoperative status, suspension of antidiabetic drugs or diabetes insipidus. Rehydration should preferably be oral and done slowly to prevent neurological damage. Treatment should include water and electrolytes (sodium and potassium salts) and requires accurate calculation of input to prevent overload and electrolyte imbalance, especially in the case of altered consciousness with the patient needing intravenous therapy. In addition to rehydration, the treatment of constipation includes educating the patient about bowel training to establish a regular pattern, posture and physical exercise to strengthen the muscles in the abdominal wall. A change in eating habits to increase dietary fiber content increases the size of the feces, improves stool consistency and reduces abdominal discomfort. Likewise, the use of prebiotics, supplemented with fermentable fiber, helps increase fecal mass. Commonly-used foods rich in fiber are wheat bran, beans, whole flour, fruit and vegetables. Recommended fiber intake is 10 to 13 g/1,000 kcal with 70-75% insoluble fiber and 25-30% soluble fiber. Judicious use of laxative drugs does have a role in the treatment of constipation if patients do not respond to the toileting / dietary measures. There are four commonly used drug classes: osmotic laxatives, peristalsis stimulants, emollients and fecal enhancers, with different indications. In the older patient, we can begin treatment with lactulose or lactitiol or go directly to stimulant drugs such as bisacodyl, cassia extracts or sodium picosulfate. Sugar osmotic laxatives are recommended for long-term use. Stimulating peristalsis laxatives have to be used with caution since secretion of water and electrolytes into the intestinal lumen can be responsible for orthostatic hypotension, causing falls in the elderly (AU)

Intervention with flaxseed and borage oil supplements modulates skin condition in women.

Ingestion of selected nutrients modulates dermal properties. In the present study, two groups of women ingested flaxseed or borage oil for 12 weeks. The control group received a placebo containing medium-chain fatty acids. Dose was 2.2 g total fatty acids/d with alpha-linolenic acid and linoleic acid as major constituents in the flaxseed oil group; in the borage oil group linoleic and gamma-linolenic acid were predominant. In the flaxseed oil group, the contribution of alpha-linolenic acid to total fatty acids in plasma was significantly increased on weeks 6 and 12, whereas there was an increase in gamma-linolenic acid in the borage oil group (P < 0.05). Skin irritation was performed by nicotinate treatment, and changes in skin reddening and blood flow were monitored. Compared to week 0, skin reddening was diminished in both groups; blood flow was also lowered. Skin hydration was significantly increased after 12 weeks of treatment compared to week 0, with flaxseed or borage oil (P < 0.05). Transepidermal water loss was decreased in both oil groups by about 10 % after 6 weeks of supplementation. A further decrease was determined after 12 weeks in the flaxseed oil group. Surface evaluation of living skin revealed that roughness and scaling of the skin were significantly decreased with flaxseed and borage oil comparing week 0 and week 12 (P < 0.05). Except for hydration, none of the parameters was affected in the placebo group. The present data provide evidence that skin properties can be modulated by an intervention with dietary lipids.

Milk as an effective post-exercise rehydration drink.

The effectiveness of low-fat milk, alone and with an additional 20 mmol/l NaCl, at restoring fluid balance after exercise-induced hypohydration was compared to a sports drink and water. After losing 1.8 (sd 0.1) % of their body mass during intermittent exercise in a warm environment, eleven subjects consumed a drink volume equivalent to 150 % of their sweat loss. Urine samples were collected before and for 5 h after exercise to assess fluid balance. Urine excretion over the recovery period did not change during the milk trials whereas there was a marked increase in output between 1 and 2 h after drinking water and the sports drink. Cumulative urine output was less after the milk drinks were consumed (611 (sd 207) and 550 (sd 141) ml for milk and milk with added sodium, respectively, compared to 1184 (sd 321) and 1205 (sd 142) ml for the water and sports drink; P < 0.001). Subjects remained in net positive fluid balance or euhydrated throughout the recovery period after drinking the milk drinks but returned to net negative fluid balance 1 h after drinking the other drinks. The results of the present study suggest that milk can be an effective post-exercise rehydration drink and can be considered for use after exercise by everyone except those individuals who have lactose intolerance.