Hydration scientific library volume 3 including EHI articles related to hydration & dehydration.

1.
Hydration Scientific Library (Volume 3)
Index
• Headache and water intake: evidence from randomized
clinical investigations.
• Hydration strategies of runners in the London marathon.
• Physical signs of dehydration in the elderly.
• An exploration of the hydration care of older people:
a qualitative study.

2. Two randomized clinical trials assessing the effect of
increasing water intake on headache have been published
to date, the last one very recently1
and the previous one
in 20052
. Both these studies were conducted by the same
research group at Maastrich University.
Previously published research work suggested a positive
effect of increased water intake on headache, but most
of the evidence provided was based on case reports.
In 2005, the study carried out by Spigt et al 2
on 18
migraine patients examined the effects of regular water
intake on migraine. An average reduction of 21 hours
of headache time in 2 weeks was observed at the end
of the 3 month follow-up period. Authors recognized
some potential biases (mainly due to a small sample
size) in their pilot study. As a result, five years later
they conducted a second randomized controlled trial in
primary care with two groups and a follow-up period of
3 months to study the said effects of increased water
intake on headache2
. Fifty (50) patients were randomized
to the control group and 52 patients to the intervention
group. Inclusion criteria included patients who had had
at least two episodes of moderately intense headache
or at least five mildly intense episodes per month and
a total fluid intake of less than 2.5 L/day. Both groups
received written instructions about stress reduction
and sleep improvement strategies. In addition, the
intervention group was instructed to increase the daily
water intake by 1.5 L. The main outcome measures were
Migraine-Specific Quality of Life (MSQOL) and number
of days with at least one moderate headache per month.
Drinking more water resulted in a statistically significant
improvement of 4.5 (confidence interval: 1.3–7.8) points
in MSQOL. In addition, 47% patients in the water group
reported significant improvement (6 or higher on a
10-point scale) in perceived intervention effect against
25% in the control group. However, drinking more water
did not result in relevant changes in the number of days
with at least one moderate headache, as observed in the
pilot study.
Considering the positive subjective effects observed,
it seems reasonable to recommend that headache
patients increase their daily intake of water and fluids
for a short period of time to assess whether they
experience improvement. This advice should be aimed
particularly at those patients with liquid intakes below
recommendations.
HEADACHE AND WATER INTAKE:
EVIDENCE FROM RANDOMIZED
CLINICAL INVESTIGATIONS
A review by Prof. Dr. Lluís Serra-Majem
3. EHI Update: March 2012
Refererences:
1: Spigt M, Weerkamp N, Troost J, van Schayck CP, Knottnerus JA. A
randomized trial on the effects of regular water intake in patients with
recurrent headaches. Fam Pract. 2011 Nov 23. [Epub ahead of print].
2: Spigt MG, Kuijper EC, Schayck CP, Troost J, Knipschild PG,
Linssen VM, Knottnerus JA. Increasing the daily water intake for the
prophylactic treatment of headache: a pilot trial. Eur J Neurol. 2005
Sep;12(9):715-8.
Previously published
research work
suggested a positive
effect of increased
water intake on
headache
HYDRATION SCIENTIFIC LIBRARY
www.europeanhydrationinstitute.org

3. There is very clear evidence that most marathon runners
are dehydrated when they finish the distance, but a
few of the slower runners drink more than they lose in
sweat and actually gain weight during the event. This
has attracted a lot of attention in recent years, largely
because of a very small number of fatalities that have
occurred in participants due to hyponatraemia caused by
excessive fluid intake.
This paper aimed to establish what participants in the
London marathon know about appropriate drinking
behaviours, where this information came from, and what
drinking strategy they adopted.
It emerged from the survey that most (93%) of the
runners had read or been told about drinking fluids on
marathon day and almost all (96%) of the participants
had made a fluid intake plan that they intended to follow
on race day. In spite of this, however, only about 1 in 5
(22%) knew the volumes of water and sports drink bottles
available on the course, so it is hard to see how this plan
would be implemented. About 1 in 5 participants (21%)
were planning to take a drink at every one of the 24 water
stations along the route. Only I in 4 (25%) planned to base
their fluid intake on how thirsty they felt at the time. Two
thirds of the runners (68%) said that they were aware of
the potential danger of over-drinking and hyponatraemia,
but only 1 in 3 (36%) had even a basic understanding of its
cause and effects.
The authors concluded from their survey that many of
the participants in the London marathon have a poor
understanding of the appropriate amounts and types of
drinks to consume during the event and that educational
interventions are still necessary to prevent over-drinking
during marathons.
Given that a very high proportion of participants in
this and other big city marathon events are taking
part to raise money for charity and have done little
preparation, this finding is perhaps not surprising, but
it does raise concerns about how educational messages
that potentially save lives – even if only a few – can be
disseminated.
HYDRATION STRATEGIES OF RUNNERS
IN THE LONDON MARATHON
A review by Williams J, Tzortziou-Brown V, Malliaras, P, Perry M, Kipps C
3. EHI Update: June 2012
Refererences:
Williams, J; Tzortziou Brown, V; Malliaras, P; Perry, M; Kipps, C.
Hydration Strategies of Runners in the London Marathon. Clinical
Journal of Sport Medicine, 22:152-156, 2012.
HYDRATION SCIENTIFIC LIBRARY
www.europeanhydrationinstitute.org

4. 2. EHI Update: October 2012
HYDRATION SCIENTIFIC LIBRARY
www.europeanhydrationinstitute.org
It is widely recognised that dehydration is a common
condition in the elderly and that it is a frequent cause of
hospitalization among older people, in spite of efforts
by caregivers to prevent its development. Successful
prevention strategies will require early identification of
individuals at increased risk, which in turn means that
knowledge of simple but reliable signs of mild dehydration
is required. In this study, various physical signs were
examined as clinical signs of dehydration in elderly. In this
study, 27 consecutive elderly patients who were admitted
to the Department of Medicine were evaluated. Based on a
definition of dehydration as a calculated serum osmolality
of more than 295 mOsm/kg, 9 patients were classified as
dehydrated (mean osmolality of 310 mOsmol/kg) and 18 as
non-dehydrated (mean osmolality of 279 mOsmol/kg).
All patients were observed for physical signs of dehydration:
decreased consciousness level; dry axilla; dry mouth;
sunken eyes; decreased skin turgor; delayed capillary
refill time. Blood and urine chemistry analyses were
also compared between the two groups. For the physical
signs, dry axilla had moderate sensitivity (44%) and good
specificity (89%) to detect dehydration. Sunken eyes and
delayed capillary refill time also showed relatively good
specificity (83%). As expected, the mean serum sodium
concentration in the dehydrated group (146 mmol/l) was
higher (p<0.01) than that in the non-dehydrated group (134
mmol/l). During the hospitalization, 44% of patients in the
dehydrated group died, while 17% in the non-dehydrated
group died. The authors concluded that physical signs of
dehydration in elderly showed relatively good specificity
but poor sensitivity. They suggested that evaluation of
the axillary moisture could help assess dehydration in
situations where laboratory analysis was not available.
Although the number of subjects in the study was small,
these preliminary results help raise the awareness of
the need for careful observation of vulnerable elderly
individuals.
References:
Shimizu M, Kinoshita K, Hattori K, Ota Y, Kanai T, Kobayashi H, Tokuda Y.
Physical signs of dehydration in the elderly. Intern Med (Tokyo)
2012;51(10):1207-10.
Physical signs of dehydration
in the elderly
Recently published paper summarized
by Professor Ron Maughan, chair of
the EHI Science Advisory Board

5. 3. EHI Update: December 2012
HYDRATION SCIENTIFIC LIBRARY
www.europeanhydrationinstitute.org
Older people may be more vulnerable than younger adults to
mild or severe dehydration. This is attributed in general to
age-related changes in physiology, psychology, physical and
cognitive abilities and living conditions. The specific factors
that promote or inhibit appropriate drinking behaviour,
particularlyinhealthcareinstitutionsarenotwellunderstood.
Consequently, ensuring adequate hydration is a challenging
issue for nurses and others involved in providing care.
The aim of this new study was to investigate the complex
issues associated with hydration and hydration care of older
people by exploring older people’s experiences of drinking
fluids and health professionals’ beliefs and behaviours
regarding hydration care.
The study was conducted in South West of England at a
hospital ward in a major hospital and in a care home providing
personal and nursing care. Participants were 21 older people
aged 68-96 y, 7 friends or relatives and 21 nurses and health
care assistants. A multi-method approach, which refers
to multiple information sources (older people, staff, and
relatives) and multiple ways of gathering data (focus groups,
interviews and observations) was employed. Data were
analysed using thematic analysis.
Older people and relatives discussed topics such as the
availability, choice and quality of drinks, the desire and
preference of drinks, and perceived physical barriers to
drinking. Healthprofessionalsprovidedtheirviewsoncurrent
hydration practice. Six key themes emerged from the data:
availability of drinks, pleasure of drinking, understanding the
importance of hydration, help and assistance with drinking,
barriers to drinking and diminished experience of drinking.
Each key items had 4-6 subcategories, which were discussed
and analysed in detail.
Older people revealed that drinking experience was
diminished by a variety of factors: lack of thirst sensation,
weakness in drinking associated with frailty and subsequent
loss of dignity, hedonic limitations such as the taste or
the temperature of the drink, and the perception of fluid
consumption as being compulsory rather than a pleasurable
and social occasion. These observations suggested some
factors that can be employed to enhance the drinking
experience. Encouraging relatives and friends to support
hydration and to drink alongside older people was suggested.
Healthprofessionalssuccessfullyappliedseveralstrategiesto
promote drinking including verbal prompting, offering choice,
placing drinks in older people’s hands in cups that were of
appropriate material, shape and/or weight and assisting with
drinking. However, insufficient time provided for hydration or
viewing hydration care as one of several, parallel tasks that
need to be balanced were some of the identified barriers in
hydration care.
The findings of the study revealed the complexity of hydration
care and identified issues that go beyond simply ensuring the
consumption of adequate fluids. Supporting the individual
needs of older people requires attention to their physical or
physiological limitations and the consideration of various
practical, perceptiual and social issues.
References:
Godfrey,H et al.
International Journal of Nursing Studies 49 (2012) 1200–1211
Anexplorationof
thehydrationcare
ofolderpeople:
Aqualitativestudy
Prof. Maria Kapsokefalou

6.
http://www.europeanhydrationinstitute.org/