Water Malabsorption Syndrome?

[Amazoniac]

- Sodium content of oral rehydration solutions: a reappraisal

"It is important to remember that absorptive and secretory processes operate simultaneously and that net solute movement represents the sum of several transport events. An oral rehydration solution sodium concentration sufficient to result in net sodium absorption is therefore unnecessary for effective rehydration. On the other hand, both sodium and water secretion occur when solutions with low sodium concentrations (23-49 mmol/l) are perfused in normal and secreting rat small intestine.[35-38] In addition to being ineffective in promoting water absorption there is also evidence in animals,[36] and from clinical trials[18,39] that these low sodium solutions may result in hyponatraemia. It therefore seems reasonable to contemplate an oral rehydration solution sodium concentration between [] extremes, aiming to promote adequate water absorption without adversely affecting sodium status."

"Introduction of the WHO-ORS to developing communities has saved millions of lives and its use in accordance with WHO recommendations should be encouraged. In developed communities such as the United Kingdom, however, where the aetiology of acute diarrhoea differs and its consequences are usually less severe, we suggest that use of the 90 mmol/l sodium solution is inappropriate and that one containing approximately 50-60 mmol/l sodium with 90-111 mmol/l glucose should be recommended."

• High-sodium ORS (90-120 mmol/L)
• Mid-sodium ORS (50-60 mmol/L)
• Low-sodium ORS (30-35 mmol/L)

- Milk salts and their interaction with caseins

Spoiler

I doubt that there aren't other factors in milk that promote optimal absorption and utilization of water, but perhaps some people could benefit from having it more concentrated in sodium.

Sodium equivalences:

• 1 mmol = 1 mEq
• 10 mmol = 230 mg
• 60 mmol = 1380 mg

(Yeah, it's a crutch.)​

Since milk will contain about 20-25 mmol/L, additional 30 mmol/L would be needed.

- Foods highest in Sodium in Fruits and Fruit Juices | nutritiondata.self.com​

Too much bull**** with milk isn't good, leads to cappuccinosis. Reacting it with vinegar should work.

- Baking Soda Can Settle the Stomach but Upset the Heart: Case Files of the Medical Toxicology Fellowship at the University of California, San Francisco

"According to [Arm et Hammer], each teaspoon of baking soda contains 4.8 g, corresponding to 59 mEq of sodium and 59 mEq of bicarbonate [1]."​

It's whatever it takes of vinegar to neutralize 1/2 of a teaspoon of bull**** for every liter of (skim) milk.

 

[Amazoniac]

The most practical approach would be to define a minimum of solutes to add and let taste guide eventual increases.

The recommended range for edemium in water is 50-60 mmol/L or 1150-1380 mg/L (based on the equivalences above).

Sea salt:

The edemium content of salt varies, may be around 35%.
- Salts (table or cooking) with the fewest additives - Toxinless

I'm going to use 6 g of salt per teaspoon for simplification, but it also varies and adjustment is needed:
- Quick Reference: Common Salt Weights & Substitutions | Revel Kitchen
- Salt by Weight | Dad Cooks Dinner

- 1 teaspoon of sea salt: 2 g of edemium
- 2/3 teaspoon of sea salt: 1.3 g of edemium

That's for a liter, but since not everyone will prepare it in abvance, it can be 1/3 tsp for 500 ml of water or 1/4-1/5 tsp for 350 ml.​

bull****:

- 1 teaspoon of baking soda: 1.35 g of edemium (how convenient!?)

If it's 350 ml of water, 1/3 of a teaspoon should be fine, it's within the range.​

Since baking soda provides less edemium per teaspoon, more is needed to obtain matching amounts of edemium.

- 1 teaspoon of sea salt: 2 g of edemium
- 1 teaspoon of baking soda: 1.35 g of edemium​

For combining, it depends on the sense of sudstitution:
- Removing sea salt and compensating with bull****: 2/1.35 (example: −1/3 tsp of sea salt → +(2/1.35)*1/3 tsp of bull**** = +~0.5 tsp = +1/2 tsp of bull****)
- Removing bull**** and compensating with sea salt: 1.35/2 (example: −1 tsp of bull**** → +(1.35/2)*1 tsp of sea salt = +~0.66 tsp = +2/3 tsp of sea salt)

Spoiler

The numbers may not be precise because they was rounded in every step.

 

[TheBeard]

The most practical approach would be to define a minimum of solutes to add and let taste guide eventual increases.

The recommended range for edemium in water is 50-60 mmol/L or 1150-1380 mg/L (based on the equivalences above).

Sea salt:

The edemium content of salt varies, may be around 35%.​

- Salts (table or cooking) with the fewest additives - Toxinless​

​

I'm going to use 6 g of salt per teaspoon for simplification, but it also varies and adjustment is needed:​

- Quick Reference: Common Salt Weights & Substitutions | Revel Kitchen​

- Salt by Weight | Dad Cooks Dinner​

​

- 1 teaspoon of sea salt: 2 g of edemium​

- 2/3 teaspoon of sea salt: 1.3 g of edemium​

​

That's for a liter, but since not everyone will prepare it in abvance, it can be 1/3 tsp for 500 ml of water or 1/4-1/5 tsp for 350 ml.​

bull****:

- 1 teaspoon of baking soda: 1.35 g of edemium (how convenient!?)​

​

If it's 350 ml of water, 1/3 of a teaspoon should be fine, it's within the range.​

Since baking soda provides less edemium per teaspoon, more is needed to obtain matching amounts of edemium.

- 1 teaspoon of sea salt: 2 g of edemium​

- 1 teaspoon of baking soda: 1.35 g of edemium​

For combining, it depends on the sense of sudstitution:
- Removing sea salt and compensating with bull****: 2/1.35 (example: −1/3 tsp of sea salt → +(2/1.35)*1/3 tsp of bull**** = +~0.5 tsp = +1/2 tsp of bull****)
- Removing bull**** and compensating with sea salt: 1.35/2 (example: −1 tsp of bull**** → +(1.35/2)*1 tsp of sea salt = +~0.66 tsp = +2/3 tsp of sea salt)

Spoiler

View attachment 21169

The numbers may not be precise because they was rounded in every step.

Hahahahahahaha

 

[Amazoniac]

- Biobehavioral variation in human water needs: How adaptations, early life environments, and the life course affect body water homeostasis

Spoiler

"[..]variation has been documented in total water intake between and within populations across different environments ranging from 2 L per day among Greek adults to almost 10 L per day among Ecuadorian Shuar men (Braun et al., 2019; Christopher et al., 2019; Rosinger & Tanner, 2015; Tani et al., 2015). Additionally, the dietary constituents that make up total water intake, that is the percentage of water consumed from foods vs from beverages, vary. It is largely assumed that approximately 20% to 30% of total water intake comes from food sources with the remaining 70% to 80% from liquids (Jequier & Constant, 2010). However, at least two studies have demonstrated population variation in hydration strategies as both Japanese and Bolivian Tsimane' adults consumed roughly 50% of their total water intake from food sources (Rosinger & Tanner, 2015; Tani et al., 2015)."

"[..]marathon runners have been shown to lose up to 11.7% of body weight (Beis et al., 2012). However, the average gut size (~500 mL) and the gastric emptying rate of humans means that humans can only consume ~half a liter of water every 15 to 20 minutes and have to wait for this to empty before consuming more (Noakes, 2010)."

- Water, Hydration and Health

Spoiler

"The proportion of water that comes from beverages and food varies with the proportion of fruits and vegetables in the diet. We present the ranges of water in various foods (Table 1)."

"A water deficit produces an increase in the ionic concentration of the extracellular compartment, which takes water from the intracellular compartment causing cells to shrink. This shrinkage is detected by two types of brain sensors, one controlling drinking and the other controlling the excretion of urine by sending a message to the kidneys mainly via the antidiuretic hormone vasopressin to produce a smaller volume of more concentrated urine.[18] When the body contains an excess of water, the reverse processes occur: the lower ionic concentration of body fluids allows more water to reach the intracellular compartment. The cells imbibe, drinking is inhibited and the kidneys excrete more water."

"Water, or its lack (dehydration), can influence cognition. Mild levels of dehydration can produce disruptions in mood and cognitive functioning. This may be of special concern in the very young, very old, those in hot climates, and those engaging in vigorous exercise. Mild dehydration produces alterations in a number of important aspects of cognitive function such as concentration, alertness and short-term memory in children (10–12 y),[32] young adults (18–25y)[53–56] and in the oldest adults, 50–82y.[57] As with physical functioning, mild to moderate levels of dehydration can impair performance on tasks such as short-term memory, perceptual discrimination, arithmetic ability, visuomotor tracking, and psychomotor skills.[53–56] However, mild dehydration does not appear to alter cognitive functioning in a consistent manner.[53, 54, 56, 58] In some cases, cognitive performance was not significantly affected in ranges from 2–2.6% dehydration.[56, 58]"

- The Hydration Equation: Update on Water Balance and Cognitive Performance
- Dehydration and cognition: an understated relation​

"In a series of studies using exercise in conjunction with water restriction as a means of producing dehydration, D’Anci and colleagues[56] observed only mild decrements in cognitive performance in healthy young men and women athletes. In these experiments, the only consistent effect of mild dehydration was significant elevations of subjective mood score, including fatigue, confusion, anger, and vigor."

"Fluids in the diet are generally absorbed in the proximal small intestine, and absorption rate is determined by the rate of gastric emptying to the small intestine. Therefore, the total volume of fluid consumed will eventually be reflected in water balance, but the rate at which rehydration occurs is dependent upon factors which affect the rate of delivery of fluids to the intestinal mucosa. Gastric emptying rate is generally accelerated by the total volume consumed and slowed by higher energy density and osmolality.[68] In addition to water consumed in food (1 L/d) and beverages (~2–3 L/d), digestive secretions account for a far greater portion of water that passes through and is absorbed by the gastrointestinal tract (~8 L/d).[69] The majority of this water is absorbed by the small intestine, with a capacity of up to 15 L/d with the colon absorbing some 5 L/d.[69]"

"Inadequate fluid consumption is touted as a common culprit in constipation, and increasing fluid intake is a frequently recommended treatment. Evidence suggests, however, that increasing fluids is only of usefulness in individuals in a hypohydrated state, and is of little utility in euhydrated individuals.[70]"

"Water excretion via the kidney removes solutes from the blood, and a minimum obligate urine volume is required to remove the solute load with a maximum output volume of 1 L/h.[78] This obligate volume is not fixed, but is dependent upon the amount of metabolic solutes to be excreted and levels of AVP [Alien versus Predator]. Depending on the need for water conservation, basal urine osmolality [solute concentration] ranges from 40 mOsm/kg up to a maximum of 1400 mOsm/kg.[78] The ability to both concentrate and dilute urine decreases with age, with a lower value of 92 mOsm/kg and an upper range falling between 500–700 mOsm/kg for individuals over 70.[79–81] Under typical conditions, in an average adult, urine volume of 1.5 to 2.0 L/d would be sufficient to clear a solute load of 900 to 1200 mOsm/d. During water conservation and the presence of AVP, this obligate volume can decrease to 0.75–1.0 L/d and during maximal diuresis can require up to 20 L/d to remove the same solute load.[78, 80, 81] In cases of water loading, if the volume of water ingested cannot be compensated for with urine output, having overloaded the kidney’s maximal output rate, an individual can enter a hyponatremic state as described above."

Compare with values below.​

"Water intake acutely reduces heart rate and increases blood pressure in both normotensive and hypertensive individuals.[85] These effects of water intake on the pressor effect and heart rate occur within 15–20 minutes of drinking water and can last for up to 60 minutes."

"Water deprivation and dehydration can lead to the development of headache.[90] Although this observation is largely unexplored in the medical literature, some observational studies indicate that water deprivation, in addition to impairing concentration and increasing irritability, can serve as a trigger for migraine and also prolong migraine.[91, 92]"

"The extent to which water intake and requirements are determined by energy intake and expenditure is understudied but in the clinical setting it has long been practice to supply 1 ml per kcal administered by tube to patients unable to take in food or fluids."

- Human Water Needs

Spoiler

"Maximal human gastric emptying rates are also variable and influenced by numerous factors, but approximate typical sweat losses (1–1.5 L/h).[43,44]"

Also differing from the above.​

- Chapter 4: Water | Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate

"Body water balance depends on the net difference between water gain and water loss. Water gain occurs from consumption (liquids and food) and production (metabolic water), while water losses occur from respiratory, skin, renal, and gastrointestinal tract losses."

Spoiler: Respiratory losses

"The amount of respiratory water loss, via evaporation within the lungs, is dependent on both the ventilatory volume and water vapor pressure gradient (Mitchell et al., 1972). Ventilatory volume is increased by physical activity, hypoxia, and hypercapnia [excess waste productide], whereas the water vapor pressure is modified by the ambient temperature, humidity, and barometric pressure. Physical activity generally has a greater effect on respiratory water loss than do environmental factors. Daily respiratory water loss averages about 250 to 350 mL/day for sedentary persons, but can increase to 500 to 600 mL/day for active persons living in temperate climates at sea level (Hoyt and Honig, 1996)." "High altitude exposure (greater than 4,300 m, 448 mm Hg) can further increase respiratory water losses by approximately 200 mL/day (Hoyt and Honig, 1996)."

"Ambient air temperature and humidity modify respiratory water losses. Breathing hot, dry air during intense physical exercise can increase respiratory water losses by 120 to 300 mL/day (Mitchell et al., 1972)."

"Freund and Young (1996) have calculated that for a 24-hour military scenario (8 hours of rest, 12 hours of moderate activity, and 4 hours of moderate-heavy activity), the respiratory water losses increase by approximately 340 mL/day when breathing −20°C versus +25°C air."

Spoiler: Urinary and gastrointestinal losses

"Since there is a limit to how much the kidneys can concentrate urine, the minimal amount of water needed is determined by the quantity of end products that need to be excreted (e.g., creatinine, urea). On typical Western diets, an average of 650 mOsmol of electrolytes and other solutes must be excreted per day to maintain electrolyte balance; thus, if the urine is maximally concentrated (Uosm approximately 1,200 mOsmol/kg water), the minimum urine output is approximately 500 mL/day. For dehydrated subjects living in hot weather, minimum daily urine outputs can be less than 500 mL/day (Adolph, 1947b).

Urine output generally averages 1 to 2 L/day but can reach 20 L/day in those consuming large quantities of fluid (West, 1990). Healthy older individuals, however, cannot concentrate urine as well as young individuals and thus have a higher minimum urine output. For example, older men and women (mean age 79 years) had lower maximal urine osmolalities of 808 and 843 mOsm/kg, respectively, compared with 1,089 mOsm/kg for young men (mean age 24 years). This corresponds to higher minimum urine outputs of 700 and 1,086 mL/day for the older men and women compared with 392 mL/day for the young men (Dontas et al., 1972)."

"Physical activity and climate also affect urine output. Exercise and heat strain will reduce urine output by 20 to 60 percent (Convertino, 1991; Mittleman, 1996; Zambraski, 1996), while cold and hypoxia will increase urine output (Freund and Young, 1996; Hoyt and Honig, 1996)."

"Gastrointestinal and thus fecal water loss in healthy adults is approximately 100 to 200 mL/day (Newburgh et al., 1930)."

Spoiler: Skin (insensible + sweat) losses

"Water loss through the skin occurs via insensible diffusion and secreted sweat. For the average adult, loss of water by insensible diffusion is approximately 450 mL/day (Kuno, 1956). During heat stress, eccrine sweat glands secrete sweat onto the skin surface, which cools the body when water evaporates from the sweat. In hot weather, sweat evaporation provides the primary avenue of heat loss to defend the body’s core temperature."

"The environmental factors that modify sweat losses include clothing worn, ambient temperature, humidity, air motion, and solar load. Therefore, considerable variability will exist for daily sweat losses among different people. Figure 4-5 provides the distribution of daily sweating rates for soldiers living in desert and tropical climates (without air conditioning). The average daily sweat loss for 97 men in the desert was 4.9 L; for 26 men in the tropics, it was 2.3 L."

"The following calculations provide the minimal sweat produced by persons performing moderately heavy (metabolic rate ≈ 600 W) exercise in the heat (Sawka et al., 1996a)."

"If the activity is 20 percent efficient, the remaining 80 percent of metabolic energy produced is converted to heat in the body so that 480 W (0.48 kJ/second, or 28.8 kJ/minute or 6.88 kcal/minute) need to be dissipated to avoid heat storage."

Spoiler

"The specific heat of body tissue (amount of energy required for 1 kg of tissue to increase temperature by 1°C) approximates 3.5 kJ (0.84 kcal)/kg/°C. For example, a 70-kg man has a heat capacity of 245 kJ (59 kcal)/°C, and a 50-kg woman has a heat capacity of 173 kJ (41 kcal)/°C."

"If these persons performed exercise in a hot environment that enabled only evaporative heat loss and they did not sweat, their body temperatures would increase by approximately 1.0°C every 8.5 min for the man (245 kJ/°C ÷ 28.8 kJ/minute or 59 kcal/°C ÷ 6.88 kcal/minute) and every 6 minutes for the woman (173 kJ/°C ÷ 28.8 kJ/minute or 41 kcal/°C ÷ 6.88 kcal/minute).

"Since the latent heat of evaporation is 2.43 kJ/g (0.58 kcal/g), such persons would need to evaporate approximately 12 g of sweat per minute (28.8 kJ/minute ÷ 2.43 kJ/g or 6.88 kcal/minute ÷ 0.58 kcal/ g) or 0.72 L/hour. Because secreted sweat drips from the body and is not evaporated, higher sweat secretions are often needed to achieve these cooling demands. If a person is physically active and exposed to environmental heat stress, sweat losses to avoid heat storage can be substantial over a 24-hour period."

Spoiler: Metabolic production

"Metabolic water is formed by oxidation of hydrogen-containing substrates during metabolism or energy-yielding nutrients. Oxidation of carbohydrate, protein, and fat produces metabolic water of approximately 15, 10.5, and 11.1 g/100 kcal of metabolizable energy, respectively (Lloyd et al., 1978). Therefore, metabolic water production is proportional to the energy expenditure with a small adjustment for the substrate oxidized. Figure 4-6 shows the metabolic water production relative to daily energy expenditure for persons eating a mixed diet (Hoyt and Honig, 1996). If the regression line in Figure 4-6 is extrapolated to the daily energy expenditures of ≈ 2,500 kcal/day, the metabolic water production will approximate 250 mL/day. Therefore, a reasonable estimate of daily metabolic water production is an average of approximately 250 to 350 L/day for sedentary persons—but which can increase to 500 to 600 mL/ day for physically active persons (Hoyt and Honig, 1996). Hence, respiratory water losses are roughly equivalent to, or offset by, metabolic water production (Table 4-2; Hoyt and Honig, 1996)."

Spoiler: Dehydration

"Incomplete fluid replacement resulting in decreased total body water affects each fluid space as a consequence of free fluid exchange (Costill and Fink, 1974; Durkot et al., 1986; Nose et al., 1983). The distribution of body water loss among the fluid spaces, as well as among different body organs during water deficit (dehydration or hypohydration), was determined in an animal model (Nose et al., 1983). The fluid deficit in rats thermally dehydrated by 10 percent of body weight was apportioned between the intracellular (41 percent) and extracellular (59 percent) spaces. Organ fluid loss was 40 percent coming from muscle, 30 percent from skin, 14 percent from viscera, and 14 percent from bone. Neither the brain nor liver lost significant water content. Various dehydration methods influence the partitioning of water loss from the fluid spaces (Mack and Nadel, 1996)."

 

[ThinPicking]

- Biobehavioral variation in human water needs: How adaptations, early life environments, and the life course affect body water homeostasis

This is quite profound. Thank you @Amazoniac.

 

[TheBeard]

I haven't had water in almost a year and never felt better.
Only fruit juices and milk.

 

[NodeCerebri]

Thank you for all this valuable info. Crazy how they still keep telling everybody to drink sh**loads of water when it can do more harm then good. I also got edema in my brain due to hyponatremia because I drank too much once and didn’t balance minerals out correctly.

 

[Amazoniac]

This kind of representation makes it clearer:

- Water, Electrolyte and Acid-Base Balance Anatomy and Physiology

Spoiler

- The 24-h frequency-volume chart in adults reporting no voiding complaints: defining reference values and analysing variables

Spoiler: Frequency, volume per void and production in a day

"The voiding frequency (a), mean volume/void (b) and 24-h urine production (c) by age decade and gender (women, red open circles; men, green closed circles). Errors bars indicate the 95% CI."

It's an endogenous toxin to have a reduced capability to concentrate solutes in urine and the total production decreasing after a certain (average) point, people start peeing less and more often, although some clowns seem to maintain it normal. I think that urine volume and frequency have to be regulated as drugs by the government, in particular in nursing homes to prohibit elderly from deviating behavior from ideal physiology.

Spoiler: Volume per void according to production in a day

"Voided volumes categorized by 24-h urine volume (red open triangles, maximum; green open circle, night-time mean; green closed circles, 24-h mean; red closed squares, daytime mean). Errors bars indicate the 95% CI."

"The mean volume/void was larger
in the night than during the day."

 

[Amazoniac]

- Dehydration and volume depletion: How to handle the misconceptions

Spoiler

"Students often confuse concepts related to sodium and water balance. One concept that has received considerable attention in recent medical teaching is the notion that disorders of water balance are manifested as hyponatraemia or hypernatraemia, whilst disorders of sodium balance are manifested as disruption of extracellular fluid (ECF) volume. In this review, we focus on another key concept regarding dehydration and volume depletion, and how the two are completely different clinical syndromes with distinct pathophysiological mechanisms, clinical features, biochemical characteristics, and management strategies."

"Mange et al[1] highlighted the importance of recognizing dehydration and volume depletion as two completely different clinical entities. However, the conceptual error of using the term “dehydration” as a non-specific, generic term to represent any type of fluid deficit affecting any fluid compartment, or even worse, to imply ECF volume depletion, remains disturbingly prevalent among medical students and doctors. Careless and casual use of the term “dehydration” for patients who, in fact, have intravascular “volume depletion” contaminates the medical language, creates misleading impressions and unfortunately, in some cases, leads to inappropriate management. Considering the magnitude of the problem, in 2004 the International Classification of Diseases coordination and maintenance Committee made recommendations to modify the coding for body fluid disorders to uniquely identify dehydration and volume depletion[2]."

"Total body water (TBW) is estimated to be 50%-60% of body weight, varying with age, gender and race, and resides in three main fluid compartments of body (Figure 1)[3,4]. The bulk of the TBW (67%) is confined intracellularly; the remaining 33% is distributed between the two sub-compartments of the extracellular space: interstitial and intravascular (25% and 8% respectively)[5]." "Fluid input and output from the body proceeds via the intravascular compartment."

"Intravascular and interstitial compartments are separated solely by highly permeable capillary membranes. Hence, their ionic composition is almost identical; the major cation is sodium (Na+) and the major anions are chloride and bicarbonate. In contrast, the major cation in the intracellular fluid (ICF) is potassium (K+) and the major anions are inorganic phosphates. Sodium chloride is typically confined to the ECF compartment by virtue of the Na-K-ATPase pumps, anchored in the cell membranes, which pump Na+ out and K+ into the cells. This constant active transport of Na+ and K+ across the cell membrane makes the ECF rich in Na+ and the ICF rich in K+. Consequently, the osmolality of the ECF is largely dependent on sodium and chloride whereas the osmolality of the ICF is derived from potassium along with other intracellular osmoles. Water moves freely between all fluid compartments through highly water permeable cell membranes; therefore, the osmolality of the plasma is equal to the osmolality of other compartments."

"Of the total plasma volume, 85% is in venous circulation and 15% is in arterial circulation. It is this small arterial volume (approximately 700 mL) that constitutes the effective circulating volume, which is responsible for tissue perfusion and regulation of the body’s salt and water balance[7,8]."

"Considering the differing permeability of the membranes that separate fluid compartments in the body, administration of different IV fluids will result in differing distribution amongst these compartments."

"Since water flows freely between all three compartments, infusion of one litre of 5% dextrose water (D5W) will lead to an increase in the volume of the intracellular compartment of approximately 670 mL (67% of one litre), that of the interstitial compartment of 250 mL (25% of one litre) and that of intravascular compartment of 80 mL (8% of one litre)."

"On the other hand, infusion of one litre of normal saline (0.9% NS) will add approximately 750 mL to the interstitial space and 250 mL to the intravascular space due to the inhibition of Na+ entry into the cell by the aforementioned Na/K/ATPase pumps located in the cell membranes."​

"Though the water content of both D5W and 0.9% NS solutions is equal (1000 mL), much more fluid will reside in the intravascular space if given in the form of 0.9% NS (as none enters the intracellular space). Hence, 0.9% NS is preferred over D5W if the aim is to correct intravascular volume depletion. Conversely, if the aim is to correct dehydration (pure water loss) then a fluid that flows to all the compartments, such as D5W is the preferred solution. Giving D5W is equivalent to giving free water because glucose is rapidly metabolized."

"As indicated by Mange et al[1], two distinct clinical syndromes can develop secondary to excessive body fluid losses:

(1) Dehydration, which means pure water loss (“Hydro” originates from the ancient Greek word “hudōr”, meaning “water”; to de-hydrate means removing water). Loss of water reduces the distribution space of Na+, thereby disturbing the Na+ and water ratio, leading to hypernatremia and hypertonicity. Because cell membranes are freely permeable to water, this results in osmotic movement of water from the larger intracellular compartment to the extracellular compartment. There is a contraction of all body water compartments proportional to their share of TBW[12]. Since the intracellular compartment is the largest reservoir of body water, it suffers the largest water deficit. For instance, for each litre of water lost from the body, the intracellular compartment contributes 670 mL. In contrast, the intravascular compartment suffers a loss of only 80 mL; hence pure water loss rarely compromises the effective circulating volume or haemodynamic stability. Pure water loss results in hypernatremia and hypertonicity because Na+ is a membrane-impermeant solute. This induces shrinkage of osmoreceptor cells in the anterior hypothalamus, stimulating the release of antidiuretic hormone (ADH) from the posterior pituitary gland. ADH promotes incorporation of water channels (aquaporin 2) in the distal nephron segments allowing increased water reabsorption. At the same time, the thirst mechanism is triggered leading to increased water ingestion. Renal conservation of water along with increased water intake act to reverse the osmolal changes brought about by the initial water loss by restoring normonatremia (Figure 2);

(2) Volume depletion, which implies an ECF volume deficit secondary to the loss of both sodium and water. Sodium is confined into the extracellular compartment by the Na-K-ATPase pumps in the cell membranes, which helps to hold water extracellularly[13]. Sodium and water loss lead to a reduction in the effective circulating volume. The human body orchestrates a number of homeostatic responses to combat hypovolemia that include activation of the renin-angiotensin-aldosterone system (receptors in renal afferent arterioles), stimulation of the sympathetic nervous system (aortic arch and carotid sinus receptors), suppression of ANP (atrial receptors) and stimulation of ADH release. All these lead to renal conservation of both salt and water, thereby restoring normovolemia. It is noteworthy that ADH release is stimulated in both dehydration (due to hypertonicity), and ECF volume depletion (due to decreased effective circulating volume)."​

"Though uncommon, some physicians have insufficient knowledge of body fluids due to a lack of factual information about body fluid compartments and differences in their composition. Most are aware that a patient with haemorrhagic shock has a depleted intravascular compartment, but only a few recognize which compartment suffers the most in a dehydrated patient with a serum sodium of 170 µmol/L. Suppose an elderly patient is admitted with community-acquired pneumonia. He has been rather drowsy for two days before admission with poor oral intake. He is tachypneic and pyrexial, but his blood pressure is normal with no postural change. Initial laboratory tests reveal a serum sodium of 170 µmol/L. He is receiving antibiotics and D5W infusion. When asked “What condition are you treating with D5W infusion?”, most students reply “hypernatremia” rather than “dehydration”, i.e., they mention the biochemical derangement rather than the condition that produced it. Further probing reveals that some students do not recognize that hypernatremia in most instances represents loss of water in relation to Na+ (not an excess of sodium) and is a manifestation of dehydration (hence we calculate the free water deficit to assess the amount of water replacement needed to correct hypernatremia). In other words, it is the water intake/excretion (rather than Na+ handling) that regulates the ECF sodium concentration. It also appears that although some students have knowledge of the different fluid compartments, they fail to apply their knowledge to real life cases."

"A number of students have a skewed understanding of body fluid compartments and harbour various misconceptions, the most common of which is erroneously referring to “ECF volume depletion” or “intravascular volume depletion” as “dehydration”. The vast majority of doctors appreciate that patients who present with profuse diarrhoea and vomiting and are consequently hypotensive and tachycardic are intravascularly depleted. They also very appropriately resuscitate these patients with 0.9% NS rather than D5W infusion. However, when presenting such a case during the ward round, they say “this patient was severely dehydrated and resuscitated with 0.9% NS”. So, although they correctly identify and treat the clinical syndrome of intravascular volume depletion, they use imprecise terminology."

"Another common misbelief among students is that dehydration can be reliably diagnosed by physical signs such as sunken eyes, decreased skin turgor and dry mucous membranes. Contrarily, the predictive value of these individual clinical signs in diagnosing dehydration is limited in adult populations. Studies endorsing these physical signs were mostly carried out on paediatric and elderly patient populations[14-18]. Many of these patients in fact had ECF volume depletion rather than dehydration, as evidenced by haemodynamic compromise and normal serum sodium levels."

"Though it had long been known that primary loss or deprivation of water produces biological disturbances (thirst) dissimilar to those seen in primary loss or deprivation of salt (circulatory instability), both types of deficits were considered to be subcategories of dehydration in the early 20th century[21,22]. These ancient concepts have managed to exercise a strong pull on some modern doctors, who have persevered in using the term “dehydration” to refer to both intracellular water loss and ECF volume loss and to sub-classify dehydration into isonatraemic, hyponatraemic and hypernatraemic forms[23-27]."

"In fact, it is volume depletion that has isonatraemic, hyponatraemic and hypernatraemic subtypes determined by the tonicity of the fluid lost and the type of fluid ingested[28-31]. If the losses are isotonic, i.e., proportionate quantities of water and sodium are lost (e.g., blood loss), then serum sodium and tonicity will remain unchanged resulting in isonatraemic volume depletion. However, if more sodium relative to water is lost (or the patient takes plenty of salt-free fluids, for example tap water), hyponatraemic volume depletion ensues. Finally, if less sodium is lost relative to water (or if the patient does not drink water, or takes hypertonic soup), hypernatraemic volume depletion follows. In contrast to volume depletion, dehydration is always hypernatraemic (due to loss of pure water); the categories “hyponatraemic” and “isonatraemic” do not apply in dehydration."

"Some patients can present with features of both dehydration and intravascular volume depletion. The co-existence of these two different entities is partly responsible for some physicians misjudging them as a single disorder. Indeed, many patients in paediatric clinical studies with diarrhoeal illnesses were both dehydrated and ECF volume depleted[14,32]. This complex pathophysiological state was oversimplified as “dehydration” and the severity of body fluid losses categorized according to percentage of body weight loss. The “dehydration” assessment scales included the physical signs and laboratory parameters of both intracellular water loss and ECF volume depletion[14,32]."

"Clinically, it is not possible to establish whether hypernatremia in an intravascularly depleted patient is secondary to hypernatraemic intravascular depletion (water loss greater than sodium loss), severe dehydration (profuse water loss alone), or a combination of the two. This differentiation requires marker/tracer studies[9-11]. In clinical situations, there is hardly any need for this differentiation. As a first step, intravascular volume depletion is treated with 0.9% NS to support organ function. Once adequate haemodynamic stability is achieved, hyperosmolality is corrected with D5W."

"Usually, dehydration does not lead to intravascular volume depletion as the intravascular space contributes only a small percentage to the TBW loss; the major bulk is lost from the intracellular space, the largest reservoir of body water. As discussed earlier, a loss of 1 L from TBW removes only 80 ml from the intravascular space (2.3% of intravascular volume); consequently, no appreciable deleterious effects on haemodynamics are seen. Development of signs and symptoms of intravascular volume depletion usually require more than 0.5 L of intravascular volume deficit. For this intravascular volume deficit to develop in a 70 kg person with dehydration, a TBW deficit of more than 6 litres (more than 15% of TBW) will be required. By this time severe hypernatremia (serum Na+ > 170 mmol/L) would have developed[12]."

 

[Amazoniac]

The title here is water malabsorption syndrome, but if it's being urinated, how could it be? It's poor retention or recovery. Some people will continue to lose a lot of water through the urine with extra edemium, if they're recommended to stuff themselves with common salt, shrinking of intracellular fluid pool will be made worse and all compartments can be disturbed.

- Understanding clinical dehydration and its treatment
- Body fluids and salt metabolism - Part I
- Body fluids and salt metabolism - Part II
- Fluid and electrolyte therapy: a primer

 

[Vins7]

The title here is water malabsorption syndrome, but if it's being urinated, how could it be? It's poor retention or recovery. Some people will continue to lose a lot of water through the urine with extra edemium, if they're recommended to stuff themselves with common salt, shrinking of intracellular fluid pool will be made worse and all compartments can be disturbed.

- Understanding clinical dehydration and its treatment
- Body fluids and salt metabolism - Part I
- Body fluids and salt metabolism - Part II
- Fluid and electrolyte therapy: a primer

So, what is the solution?

 

[Rafael Lao Wai]

Thyroid for me had a huge impact on excessive urination. I think Danny Roddy reported the same thing.

 

[Amazoniac]

So, what is the solution?

Rafael's suggestion can work, it may also indirectly improve infectious issues and compromised immunity that are common when the metabolism is sluggish, there are many articles now paying attention to bowel toxins and how they can burden kidneys (in disease).


The justification to shove down sea salt must be based on the 'hyponatremia' of hypothyroidism. Wasting can occur, but the picture is more complex. There are cases where it's water that's responsible for the imbalance when it's dysregulated and retained, diluting edemium. At times, total body edemium is increased in spite of appearing decreased in blood. I doubt that it's a good idea to consume a lot of it without the other "nutrients".

Saving for later:

- Effect of Optimal Thyroid Replacement Therapy on Chronic Hyponatremia with Focused Review of the Evidence, Mechanisms, and Clinical Implications
- The Controversies of Hyponatraemia in Hypothyroidism
- Hyponatremia and the Thyroid: Causality or Association?
- Hypothyroidism and Hyponatremia: Simple Association or True Causation
- Hypothyroidism as A Cause of Hyponatremia: Fact or Fiction?
- Potential Mechanisms of Hypothyroidism-induced Hyponatremia
- Hypothyroidism and Hyponatremia: Rather Coincidence Than Causality
- Hyponatremia in Hypothyroid Disorders: Current Understanding
- Hyponatremia and hypothyroidism
- Management of Endocrine Disease: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment
- Evaluation of significance of hyponatremia in hypothyroidism in an urban female population of Eastern India: A cross-sectional study
- 'Dos and don'ts' in the management of hyponatremia

 

[Peatress]

Great thread - Lots of useful info

Effect of serum albumin on serum sodium: necessity to consider the Donnan effect

Sir,

academic.oup.com