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Hydration assessment using the cardiovascular response to standing

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Abstract

The cardiovascular response to standing (sit-to-stand change in heart rate; SSΔHR) is commonly employed as a screening tool to detect hypohydration (body water deficit). No study has systematically evaluated SSΔHR cut points using different magnitudes or different types of controlled hypohydration. The objective of this study was to determine the diagnostic accuracy of the often proposed 20 b/min SSΔHR cut point using both hypertonic and isotonic models of hypohydration. Thirteen healthy young adults (8M, 5F) underwent three bouts of controlled hypohydration. The first bout used sweating to elicit large losses of body water (mass) (>3 % sweat). The second two bouts were matched to elicit 3 % body mass losses (3 % diuretic; 3 % sweat). A euhydration control trial (EUH) was paired with each hypohydration trial for a total of six trials. Heart rate was assessed after 3-min sitting and after 1-min standing during all trials. SSΔHR was compared among trials, and receiver operator characteristic curve analysis was used to determine diagnostic accuracy of the 20 b/min SSΔHR cut point. Volunteers lost 4.5 ± 1.1, 3.0 ± 0.6, and 3.2 ± 0.6 % body mass during >3 % sweat, 3 % diuretic, and 3 % sweat trials, respectively. SSΔHR (b/min) was 9 ± 8 (EUH), 20 ± 12 (>3 % sweat; P < 0.05 vs. EUH), 17 ± 7 (3 % diuretic; P < 0.05 vs. EUH), and 13 ± 11 (3 % sweat). The 20 beats/min cut point had high specificity (90 %) but low sensitivity (44 %) and overall diagnostic accuracy of 67 %. SSΔHR increased significantly in response to severe hypertonic hypohydration and moderate isotonic hypohydration, but not moderate hypertonic hypohydration. However, the 20 beats/min cut point afforded only marginal diagnostic accuracy.

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Notes

  1. Based on different preferences and usage in terminology (Mange et al. 1997; Sawka et al. 2007; Thomas et al. 2008), a generic body water deficit is referred to herein as ‘hypohydration.’ The specific type of hypohydration is accurately described using the tonicity of blood (hypertonic, isotonic, and hypotonic) that results from the body water deficit. ‘Euhydration’ is used to refer to a state of normal hydration (the absence of a measureable body water deficit).

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Acknowledgments

We thank our soldier volunteers for their study participation and for their military service. We also appreciate the expert technical assistance afforded to us by Kurt Sollanek, Myra Jones, Jeff Staab, SPC Marissa Spitz, and Mary C. Pardee.

Conflict of interest

None of the authors had a conflict of interest. The opinions or assertions contained herein are the private views of the authors and should not be construed as official or reflecting the views of the Army the Department of Defense. Approved for public release: distribution unlimited.

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Authors and Affiliations

  1. Thermal and Mountain Medicine Division, US Army Research Institute of Environmental Medicine, Kansas Street, Natick, MA, 01760-5007, USA

    Samuel N. Cheuvront, Brett R. Ely, Robert W. Kenefick, Mark J. Buller, Nisha Charkoudian & Michael N. Sawka

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  1. Samuel N. Cheuvront
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  2. Brett R. Ely
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  3. Robert W. Kenefick
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  4. Mark J. Buller
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  5. Nisha Charkoudian
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  6. Michael N. Sawka
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Correspondence to Samuel N. Cheuvront.

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Communicated by Narihiko Kondo.

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Cheuvront, S.N., Ely, B.R., Kenefick, R.W. et al. Hydration assessment using the cardiovascular response to standing. Eur J Appl Physiol 112, 4081–4089 (2012). https://doi.org/10.1007/s00421-012-2390-0

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