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Diagnosing dehydration? Blend evidence with clinical observations

Armstrong, Lawrence E.; Kavouras, Stavros A.; Walsh, Neil P.; Roberts, William O.

Current Opinion in Clinical Nutrition and Metabolic Care: November 2016 - Volume 19 - Issue 6 - p 434–438
doi: 10.1097/MCO.0000000000000320
NUTRITION AND PHYSIOLOGICAL FUNCTION: Edited by Annemie M.W.J. Schols and Labros S. Sidossis

Purpose of review The purpose of the review is to provide recommendations to improve clinical decision-making based on the strengths and weaknesses of commonly used hydration biomarkers and clinical assessment methods.

Recent findings There is widespread consensus regarding treatment, but not the diagnosis of dehydration. Even though it is generally accepted that a proper clinical diagnosis of dehydration can only be made biochemically rather than relying upon clinical signs and symptoms, no gold standard biochemical hydration index exists. Other than clinical biomarkers in blood (i.e., osmolality and blood urea nitrogen/creatinine) and in urine (i.e., osmolality and specific gravity), blood pressure assessment and clinical symptoms in the eye (i.e., tear production and palpitating pressure) and the mouth (i.e., thirst and mucous wetness) can provide important information for diagnosing dehydration.

Summary We conclude that clinical observations based on a combination of history, physical examination, laboratory values, and clinician experience remain the best approach to the diagnosis of dehydration.

aHuman Performance Laboratory, University of Connecticut, Storrs, Connecticut

bHydration Science Lab, University of Arkansas, Fayetteville, Arkansas, USA

cExtremes Research Group, Bangor University, Bangor, Wales, UK

dDepartment of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA

Correspondence to Stavros A. Kavouras, PhD, FACSM, Hydration Science Lab, University of Arkansas, Fayetteville, AR 72701, USA. Tel: +1 479 445 7308; e-mail:

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