Hydration

HYD: Assessing Hydration Status (2007)

• Assessment
  What is the best clinical and/or biochemical parameter for hydration status in the adult (19-64 years)?

  • Conclusion

    In young, healthy and/or active adults urine specific gravity (Usg), urine osmolality (Uosm), serum osmolality (Sosm), and urine color (Ucol) are good indicators of hydration status. Additionally, body weight loss greater than 3% is a good indicator of acute dehydration.

    No single parameter is best in all adult populations.  

     

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Clinical and/or Biochemical Parameter for Determining Hydation Status (19-64 years)
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Armstrong LE, Maresh CM, Castellani JW, Bergeron MF, Kenefick RW, LaGasse KE, Riebe D.  “Urinary indices of hydration status,” International J Sport Nutrition 1994; 4: 265-279.
      • Armstrong LE, Soto JAH, Hacker FT, Casa DJ, Kavouras SA, Maresh CM. Urinary indices during dehydration, exercise, and rehydration. International Journal of Sport Nutrition 1998; 8: 345-355. 
      • Francesconi RP, Hubbard RW, Szlyk PC, Schnakenberg D, Carlson D, Leva N, Sils I, Hubbard L, Pease V, Young J, Moore D.  Urinary and hematologic indexes of hypohydration.  J Applied Physiology 1987; 62(3): 1271-1276.
      • Hackney AC, Coyne CJT, Pozos R, Feith CS, Seale J.  Validity of urine-blood hydrational measures to assess total body water changes during mountaineering in the Sub-Artic.  Arct Med Res 1995; 54: 69-77.
      • Koulmann N, Jimenez C, Regal D, Bolliet P, Launay JC, Savourey G, Melin B.  Use of bioelectrical inpedance analysis to estimate body fluid compartments after acute variations of the body hydration level.  Med Sci Sports & Exercise 2000; 32(4): 857-864.
      • Kovacs EMR, Senden JMG, Brouns F.  Urine color, osmolality and specific electrical conductance are not accurate measures of hydration status during postexercise rehydration.  J Sports MEdicine and Physical Fitness Mar 1999; 39 (1): 47-53.
      • Moran DS, Heled Y, Margaliot M, Shani Y, Laor A, Margaliot S, Bickels EE, Shapiro Y.  Hydration status measurement by radio frequency absorptiometry in young athletes - a new method and preliminary results.  Physiol Meas 2004; 25: 51-59.
      • O'Brien C, Freund BJ, Sawka MN, McKay J, Hesslink RL, Jones TE.  Hydration assessment during cold-weather military field exercises.  Arct Med Res 1996; 55: 20-26.
      •  Oppliger RA, Magnes SA, Popowski LA, Gisolfi CV.  Accuracy od urine specific gravity and osmolality as indicators of hydration statua.  International J of Sport Nutrition and Exercise Metabolism 2005; 15: 236-251. 
      • Ormerod JK, Elliott TA, Scheett TP, VanHeest JL, Armstrong LE, Maresh CM.  Drinking behavior and perception of thirst in untrained women during 6 weeks of heat acclimation and outdoor training.  Int J Sport Nutrition and Exercise Metabolism 2003; 13: 15-28.
      • Pialoux V, Mischler I, Mounier R, Gachon P, Ritz P, Coudert J, Fellman N.  Effect of equilibrated hydration changes on total body water estimates by bioelectrical impedance analysis.  British J Nutrition 2004; 91: 153-159.
      •  Popowski LA, Oppliger RA, Patrick Lambert G, Johnson RF, Kim Johnson A, Gisolf CV. Blood and urinary measures of hydration status during progressive acute dehydration. Med Sci Sports Exerc. 2001, May;33(5):747-53
      • Ship JA, Fischer DJ. Metabolic indicators of hydration status in the prediction of parotid salivary-gland function. Archives of Oral Biology. 1999 Apr;44(4):343-50
      • Shirreffs SM, Maughan RJ. Urine osmolality and conductivity as indices of hydration status in athletes in the heat. Med Sci Sports Exerc. 1998;30(11):1598-602
      • Walsh N, Laing S, Oliver S, Montague J, Walters R, Bilzon J. Saliva parameters as potential indices of hydration status during acute dehydration. Med Sci Sports Exerc 2004;36(9):1535-42
      • Zappe DH, Tankersley CG, Meister TG, Kenney WL. Fluid restriction prior to cycle exercise: effects on plasma volume and plasma proteins. Med Sci Sports Exerc. 1993;25(11):1225-30.
  • Search Plan and Results: HYD: Clinical/Biochemical Parameters to Monitor Hydration: Adults 19-64 Years 2007
     
  What is the best clinical and/or biochemical parameter for assessing hydration status in the older adult (>65 years) patient?

  • Conclusion

    There is no evidence, which identifies a clinical, and/or biochemical parameter, which is best for assessing hydration status in the older adult. One positive quality study suggested ranges of Psg, which may be useful for assessing volume depletion in elderly adults.  A neutral quality study found Ucol reflected hydration status (narrow range) as measured by Usg and Uosm in euhydrated, elderly patients.  Based upon a postive quality study, researchers identified the following physical exam data as useful in detecting severe dehydration: dry tongue, longitudinal tongue furrows, dry mucous membranes of nose and mouth, eyes that appear recessed in their sockets, upper body muscle weakness, speech difficulty, and confusion.  A positive quality study found multi-frequency BIA useful in detecting change in hydration status, but a single measurement was a poor indicator of hydration status.  Additional well-controlled studies are needed to validate these findings.

     

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Clinical and/or Biochemical Parameter for Determining Hydation Status (65 or older)
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Dauterman KW, Bennett RG, Greenough WB, Redett RJ, Gillespie JA, Applebaum G, Schoenfeld CN. Plasma specific gravity for identifying hypovolaemia. J Diarrhoeal Dis Res 1995 Mar;13(1):33-8.
      • Eaton D, Bannister P, Mulley GP, Connolly MJ. Axillary sweating in clinical assessment of dehydration in ill elderly patients. BMJ 1994 May 14;308(6939):1271.
      • Fisher RD, Papoff PM, Fisher AS.  The interstitial fluid pressure monitor: a device to aid in the determination of patient fluid requirements.  J Am Board of Family Practice 1990; 3: 7-17.
      • Gross CR, Lindquist RD, Woolley AC, Granieri R, Allard K, Webster B. Clinical indicators of dehydration severity in elderly patients. J Emerg Med 1992;10(3):267-74.
      • Olde Rikkert MG, Deurenberg P, Jansen RW, van't Hof MA, Hoefnagels WH. Validation of multi-frequency bioelectrical impedance analysis in detecting changes in fluid balance of geriatric patients. J Am Geriatr Soc 1997 Nov;45(11):1345-51.
      • Wakefield B, Mentes J, Diggelmann L, Culp K. Monitoring hydration status in elderly veterans. West J Nurs Res 2002 Mar;24(2):132-42.
  • Search Plan and Results: HYD: Clinical/Biochemical Parameters to Monitor Hydration: Adults 65 and Older 2007