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Concept: Dehydration

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It is often suggested that coffee causes dehydration and its consumption should be avoided or significantly reduced to maintain fluid balance. The aim of this study was to directly compare the effects of coffee consumption against water ingestion across a range of validated hydration assessment techniques. In a counterbalanced cross-over design, 50 male coffee drinkers (habitually consuming 3-6 cups per day) participated in two trials, each lasting three consecutive days. In addition to controlled physical activity, food and fluid intake, participants consumed either 4×200 mL of coffee containing 4 mg/kg caffeine © or water (W). Total body water (TBW) was calculated pre- and post-trial via ingestion of Deuterium Oxide. Urinary and haematological hydration markers were recorded daily in addition to nude body mass measurement (BM). Plasma was analysed for caffeine to confirm compliance. There were no significant changes in TBW from beginning to end of either trial and no differences between trials (51.5±1.4 vs. 51.4±1.3 kg, for C and W, respectively). No differences were observed between trials across any haematological markers or in 24 h urine volume (2409±660 vs. 2428±669 mL, for C and W, respectively), USG, osmolality or creatinine. Mean urinary Na(+) excretion was higher in C than W (p = 0.02). No significant differences in BM were found between conditions, although a small progressive daily fall was observed within both trials (0.4±0.5 kg; p<0.05). Our data show that there were no significant differences across a wide range of haematological and urinary markers of hydration status between trials. These data suggest that coffee, when consumed in moderation by caffeine habituated males provides similar hydrating qualities to water.

Concepts: Urine, Water, Hydrogen, Coffee, Dehydration, Caffeine, Deuterium, Drink

149

Hyperemesis gravidarum (HG), or intractable vomiting during pregnancy, is the single most frequent cause of hospital admission in early pregnancy. HG has a major impact on maternal quality of life and has repeatedly been associated with poor pregnancy outcome such as low birth weight. Currently, women with HG are admitted to hospital for intravenous fluid replacement, without receiving specific nutritional attention. Nasogastric tube feeding is sometimes used as last resort treatment. At present no randomised trials on dietary or rehydration interventions have been performed. Small observational studies indicate that enteral tube feeding may have the ability to effectively treat dehydration and malnutrition and alleviate nausea and vomiting symptoms. We aim to evaluate the effectiveness of early enteral tube feeding in addition to standard care on nausea and vomiting symptoms and pregnancy outcomes in HG patients.

Concepts: Nutrition, Obstetrics, Dehydration, Vomiting, Nausea, Hyperemesis gravidarum, Morning sickness

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Participants (N = 34) undertook a CANTAB battery on two separate occasions after fasting and abstaining from fluid intake since the previous evening. On one occasion they were offered 500 ml water shortly before testing, and on the other occasion no water was consumed prior to testing. Reaction times, as measured by Simple Reaction Time (SRT), were faster on the occasion on which they consumed water. Furthermore, subjective thirst was found to moderate the effect of water consumption on speed of responding. Response latencies in the SRT task were greater under the “no water” condition than under the “water” condition, but only for those participants with relatively high subjective thirst after abstaining from fluid intake overnight. For those participants with relatively low subjective thirst, latencies were unaffected by water consumption, and were similarly fast as those recorded for thirsty participants who had consumed water. These results reveal the novel finding that subjective thirst moderates the positive effect of fluid consumption on speed of responding. The results also showed evidence that practice also affected task performance. These results imply that, for speed of responding at least, the positive effects of water supplementation may result from an attenuation of the central processing resources consumed by the subjective sensation of thirst that otherwise impair the execution of speeded cognitive processes.

Concepts: Hypothalamus, Effect, Cognitive psychology, Affect, Dehydration, Reaction time, Thirst, Fluid balance

49

Exercise in the heat causes important water and electrolytes losses through perspiration. Optimal rehydration is crucial to facilitate the recuperation process after exercise. The aim of our study was to examine whether a moderate beer intake as part of the rehydration has any negative effect protocol after a short but dehydrating bout of exercise in the heat.

Concepts: Clinical trial, Water, Dehydration, Electrolyte, Oral rehydration therapy, Water intoxication

31

Secondarily marine vertebrates are thought to live independently of fresh water. Here, we demonstrate a paradigm shift for the widely distributed pelagic sea snake, Hydrophis (Pelamis) platurus, which dehydrates at sea and spends a significant part of its life in a dehydrated state corresponding to seasonal drought. Snakes that are captured following prolonged periods without rainfall have lower body water content, lower body condition and increased tendencies to drink fresh water than do snakes that are captured following seasonal periods of high rainfall. These animals do not drink seawater and must rehydrate by drinking from a freshwater lens that forms on the ocean surface during heavy precipitation. The new data based on field studies indicate unequivocally that this marine vertebrate dehydrates at sea where individuals may live in a dehydrated state for possibly six to seven months at a time. This information provides new insights for understanding water requirements of sea snakes, reasons for recent declines and extinctions of sea snakes and more accurate prediction for how changing patterns of precipitation might affect these and other secondarily marine vertebrates living in tropical oceans.

Concepts: Water, Oceanography, Dehydration, Seawater, Ocean, Marine biology, Rain, Elapidae

27

Diarrheal disease is the second leading cause of disease in children less than 5 y of age. Poor water, sanitation, and hygiene conditions are the primary routes of exposure and infection. Sanitation and hygiene interventions are estimated to generate a 36% and 48% reduction in diarrheal risk in young children, respectively. Little is known about whether the number of households sharing a sanitation facility affects a child’s risk of diarrhea. The objective of this study was to describe sanitation and hygiene access across the Global Enteric Multicenter Study (GEMS) sites in Africa and South Asia and to assess sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to-severe diarrhea (MSD) in children less than 5 y of age.

Concepts: Epidemiology, Africa, Poverty, Child, Vitamin C, Dehydration, Clostridium difficile, Diarrhea

27

From 1990 to 2004, the reported rates of diarrheal disease (three or more loose stools or a greater than normal frequency in a 24-hour period) on cruise ships decreased 2.4%, from 29.2 cases per 100,000 travel days to 28.5 cases (1,2). Increased rates of acute gastroenteritis illness (diarrhea or vomiting that is associated with loose stools, bloody stools, abdominal cramps, headache, muscle aches, or fever) occurred in years that novel strains of norovirus, the most common etiologic agent in cruise ship outbreaks, emerged (3). To determine recent rates of acute gastroenteritis on cruise ships, CDC analyzed combined data for the period 2008-2014 that were submitted by cruise ships sailing in U.S. jurisdiction (defined as passenger vessels carrying ≥13 passengers and within 15 days of arriving in the United States) (4). CDC also reviewed laboratory data to ascertain the causes of acute gastroenteritis outbreaks and examined trends over time. During the study period, the rates of acute gastroenteritis per 100,000 travel days decreased among passengers from 27.2 cases in 2008 to 22.3 in 2014. Rates for crew members remained essentially unchanged (21.3 cases in 2008 and 21.6 in 2014). However, the rate of acute gastroenteritis was significantly higher in 2012 than in 2011 or 2013 for both passengers and crew members, likely related to the emergence of a novel strain of norovirus, GII.4 Sydney (5). During 2008-2014, a total of 133 cruise ship acute gastroenteritis outbreaks were reported, 95 (71%) of which had specimens available for testing. Among these, 92 (97%) were caused by norovirus, and among 80 norovirus specimens for which a genotype was identified, 59 (73.8%) were GII.4 strains. Cruise ship travelers experiencing diarrhea or vomiting should report to the ship medical center promptly so that symptoms can be assessed, proper treatment provided, and control measures implemented.

Concepts: Influenza, Dehydration, Diarrhea, Gastroenteritis, Norovirus, Ship, Cruise ship, Passenger ship

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The subcutaneous (SC) route has recently emerged as a rehydration method with potential advantages in the geriatric population. Nevertheless, little is known about its application during hospitalization. The objective of the present study is to evaluate the subcutaneous non-inferiority efficacy in hydration against the intravenous (IV) route in elderly patients with dehydration.

Concepts: Patient, Hospital, Dehydration

27

Fruits serve as a source of energy, vitamins, minerals, and dietary fiber. One of the barriers in increasing fruit and vegetables consumption is time required to prepare them. Overall, fruit bars have a far greater nutritional value than the fresh fruits because all nutrients are concentrated and, therefore, would be a convenience food assortment to benefit from the health benefits of fruits. The consumers prefer fruit bars that are more tasted followed by proper textural features that could be obtained by establishing the equilibrium of ingredients, the proper choosing of manufacturing stages and the control of the product final moisture content. Fruit bar preparations may include a mixture of pulps, fresh or dried fruit, sugar, binders, and a variety of minor ingredients. Additionally to the conventional steps of manufacturing (pulping, homogenizing, heating, concentrating, and drying) there have been proposed the use of gelled fruit matrices, dried gels or sponges, and extruders as new trends for processing fruit bars. Different single-type dehydration or combined methods include, in order of increasing process time, air-infrared, vacuum and vacuum-microwave drying convective-solar drying, convective drying, and freeze drying are also suggested as alternative to solar traditional drying stage. The dehydration methods that use vacuum exhibited not only higher retention of antioxidants but also better color, texture, and rehydration capacity. Antioxidant activity resulting from the presence of phenolic compounds in the bars is well established. Besides this, fruit bars are also important sources of carbohydrates and minerals. Given the wide range of bioactive factors in fresh fruits that are preserved in fruit bars, it is plausible that their uptake consumption have a positive effect in reducing the risk of many diseases.

Concepts: Nutrition, Antioxidant, Food, Dehydration, Vegetable, Food preservation, Dried fruit, Pear

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Abstract Congenital nephrogenic diabetes insipidus (NDI) is a rare inherited disorder, mostly caused by AVPR2 mutations. Less than 10% of cases are due to mutations in the aquaporin-2 (AQP2) gene. Diagnosis and management of this condition remain challenging especially during infancy. Here, we report two unrelated patients, a 6-month-old Thai boy and a 5-year-old Emirati girl, with a history of failure to thrive, chronic fever, polydipsia, and polyuria presented in early infancy. The results of water deprivation test were compatible with a diagnosis of NDI. The entire coding regions of the AVPR2 and AQP2 gene were amplified by polymerase chain reaction and sequenced. Patient 1 was homozygous for a novel missense AQP2 mutation p.G96E, inherited from both parents. Patient 2 harbored a previously described homozygous p.T126M mutation in the AQP2 gene. Both patients were treated with a combination of thiazide diuretics and amiloride. Patient 1 developed paradoxical hyponatremia and severe dehydration 2 weeks after medical treatment began. In conclusion, we report a novel mutation of the AQP2 gene and highlight an important role of genetic testing for definite diagnosis. Vigilant monitoring of the fluid status and electrolytes after beginning the therapy is mandatory in infants with NDI.

Concepts: DNA, Genetics, Mutation, Diabetes mellitus, Dehydration, Diabetes insipidus, Nephrogenic diabetes insipidus, Water intoxication