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Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005)
Food and Nutrition Board (FNB)

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. "4 Water." Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press, 2005.

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Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate

tion studies were performed on euhydrated subjects under standardized clinical conditions (e.g., controlled diet, body posture, skin temperature, inactivity).

Studies have indicated that BIA may not have sufficient accuracy to validly detect moderate dehydration (approximately 7 percent TBW) and loses resolution with isotonic fluid loss (O’Brien et al., 1999). Because fluid, electrolyte, and plasma protein concentrations can have independent effects, BIA can provide misleading values regarding dehydration or hyperhydration status (Gudivaka et al., 1999; O’Brien et al., 2002). Fluid and electrolyte concentrations may have independent effects on the BIA signal, thus often providing grossly misleading values regarding dehydration status (O’Brien et al., 2002). The BIA with a 0/∞ − kHz parallel (Cole-Cole) multifrequency model may have promise to measure body hydration changes if corrections are made for changes in plasma protein concentration (Gudivaka et al., 1999). However, recently a multifrequency BIA with Cole-Cole analysis was reported not to be sensitive to hypertonic dehydration (Bartok et al., 2004).

Plasma and Serum Osmolality

Plasma osmolality provides a marker of dehydration levels. Osmolality is closely controlled by homeostatic systems and is the primary physiological signal used to regulate water balance (by hypothalamic and posterior pituitary arginine vasopressin secretion), resulting in changes in urine output and fluid consumption (Andreoli et al., 2000; Knepper et al., 2000). Plasma osmolality rarely varies beyond ± 2 percent and is controlled around a set-point of 280 to 290 mOsmol/kg; this set-point increases with aging and becomes more variable among people. Water deprivation (if it exceeds solute losses) increases the osmolality of plasma and of the ECF and thus fluids bathing the hypothalamus. This causes loss of ICF from osmoreceptor neurons, which then signals the release of arginine vasopressin from the hypothalamus and the posterior pituitary. Arginine vasopressin acts on the renal tubules to increase water reabsorption.

Arginine vasopressin release is proportional to increased plasma osmolality and decreased plasma volume. While body water loss will induce plasma volume reduction and increased plasma osmolality, the influence of body water loss on each depends upon the method of dehydration, physical fitness level, and heat acclimatization status (Sawka, 1988; Sawka and Coyle, 1999).

Many studies have measured plasma osmolality of euhydrated sub-

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Front Matter (R1-R20)
Summary (1-20)
1 Introduction to Dietary Reference Intakes (21-36)
2 Overview and Methods (37-49)
3 A Model for the Development of Tolerable Upper Intake Levels (50-72)
4 Water (73-185)
5 Potassium (186-268)
6 Sodium and Chloride (269-423)
7 Sulfate (424-448)
8 Applications of Dietary Reference Intakes for Electrolytes and Water (449-464)
9 A Research Agenda (465-470)
Appendix A: Glossary and Acronyms (471-476)
Appendix B: Origin and Framework of the Development of Dietary Reference Intakes (477-484)
Appendix C: Predictions of Daily Water and Sodium Requirements (485-493)
Appendix D: U.S. Dietary Intake Data from the Third National Health and Nutrition Examination Survey, 1988–1994 (494-517)
Appendix E: U.S. Dietary Intake Data for Water and Weaning Foods from the Continuing Survey of Food Intakes by Individuals, 1994–1996, 1998 (518-526)
Appendix F: Canadian Dietary Intake Data for Adults from Ten Provinces, 1990–1997 (527-533)
Appendix G: U.S. Water Intake and Serum Osmolality Data from the Third National Health and Nutrition Examination Survey, 1988–1994 (534-536)
Appendix H: U.S. Total Water Intake Data by Frequency of Leisure Time Activity from the Third National Health and Nutrition Examination Survey, 1988–1994 (537-545)
Appendix I: Dose-Response Effects of Sodium Intake on Blood Pressure (546-557)
Appendix J: Serum Electrolyte Concentrations NHANES III, 1988-94 (558-563)
Appendix K: Options for Dealing with Uncertainties (564-568)
Appendix L: Acknowledgments (569-571)
Appendix M: Biographical Sketches of Panel Members (572-576)
Index (577-618)