hydration pdf
TRANSCRIPT
-
8/8/2019 Hydration PDF
1/72
b o r d e n i n s t i t u t e m o n o g r a p h s e r i e s
Water Requirementsand Soldier
Hydration
Scott J. Montain, PhD, and Matthew Ely, MSedited by
William R. Santee, PhD
Karl E. Friedl, PhD, Colonel, US Army
-
8/8/2019 Hydration PDF
2/72
-
8/8/2019 Hydration PDF
3/72
b o r d e n i n s t i t u t e m o n o g r a p h s e r i e s
boRden inStitute
WaterRequirementsand Soldier
HydrationScott J. Montain, PhD, and Matthew Ely, MS
editedby
William R. Santee, PhD
Karl E. Friedl, PhD, Colonel, US Army
-
8/8/2019 Hydration PDF
4/72
i has lg kw ha vals ca srvv mch lgr wh f ha
hy ca wh war. oly rc cas has scc al qafy h
facrs ha flc h ys aly maa pmal war lvls a h phys-
lgcal csqcs f war malac. ths mgraph prss frma
asss h cargvrwhhr physca, mc, lar, r fllw slr
rsag h flc f vrm, physcal acvy, y sz a gr,
a la carrag maag war alac.
ths mgraph was prpar fr mlary mcal caal s. th fcs f h frma-
s fsr scss ha may frm h ass f cr a plcy. th ps r as-
srs ca hr ar h prva vws f h ahrs a ar csr as f-fcal r as rflcg h vws f h dparm f h Army r h dparm f dfs.
dsag Slc: th ahrs a plshr hav ma vry ffr sr h accracy f
sags c hr. Hwvr, s h rspsly f vry pracr csl apprpr-
a frma srcs ascra crrc sags fr ach clcal sa, spcally fr
w r famlar rgs a prcrs. th ahrs, rs, plshr, a h dparm
f dfs ca hl rspsl fr ay rrrs f hs k.
us f tra r bra nams: us f ra r ra ams hs plca s fr llsrav
prpss ly a s mply rsm y h dparm f dfs.
nral Lagag: ulss hs plca sas hrws, mascl s a prs
rfr xclsvly m.
Cra pars f hs plca pra cpyrgh rsrcs.
ALL RiGHtS ReSeRVed.
n cpyrgh pars f hs plca may rprc r rasm ay frm
r y ay mas, lcrc r mchacal (clg phcpy, rcrg, r ay fr-
ma srag a rrval sysm), wh prmss wrg frm h plshr r
cpyrgh wr.
br is
Walr R Army Mcal Cr
uS Army Mcal dparm Cr & Schl
This monograph was originally submitted to the Borden Institute as a chapter intended for
publication in Mlary Qaav Physlgy, a book in the txks f Mlary Mcseries. Because changes may be made before publication, this monograph is made available
with the understanding that it will not be cited or reproduced without the permission of the
publisher.
-
8/8/2019 Hydration PDF
5/72
-
8/8/2019 Hydration PDF
6/72
eFFectoF cold weather operationson water requirements 27
effc f Cl Wahr thrs a Vlary dhyra 29
effc f Cl Wahr War dlvry 29daly War Rqrms 30
eFFectoF high-altitude operationson water requirements 31
effc f Hgh-Al opras War balac 31
effc f Hypxa thrs a Vlary War iak 32
ohr Facrs Assca Wh Hgh-Al opras tha
Affc War Rqrms 32
effc f Hgh-Al opras War dlvry 33
War Rqrms 33
eFFectoF water immersionon water requirements 35
barriersto rehydration 37
War Avalaly 37
Palaaly f War 39
Gasrc empyg 39
Ls Sls 40
strategiesto sustain hydrationin harsh environments 43
d n Skp Mals 43
Mak tm drk 43
Maxmz Palaaly 44
Mmz by War Lsss 47
Prv eca 47
Summary 51
referenceS 53
Cover photo: Courtesy of US Army
Scott J. Montain is a Research Physiologist, Military Nutrition Division, US Army ResearchInstitute of Environmental Medicine, Building 42, Kansas Street, Natick, Massachusetts
01760-5007.
Matthew Ely is a Researcher, US Army Research Institute of Environmental Medicine, Build-
ing 42, Kansas Street, Natick, Massachusetts 01760-5007.
-
8/8/2019 Hydration PDF
7/72
Frwr
War s h largs chmcal cmp f h hma y, ypcally
accg fr a 60% f y wgh. Amals wr al lav h
prmral ca y vlpg wha Cla brar (h grafahrf physlgy) call h milieu intrieur, a ral sal vrm
ah r clls. ths spcal capaly allws s mra r -
ral vrm hrgh hmsac mchasms a srvv h
fac f a w vary f xral srssrs. ehacg hs capaly
r xrm vrms s f parclar mprac h Army,
whr ay avaag r xpl hsl cs may cr-
cal mss sccss. ths, war lgscal plag a pmza
f slr smrgla ar, ssc, accal waps. Rlavlysmall ragms hyra sas ca sgfcaly mpar mss
prfrmac. Mr svr hyra ca prc ha jry casals.
thrfr, shl srprsg ha h Army has h lar
physlgy rsarch rgarg war alac. Gv h mprac
f srg aqa hyra rg mlary pras, s acally
asg ha hr rma larg gaps r kwlg f hs crcal
ara. ths mgraph smmarzs h sa f r kwlg.
Sc Ma a Mahw ely hav fcs h vry pragmac
aspcs f vars saars a prcs ha crrly rv ml-
ary plag facrs fr war, ky praal facrs ha affc hs
prcs, a apprachs maag apprpra lvls f war
ak. ths mgrah rcs a gra al f physlgcal rsarch
-
8/8/2019 Hydration PDF
8/72
praccal gac ha s f gra mprac h mlary. Hwvr,
h h clar, ccs gac s mr spcfc scfc lrar
ha s h ass fr a pr rsag f h mchasms gvrghrs, swag, a hr (swag) war lsss hrgh h sk
a rsprary rac, ral rgla, a fl shfs w cmpar-
ms affc y xrcs, r, a hr ky facrs. Sm f
hs pcs ar cvr hr chaprs ha wll par f h br
iss vlm Military Quantitative Physiology. ohr aspcs
f hs ara may f clcal xks war a lcrly
maagm f pas.
S, wha mr s hr lar a hs sjc? Csr
camls a hr mammals ha hav aap xrm sr c-s. Alhgh w ca mmc amals ha hav aap h sr
vr mlla, w ca lar frm hm. Camls ca ls war alg
30% f hr y wgh a sll maa plasma vlm. thy ca
als cmplly rsr hs war fc a sgl f rkg.
Hmas ca lra lss ha half f hs mag f war lss a,
mr sgfcaly, rflc h fc sprpraly plasma vlm
lsss. ths cmprms s hac wh hyra, spcally rg
wrk h vrms wh prphral vasla s maxmallyacva fr clg. W rplac r lsss y h am f h
fc a ms rly mals crag aal rhyra (hs,
par f h ras fr a sr f csmp h fl
a war csmp).
th ffrcs lrac hyra w hmas a
camls ar rmarkal, a hr s sll mch lar frm hr
sr aapas, as wll as frm h havral aapas f hma
sr wllrs ha mgh allw l frcs hac pras ryvrms. t. e. Lawrc (als kw as Lawrc f Araa)
hgh ha h a hs b fghrs cl sprhyra avac
f a challgg v h sr y frcly vrcsmg war;
mr rc xprms r hs wh glycrl-hac war
lag, a hr f hs mhs was ffcv.
uS Army cr arlr h pas cry hl ha slrs cl
aap hyra y rag wh rsrc war csmp. A
sy wh Asra Spcal Frcs s hs prms a rm
ha slrs wr srsly a cssly capaca wh 5 ays
f rsrc war csmp f 1 lr pr ay rg cmma
rag xrcss, hs rfrcg arlr rsarch fgs.
i may sgfca ha war cr was havly frc rg
vi | Foreword
-
8/8/2019 Hydration PDF
9/72
h frs Glf War a ha hr wr rlavly fw ha casals, r
may w wr smply lcky. Hwvr, w vryhg ha w kw
ssa hyra, v h p f plc scss ah qaly f l war g prv rps h fl. i fac,
h uS Army was s ffcv lvrg hs mssag f hyra
prv ha jry ha a srs f cass f hyparma ccrr
rag s, a w ppr lms h hyra gac ha
vlp. dsp h gra ffrs y h uS Army rc
vrmal jrs, hasrk cass hav lma frm
mlary rag a sm flca wh cycls f rag car a
hgh awarss cas y w rags.
tchlgs xs ay cra a mmally vasv hyramr ha qrs h rsal vrm a prvs a ral-
m assssm f hyra sas a cl alr slrs, mcs,
r cmmars a mly rv. th chlgs als xs
cra a d s (frm h Frak Hrr scc fc srs) ha
wl cllc, prfy, a rcycl all war lavg h y va ca-
s, rsprary, a rary rs. nhr f hs marl sls
has prc. Wh hr mr mhs (a a cmmm
f rsrcs hs ffr), may y aswr qss a flsr w y cmparms, spcally h vrms
a cs whch slrs may xps, a h rlashp
physcal a mal prfrmac, cl arss. May hr qs-
s, sch as appar sx ffrcs war rvr ras,
frhr lca. Srags prc h hma caml hav y
prps, shl far h wh h crr avacs
gmcs, prmcs, a gc grg.
i s grally rs ha hr ar rg mlary s frrsarch a vlpm cra famal las whr w
mlary ps shl csly vlvg wh w mrgg
chlgs a rsag. osmrgla a war alac ar
rg rqrms. Mch f ays kwlg s f h
xsv a praccal rsarch ss f physlgss mlz frm
h Harvar Fag Larary Wrl War ii, cc a h Fr
Kx Armr Mcal Rsarch Larary a hr Army facl-
s, y e. F. Alf a d. b. dll hr fams sr ss, a y
hrs wh fllw hm, as scr hs mgraph. tay, h
rsarch capaly hyra rsarch rss alms xclsvly a
h uS Army Rsarch is f evrmal Mc (uSARieM)
wh dr. Ma a hs cllags. th cmpaal mls f war
Foreword | vii
-
8/8/2019 Hydration PDF
10/72
rqrms prc h 1970s a 1980s y uSARieM ar c as
aal saars y may hr fral agcs a saars-crag
s. th wrk s ssal h uS Army, h rsarch als -fs wrkrs sry, ahls, mrgcy rsprs, gvrm
agcs (g, nASA [naal Aracs a Spac Amsra],
oSHA [occpaal Safy a Halh Amsra], uSdA [uS
dparm f Agrclr]), a may hrs. th naal iss
f Halh rls h uS Army fr mcal rsarch prfrmac
pmza halhy m a wm.
War a hyra saars ar js as rlva ay as hy
wr Wrl War ii. W sll hav ahs rag frm aqa
fl csmp, a, rar cass, v frm xcssv hyra ahyparma. tay, mlary pras a hmaara a msss
frqly ak plac whr h lcal war rsrcs ar lackg. War
s a majr lgscal r iraq a Afghasa, pg slr lvs
a rsk vry war spply cvy a callg fr h gras pssl
prcs war plag als. th slr la parl rm
rgs s als crcal; a war s a sgfca pr f hs la.
th avalaly f pal war hrgh h wrl s cmg a
crasg prlm ha may v rv sm fr raal c-flcs. ursag h mpac f war rvr ras a h ffcs f
hyra wll cm v mr mpra. dr. Mas mgraph
s a ms ra fr vry prvv mc ffcr a mlary mcal
cslas, avsrs, a srgs assg praal s.
Karl e. Friedl, phd, colonel, us army
drcr, tlmc a Avac tchlgy
Rsarch CruS Army Mcal Rsarch a Marl Cmma
william r. santee, phd
Rsarch Physcal Scs
uS Army Rsarch is f evrmal Mc
viii | Foreword
-
8/8/2019 Hydration PDF
11/72
irc
th prvs f sffc pal war ssa slr hyra
s a prrqs fr sccssfl plym. Alph al1 a echa
al2 cm ha hyra ca gra slr mral, as wll as
h sr wrk (Fgr 1). by war fcs as ll as 2% ywgh ca mpar physcal prfrmac.3 War fcs f 5% 7% f
al y wgh ar assca wh yspa, haach, zzss, a
apahy.1 A xrm xampl f h hra hyra pss rps
s shw y h ahs f may egypa slrs wh wr c ff frm
sppls a wh sffr war fcs a ha llss rg
h 1967 Sx-day War.
drg mlary pras, a val slrs aly war r-
qrms ssa hyra ca rag frm 2 L/ a xcss f
12 L/, pg wahr cs, wrkla, a physcal sz.
Alhgh 2 L/ s rlavly asly achv h garrs a rg
plym, 12 L/ wll rqr ccr ffr a cra y
mlary lgsc sppr prsl a fl cmmars sr ha
aqa fl s avalal (Fgr 2). i s h rspsly f mcal
prsl ca lars a h mprac f hyra
a h cssary masrs pmz fl ak a r. ths
mgraph scsss h ffc f harsh vrms fl rqr-
ms a prss mhs ssa war alac rg plym vrmal xrms.
-
8/8/2019 Hydration PDF
12/72
2 | water requirementsand soldier hydration
Figure 1. E. F. Adolph stands alongside a military jeep in the desert in 1943. Adolph and col-
leagues were in California conducting experiments for the military on the adaptability of man
to a desert environment.
Photograph: Courtesy of the University of Rochester archives.
-
8/8/2019 Hydration PDF
13/72
Figure 2.World War II soldier using steel helmet to hold water and to bathe. Earlier beliefs
that water restriction would improve human tolerance to dehydration were not borne out by
the careful studies of Adolph and others in the 1940s.
Photograph: Courtesy of the National Archives, photo no. 208-AA-4NN-24.
introduction | 3
-
8/8/2019 Hydration PDF
14/72
-
8/8/2019 Hydration PDF
15/72
War-elcrly balac
th hma y s cmps maly f war. i accs fr 50%
70% f y wgh fr a al ma a 40% 60% f y wgh
fr a al wma.4 War s prmarly sr fa ssa accs fr 72% 73% f la y mass. th larg, w-
val vara al y war rlav y wgh s pr-
marly a fc f y fa (, aps ss s a majr crr
a cras y wgh wh a crrspg cras y
war). th ypcal mal slr has 47 L f y war, whras h
ypcal fmal slr has 33 L f y war.
o a aly ass, y war s rlavly sal, prv aqa
fl s avalal ffs war ls y swag, rspra, a ra-. War alac s rgla aly wh ~0.66% f y wgh
halhy, acv pplas.5 ths gh alac s achv hrgh
fl gs assca wh ag a rkg, cpl wh ma-
lc war prc a physlgcal sysms ha rgla fl lss
(g, ral, carvasclar, a hrmal sysms). tal 1llsras h
srcs f war lsss a prc,3 as wll as h lwr smas
f h rvr frm hs srcs. i shl rcgz, hwvr,
ha h vals prs ca vary markly. Rsprary war lsss,
fr xampl, ca rag frm 0.2 L/ hm ar mr ha 1.5 L/
rg xrcs a xrmly hgh als. Cas swag ca
cras frm 0.5 L/ mr ha 10 L/ wh prlg xrcs h
vrms. Smlarly, arrha ca graly cras fcal war lsss.
-
8/8/2019 Hydration PDF
16/72
Fr mr frma, h is f Mc has plsh ary
rfrc aks fr war (tal 2) a lcrlys.3
by war lvls ca vary markly hrgh a ay. i s -
cmm fr ahls r slrs ls 2% 5% f y wgh rg
physcal acvy,69 a mak p h shr-rm war fc y rkg
rg rs prs a a mals.1,10,11 ths par f vlary hyra-
rg physcal acvyfllw y rkg h majry f alywar ak a malmrsls mark flcas ha ar ap-
par rg ay--ay xamas f al y war masrms.
by war s sr hr prcpal fl cmparms: (1)
raclllar, (2) rsal, a (3) ravasclar. Mvm wh h
raclllar a xraclllar cmparms s rm largly y
smc frcs;12 hrfr, maac f al y war s p
al sl a sr f ha sl. dhyra ma
y swag flcs ach fl spac as a csqc f fr fl
xchag. ns a cllags13rm h sr f ywar lss amg h fl spacs, as wll as amg ffr y
rgas ras wh hy wr hyra y 10% al y wgh
wh xrcs-ha srss. th war fc was appr w
h raclllar (41%) a xraclllar (59%) spacs, a als amg
h rgas as fllws:
40%frommuscle,
30%fromskin, 14%fromviscera,and
14%frombone.
table 1.Estimates of Minimal Daily Water Losses and Production*
Source Loss (mL/d) Production (mL/d)
Respiratory loss 250 to 350Urinary loss 500 to 1,000Fecal loss 100 to 200Insensible loss 450 to 1,900Metabolic production +250 to +350Total 1,300 to 3,450 +250 to +350Net loss 1,050 to 3,100
*Assuming conditions in which there is minimal water loss from sweating.Adapted from: Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Water, Potassium,Sodium, Chloride, and Sulfate. Washington, DC: National Academy Press; 2005.
6 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
17/72
table 2. Criteria and Dietary Reference Intake Values* for Total Water
Adequate Intake (L/d)
Male Female
Life-Stage From From Total From From TotalGroup Criterion Foods Beverages Water Foods Beverages Water
06 mos Average consumption of 0.0 0.7 0.7 0.0 0.7 0.7water from human milk
712 mos Average consumption of 0.2 0.6 0.8 0.2 0.6 0.8water from human milkand complementaryfoods
1 yr Median total water intake 0.4 0.9 1.3 0.4 0.9 1.3from NHANES III
48 yrs Median total water intake 0.5 1.2 1.7 0.5 1.2 1.7from NHANES III
913 yrs Median total water intake 0.6 1.8 2.4 0.5 1.6 2.1from NHANES III
1418 yrs Median total water intake 0.7 2.6 3.3 0.5 1.8 2.3
from NHANES III
>19 yrs Median total water intake 0.7 3.0 3.7 0.5 2.2 2.7from NHANES III
Pregnancy1450 yrs Same as median intake 0.7 2.3 3.0
for nonpregnant womenfrom NHANES III
Lactation1450 yrs Same as median intake 0.7 3.1 3.8
for nonlactating womenfrom NHANES III
NHANES III: Third National Health and Nutrition Examination Survey (19881994)*No Tolerable Upper Intake Level is established; however, maximal capacity to excrete excess water in individuals withnormal kidney function is 0.7 L/h.Totalwater represents drinking water, water in other beverages, and water (moisture) from food. (See Table S-1 inDietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfatefor the median percentage if totalwaterintake from beverages [including drinking water] and from foods reported in the NHANES III.)The observed average or experimentally determined intake by a defined population or subgroup that appears to sustaina defined nutritional status, such as growth rate, normal circulating nutrient values, or other functional indicators of health.Adequate intake is used if sufficient scientific evidence is not available to derive an Estimated Average Requirement.Bold numbers = adequate intake is not equivalent to a Recommended Dietary Allowance. (Adequateintake is provided where no Recommended Dietary Allowance has been established.)Adapted from: Food and Nutrition Board, Institute of Medicine.Dietary Reference Intakes for Water, Potassium, Sodium,
Chloride, and Sulfate. Washington, DC: The National Academies Press; 2005.
water-electrolyte balance | 7
-
8/8/2019 Hydration PDF
18/72
nhr h ra r lvr ls sgfca war c. ths, hyra-
rsls war rsr largly w h raclllar a
xraclllar spacs f mscl a sk.Swa-c hyra crass plasma vlm a crass
plasma smc prssr prpr h lvl f fl lss. Plasma
vlm crass cas prvs h prcrsr fl fr swa.
osmlaly crass cas swa s rarly hypc rlav
plasma.14,15Sm a chlr ar prmarly rspsl fr lva
plasma smlaly.15 i s h plasma hyprsmlaly ha mlzs fl
frm h raclllar spac h xraclllar spac a als plasma
vlm fs wh a prs s hyra.
8 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
19/72
thrs a Saa
Svral facrs smla hrs a play a rl saa. th ms
s mchasm s smrcpr clls, whch ar acva y ra-
clllar hyra. ths cllslca h prpc/hyphalamcrg f h raar ssv cll vlm rcs c y
hr xraclllar hyprcy r ssmc war lss (g, hmr-
rhag, rc amsra). Acva f hs clls smlas h
hrs a arg vasprss (AVP) scr. Smla f AVP
scr crass h sr rk a faclas war r y
crasg ral war rasrp.
Chags xraclllar fl vlm als cr hrs a
war alac. evc cag ha war vlm s p fsmc sml cms frm xprms ha hav mapla l
vlm r carac fllg r h. icras l vlm r cral v-
s prssr (g, ha- mmrs) las rss, rc hrs,
a vlary war ak.1618 i cras, cral vs prssr
rcs frm hmrrhag, rcs, r lwr y gav prssr
cras r p a cras hrs a rkg.16 Ssvy f
h rsps s mch lwr, hwvr, ha h smc hrs mchasm
a sms mr ffcv wh ac kys,19 hs sggsg ha
h r-ags sysm crs hrs rsps.
Amal xprms hav msra ha ags ii ca
a p psg.20 Rcprs fr ags ii xs h prpc/
hyphalamc rgs f h ra. iravrclar fs f small
-
8/8/2019 Hydration PDF
20/72
qas f ags ii smla hrs.20 Pharmaclgcal lcka f
ags i-yp rcprs a ags ii rcprs rcs h hrs
rsps accmpayg f ak, hmrrhag, a war fc.
2123
Whhr sysmc ags ii plays a rc rl smlag hrs
hmas rmas clar. Crr vc sggss ha l-r
ags ii s rcprs wh h prpc/hyphalamc r-
gs, a h rasc sgal s gra wh hr ps frm
sysmc arral l prssr a vlm rcprs.24
uplasa ral ssas als play a rl smlag vl-
ary fl ak. Svral ss hav msra ha 24 hrs f
fl asc prcs a mark cras h sjcv rags
f hrs, mh ryss, a plasa as.25th rvrsal f hsral ssas s sgfcaly crrla wh ssq war ak.
Smlarly, c f gra lvls f hyra y f rsrc,
fl rsrc, a xrcs-ha srss ar accmpa y gra
crass h mr a mag f plasa ral ssas.26
Ssas shwg a lar r wh hyra lvl cl h
fllwg:
dryandirritatedthroat; chappedlips;
feelingsofweariness,dizziness,andappetiteloss;and
thinkingofdrinking.
t xam f hs ral ssas cr rkg havr,
Phllps a cllags10 a l sampls a vsal aalg scal
hrs masrms a hrly rvals a wh vlrs rak wa-
r rg a rmal wrkg ay. thy f ha ssas f hrs,mh ryss, plasa mh as, a h plasr f rkg
war cras fr a lmak, wh ccma chags
l cy r vlm. ths rsls prv vc ha, rg
fr accss war, hmas cm hrsy a rk fr y war
fcs accr, prhaps rsps sl rpharygal cs.10
10 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
21/72
Physlgcal Csqcs fby War imalac
Dehydration
by war fcs ca ccr all vrms, hr frm aqa
war avalaly, sffc vlary ak ffs war lsss
swa a rspra, r xcssv war lss frm rss r arrha. R-
garlss f h spcfc prcss, war fc r hyra ca rc h
aly f slrs prfrm mss-ssal asks a mly a ffcv
mar, hs crasg hr lklh f cmg mcal casals.
Symptoms
o f h arls qalav sgs f hyra s h vlpm
f hrs.1 Wh apprxmaly 2% y wgh lss, vag scmfr
vlps, a h mr f cmplas cras. Wh aal war
lss, slrs ca vlp:
flushedskin,
heatoppression, weariness,
sleepiness,
impatience,and
anorexia.
-
8/8/2019 Hydration PDF
22/72
A 4% lss f y wgh, slrs splay sgs f apahy, a mgh
cmpla f mscl fag a asa. A war fcs f 6% y
wgh a grar, slrs wll lkly splay
dizziness,
headache,
dyspnea,
tinglinginlimbs,and
verydrymouth.
thy mgh prs wh sc spch a h aly walk.
Thermoregulatory and Cardiovascular Effects
by war fcs cras h hrmal sra f xrcs m-
pra a h vrms. ivals prfrmg h sam physcal
ask wh hyra hav hghr cr mprars ha hy wl f
hy wr rmally hyra, a h mag f h cr mprar
cras s prpral h y war fc. Ss xamg
h cr mprar rsps gra war fcs rpr ha cr
mprar crass 0.15C 0.20C fr vry 1% y wghls.1,2729 ths rlashp s maa p f xrcs -
sy30 a s affc y chagg h par f rkg.1,31 th
mag f cr mprar cras s, hwvr, lss mpra
vrss warmr vrms. i cl vrms, hyra s
sm cras h rsk f hyphrma; lm aa avalal
sggs ha y mprar falls smlarly rg whl-y clg,
pg f a val s rmally hyra r hyra.32
Whhr hyra prss ar a cras rsk f prphral cljry s crvrsal.3335
dhyra xrs s ffcs hrmrgla y alrg h
aly sspa ha h vrm. bh sk l flw a
swag rspss ar affc. Fry a cllags36 rpr ha
hrmally c hyra cras h sphagal mprar
hrshl fr cas vaslaa a aa h cras
cas l flw pr cras y mprar. dhyra-
als rcs pak cas vaslaa h hmas36 a
hma prmas.37,38 Ma a cllags39 f ha hrmally
c hyra cras h sphagal mprar hrshl
fr swag a aa h cras swag pr cras
y mprar. i a, h mag f h swag ga
12 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
23/72
a ssvy alras cras as a fc f y war lss,
whch s agrm wh h srva ha mprar crass
prpr h war fc.Sglar a cm ffcs f hyprcy a hypvlma
cr mlag hrmrgla wh a val s hyp-
hyra. Hyprcy, pr s, wll cras h sphagal mprar
hrshl fr swag36 a cras cr mprar rg xrcs-
ha srss.36,40,41 Smlarly, h prc f a sc hypvlma
wh rc amsra avrsly affcs cas vaslaa42
a swag,43 a crass cr mprar rg xrcs-ha srss.
Affr sgals rspsl fr h hrmrglary ffcs f
hyra cm frm svral aamcal aras. osmrcpr cllslca h prpc/hyphalamc ara ar acva wh raclllar
vlm cls. ths clls affc h frg f hrmssv rs
h hrmrglary crl cr.44,45 Carac mcharcprs r
plmary arrcprs, r h, als mla h hrmrglary
rsps xrcs a ha srss cas applca f lwr y
gav prssr rg ha srss agms ha srag p f
chags l vlm r cy.46,47 ths srvas ar css
wh h rphyslgcal fgs ha smc a l prssrsml mla h frg f hrmssv rs h prpc
a arr hyphalams.44
th csqcs f hyra h carvasclar rsps
xrcs hav als characrz. drg smaxmal xrcs wh
ll hrmal sra, hyra lcs a cras har ra a a
rc srk vlm wh ll r chag carac p
rlav hyra lvls.48 drg mr vgrs xrcs, h cras
har ra s flly cmpsa fr rcs srk vlm,a carac p s rc.49 i warm vrms, h rm-
al ffcs f hyra ar xacra. exprms xamg h
ffc f gra lvls f war lss h carvasclar rsps
xrcs rpr gra crass har ra1,27,28,30 a srk vlm
rcs,28,30,48 wh crasg war fc. Carac p falls a
gra mar wh war fc28,30 cas h cras har ra
s sffc ffs srk vlm rcs.
Effects on Physical Performance
dhyra xcss f 2% rmal y mass has gav f-
fcs mral a wllgss wrk. Cmms frm vsgars
wrkg wh slrs rg Wrl War ii llsra hw vasag
physiological consequencesoF body water imbalance | 13
-
8/8/2019 Hydration PDF
24/72
hyra ca (Fgr 3). Alph al1 rpr ha, hyra
slrs, walkg was mchacal, a a mar f wll pwr a ha
slrs hra q lss gv war. echa a cllags
2
f ha asks cam mch mr ffcl, a acclmaz sjcs
wh ha prfrm a gv ask asly, rgcally, a chrflly
wr rc apahc, lslss, plg m srag fsh h
sam ask. Mr rcly, Srym al50,51 rpr ha hyra
m cam lhargc a mrs, a wr aggrssv a s
war hr sprrs.
dhyra xcss f 2% y mass cmprmss physcal pr-
frmac. exrcs rac m s shrr rg h smaxmal
a maxmal xrcs, a lss wrk s accmplsh pr f mwh hyra y 2% y mass (~1.5 L fr a 70-kg slr)
mpra a warmr vrms. drmal ffcs f hyra
afflc larg5256 a small mscl mass acvs.52,53,55,5759 i cras,
hyra has ll ffc mscl srgh, a las p 5% lss
f y wgh.6 evc als cas ha smwha grar hy-
ra s cssary fr rac prfrmac s affc cl/
cl clmas.60
dhyra als rcs ha lrac. i a 1992 sy,61 scssha sjcs walk vlary xhas wh hr hyra r hy-
ra (8% f al y war). th xprms wr sg s ha h
cm vrm (Ta= 49C, rlav hmy = 20%) a xrcs
sy (47% maxmal xyg) wl allw hrmal qlrm;
hs, ha xhas vally ccrr. dhyra rc lr-
ac m frm 121 ms 55 ms; , mr mpraly, cr
mprars a xhas wr apprxmaly 0.4C lwr wh
sjcs wr hyra. ths fgs sggs ha hyra ly mpars xrcs prfrmac, als rcs lrac ha
sra.
Hyperhydration
bcas mra lvls f hyra ca rmal slr
prfrmac, s mpra csr whhr vrrkg r akg
ssacs achv hyprhyra r grar-ha-rmal y war
wl fcal fr mprar rgla a xrcs prfrmac.
Ss ha rcly xpa l vlm hav sally rpr -
cras carvasclar sra6264 rg xrcs, spara rsls
ha sspa6365 a xrcs-ha prfrmac.6466ohr ss
14 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
25/72
Figure 3. (Top) Man falls out of formation as other troops keep marching. He has been over-
come by heat exhaustion and collapses. (Bottom) Two first-aid men helping the GI who has
been overcome by heat exhaustion. They have loosened his clothes and are giving him a drink
of water. [Original caption]
Photographs: Courtesy of the National Archives, photo nos. SC-391634 (top) and SC-391635
(bottom).
physiological consequencesoF body water imbalance | 15
-
8/8/2019 Hydration PDF
26/72
xamg h ffc f vrrkg prc a ras hyprhy-
ra hav f grally rc har ras rg smaxmal
xrcs, spara rsls rgarg cr mprar (rvw Sawka al6). Ss srvg lwr cr mprars wr f
cf y lwr cr mprars fr xrcs. Wh hs ffc
was crll,67 hyprhyra ha apprcal ffc hrm-
rgla rg xrcs.
Alhgh may ss hav amp c hyprhyra
y vrrkg war r war-lcrly sls, hs apprachs
hav prc ly a ras xpas f y war. Grar fl
r ca achv wh aqs sls cag small qa-
s f glycrl.6871 Alhgh a arly rpr sggs ha glycrlhyprhyra hac ha sspa rg xrcs-ha srss,70
hs fg has cfrm y ssq vsgas.67,72 i
a, hs fg has mprv rac xrcs prfrmac73
r xrcs-ha lrac.74
Water Intoxication or Hyponatremia
drkg mch ca mak slrs sck. A rlavly rar cl-
cally mpra prlm fr mlary prsl s h vlpm f
hyparma csq vrrkg war rg rag. Frm
1989 1998, 10 20 uS Army slrs wr hspalz yarly wh
sympmac hyparma,75 a hyparma was h cas f a
las slrs ah.76 th majry f cass ccrr rg warm
wahr rag a afflc slrs a asc rag vrm.77
Sympmac hyparma ccrs ms f slrs a ahlswh prfrm prlg physcal acvs ha prc (r ar lv
wll prc) rlavly hgh swa ras a ar ssa lgr ha 5
hrs.78,79 th majry f cass hav ccrr rg physcal acvs
lasg lgr ha 8 hrs.
Symptoms and Etiology
Sympms f hyparma grally ccr a srm sm c-
cras
-
8/8/2019 Hydration PDF
27/72
nausea,
transientneurologicaldeficits,
seizures,and coma.
th asc f hyprhrma xcls h agss f hasrk.80
Sympms ar ms svr wh sm s l raply (, vr hrs
rahr ha ays). ths c s a csqc f h cm lss
f sm swa a falr xcr h larg ams f hyp-
c fl ha hav gs. th rsl s a l f y
sm. R f xcss war s frm armal ral fc,
rahr xraral facrs ha spprss ral war xcr81 a/rapprpra AVP lvls.82 Fr xampl, Prmas83 msra ha
physcal xrcs rcs r flw ra v vrly hyra m.
i h xprm, vrrkg fr prfrmg xhasv xrcs
prc r flw ras f 12 mL/m. dsp cg rk 200
mL f war vry 20 ms rg vgrs xrcs, h r flw
ra fll 2 3 mL/m. ths ccrr lkly cas vgrs xr-
cs rcs h glmrlar flra ra.81 i a, vars facrs
hacg lar sm rasrp cass ssmc rasrpf war cras. As a csqc f cras glmrlar flra
ra a cras war rasrp, r vlm wll cras.
Prevention
epss f hyparma hav, ms cass, assca wh
xcssv war ak rlav swa lsss.78,79Slrsspcally
cmmss ffcrs, rag car, a jr ffcrs
ca ha vrrkg s fcal (, s hachrmrgla r xrcs capacy). th ky prv s sr
ha vlrs rk ly ams lss ha r qal hr swa-
g ra. dhyra lss ha 2% y mass s cmprms
prfrmac; hrfr, fll fl rplacm s ssal rg
wrk. bcas sm s h majr cs f swa (2060 meq/L),
prlg swag ca prc ssaal sm fcs. t prv
sm pl, slrs shl hav accss rglar mals. i wrk
vrms ha prc prlg, prss swag, salg f
as s grally sffc prv sal pl. Hwvr, wh
cs prm ag mals, ag small qas f sal
(~0.05% naCl sl) h war spply, clg sal-cag
vrags (g, cmmrcal sprs rks), r sg cmmrcally avalal
sal als ar val ps rplac sal lsss.
physiological consequencesoF body water imbalance | 17
-
8/8/2019 Hydration PDF
28/72
-
8/8/2019 Hydration PDF
29/72
Facrs iflcg dalyWar Rqrms
Svral facrs flc a slrs aly war rqrms. ths sc- smmarzs h ffc f vrm, physcal acvy, y sz,
gr, a la carrag aly war lss. Hwvr, hs facrs
rarly ccr ply, a s hr rac ha rms a
slrs aly war s.
Environment
th vrm cas h avs f ha lss avalal. i cl
a mpra vrms, a ssaal qay f ha ca s-
spa va raa a cvc. drg mra physcal acvy
mpra vrms, apprxmaly 50% f h ha prc
ca sspa va swag mas. i cl vrms, alms
75% f h ha prc ca sspa y swag mas. i
cras, ar mprars 35C a hghr, vrally all ha prc
ms sspa y swa vapra. th grar ma swa-
g h vrms ca ssaally cras a slrs aly fl
rqrms.
-
8/8/2019 Hydration PDF
30/72
Physical Activity
A slrs aly war rqrms cras as a fc f h alcalrs xp pr ay (Fgr 4). ths ccrs cas swa lsss ar
p xrcs sy a ra f ffr. Fr xampl,
mpra cs, mra-sy mlary asks (~425 was; 6.1
kcal/m) wll lc swag ras f apprxmaly 0.3 L/h, whras har
wrk (~600 was, 8.6 kcal/m) wll lc swag ras apprxmaly
0.7 L/h. th ra f physcal acvy als has a sgfca ffc
war . Alhgh mra-sy wrk mpra c-
s mgh lc hgh ras f swag (~0.3 L/h) wh x
vr a 8-hr pr, a slrs aly fl rqrms cras a
aal 2.4 L/.
Body Size and Gender
bcas m ypcally ar havr a swa mr prfsly ha wm
rg physcal acvy, hy wll lkly hav largr aly fl rqr-
ms. ths ccrs cas h calrc cs f amlary acvy -crass as a fc f y mass; hrfr, largr prss xp mr
rgy walkg 1 ml ha smallr prss. ths, m wll xp
mr rgy rg marchg, a hs prc mr ha, ha wm.
i a, ss shw ha m hav fwr swa glas pr ara
cmpar wh wm, hy prc mr swa pr gla.84As sch,
m wll grally rqr largr qas f fl ha wm.
Fr amlary acvs, ras f swag ar arly prpral
h w-hrs pwr f y wgh. thrfr, a 91-kg ma wllswa apprxmaly 30% mr ha hs 59-kg cmpa walkg a
h sam sp.1
Load Carriage
th rgy cs f marchg wh a All-Prps Lghwgh ival
Carryg eqpm (ALiCe) pack a la-arg qpm (Lbe) smch grar ha marchg wh . Slrs warg a 31-kg ALiCe
pack a Lbe xp 29% mr rgy march 3.5 mph. Slrs car-
ryg a 49-kg ALiCe packLbe sml xp 63% mr rgy
20 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
31/72
march a h sam sps wh h packs.85 i mpra vrms,
h a rgy cs f carryg h 31- r 49-kg ackpack sml
wl cras h xpc swag ra frm apprxmaly 0.3 L/h
wh h pack 0.6 a 1.1 L/h fr h w packs, rspcvly. A
aal facr affcg swag rqrms s h lss f ffcv
srfac ara fr vapra f swa, cas h pack lcks swa-
g vapra frm h ack. Ms lkly, hs wl frhr cras
swag y h swag ra calcla frm h a rgy
cs al. Alph al1 rpr ha swag ra cras 7 g/h/kg
f ackpack wgh fr packs wghg 10 20 kg.
Figure 4.Estimates of daily water requirements for range of environmental conditions and
energy expenditures.
WBGT: wet-bulb globe temperature
Data source: Sawka MN, Wenger CB, Montain SJ, et al. Ha Srss Crl a Ha Casal-y Maagm. Washington, DC: Headquarters, US Department of the Army and Air Force;
2003: 13. TB MED 507/AFPAM 48-152.
Daily
WaterRequirements,qt/d
Daily Means WBGT, F
Daily Means WBGT, C
50 60 70 80 90 100 110
105 15 20 25 30 35 40
5,500 kcal/day
4,500 kcal/day
3,500 kcal/day
2,500 kcal/day
18
16
14
12
10
8
6
4
2
0
Factors inFluencing daily water requirements | 21
-
8/8/2019 Hydration PDF
32/72
-
8/8/2019 Hydration PDF
33/72
impac f H evrms Fl Rqrms
i mpra vrms, h aly fl rqrms f slrs yp-cally rag frm 2 5 L/, pg h sy a ra f
physcal acvs. Hwvr, as ar mprar rss, aly fl rqr-
ms ca cras ssaally. i xrmly h cs, war
rqrms fr slrs prfrmg prmarly sary acvs ca
cras frm apprxmaly 2 3 L/ 5 L/. War rqrms
fr slrs prfrmg havy wrk r lg hrs f mra wrk
(4,2005,300 kcal/) ca cras frm 4 6 L/ mpra vr-
ms a frm 8 10 L/ xrmly h vrms.Rlav hmy ca cras war rqrms p f
am mprar. Alhgh rlav hmy has ll mpac
swag a war rqrms mpra vrms, hgh hm-
y cs cras war rqrms as mch as 2-fl warmr
vrms.2 Wh h hmy s hgh, h ramac cras swa-
g rqrms rscrs h rms war spply rqrms
ps wh rps ar ply rpcal a sr clmas.
ivals xps h vrms grally rk sffc
fls rg physcal acvy ffs war ls frm swag.2,86 Ha
acclmaza shrs h m lay w wh swag gs
a wh rkg s a.86 i a, ha-acclmaz vals
rk mr frqly a mr clsly mach fl ak wh swag
-
8/8/2019 Hydration PDF
34/72
ra; hs rsls lss vlary hyra.2,86 drg lgh xrcs,
ha-acclmaz slrs ca a f wll rk sffc qas
ssa hyra.
1
Hwvr, rg mra--havy sy xrcs,rkg a lm grally rplacs 50% 70% f swa lsss,1,2,8789
a fcs arss rg rs raks.
Clhg ca hav a sgfca ffc aly war rqrms.
typcally, clhg as sla a hrs vapr prmaly, hs
crasg h swag ra (cmpar wh warg shrs a a t-shr).
th a f ackpacks a y armr crass h rgy cs
f lcm a rcs h srfac ara avalal fr ha rasfr,
hry frhr crasg pc swag. Hwvr, hr ar
cs whch clhg ca acally a rcg war rqr-ms. Fr xampl, h, ar vrms, flly clh slrs
warg lgh, rahal clhg acally swa lss ha mmally
clh m.1 drg sr walks h fll s, lgh, rahal farc
ha rflcs slar raa ca rc swag as mch as 20%.1,90
Effect of Hot Environments on Thirst and Voluntary Dehydration
thrmal srsss assca wh h vrms ar a psv sm-
ls fr hrs a vlary ak.91 i s cmm, hwvr, fr
prss wrkg h sr accr war fcs. As scss
prvsly, h jcv f rkg s prv war fcs frm
xcg apprxmaly 2% f rmal y mass (g, ~1.5 L fr a 70-
kg slr). ths lvl f war fc s assca wh h s f r-
c prfrmac. Ay malac w swag ra a vlary
ak wll lkly mr prval a f grar mag prssacclmaz wrkg h ha. Grlaf al92 rval ha
vlrs mach war ak swag ra rg rpa s
f xrcs-ha xpsr. thy hs y rkg arlr, a h vl-
rs rak mr frqly rg h 2-hr xrcs-ha xpsr
pr. th avrag vlm csm pr rk chag.
Effect of Hot Environments on Water Delivery
i rpcal rgs, war srcs ar f aa (g, rvrs, srams,
laks, ps, wlls, a lcal war sysms). Hwvr, cas f s
vga, pr gr raspra (va rck) ca mpar war
24 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
35/72
sr a cras rlac aral rspply. i sr rgs,
war srcs ar lm a wly sprs. Alhgh war s
ar gras hs h vrms, srfac frsh war s alms -xs, a avalal ssrfac war ca vary frm rg rg.
Lack f avalal war sr vrms crass war srag
a sr rqrms.
Hot Weather Water Requirements
i h, clmac xrms, aly war rqrms fr slrs ca rag
frm 5 12 L/. th Water Consumption Planning Factors sy rpr
(als kw as h Potable Water Planning Guide), plsh y h
uS Army Cm Arms Sppr Cmma,93 rcmms ha ach
slr prv wh 11.4 L f war pr ay (, ak fr ach
slr shl be no more than 11.4 L f war pr ay93a). thrfr,
a salsh alfl sa whch war spply s achv,
sffc war shl avalal ssa h war alac f ach
val slr.
impactoF hot environmentson Fluid requirements | 25
-
8/8/2019 Hydration PDF
36/72
-
8/8/2019 Hydration PDF
37/72
effc f Cl Wahropras WarRqrms
A mr f facrs ca cras fl rqrms rg cl wahr
pras. o facr s h vlpm f cl-c rss. ths
phm, frs scr mr ha 200 yars ag,94 ccrs wh
ppl cm chll rg hr cl war r cl ar xpsr. i
s a smc rss a ca cras r war lsss 2-fl av
asal cs.95,96 Alhgh h prcs mchasm s kw,
grally ccrs as a csqc f cras cral vasclar prs-sr cas y prphral vascsrc. Fraly, rss sms
slf-lmg, cas h ra f r prc cls wh h
vlpm f hyra.
A sc facr s cras rsprary war lss frm rahg
cl, ry ar. th mag f war lss s p h h
vlary vlm a war vapr am ar.97,98 bcas cl
vrms cras h war vapr prssr gra w h
lgs a h amsphr, mr war s ls hrgh rspra cl
vrms ha warm vrms. th ffc f cl mprars
rsprary war lss, hwvr, s graly cras aly fl
rqrms. Slrs prfrmg 12 hrs f asy--mra xrcs,
fllw y 4 hrs f har xrcs vry cl wahr, wl accr
-
8/8/2019 Hydration PDF
38/72
ly a 0.3 L grar aly fl rqrm ha f hy prfrm h
sam acvs a mr mpra vrm.
A hr facr s ha warg lky, cl wahr clhg clcr war lss. Mlary physcal rag acvs ca gra
ssaal malc ha ha ms sspa prv xcssv
lvas y mprar. if clhg sla s hck fr h
acvy lvl, h ssaal swag ca ccr. Fr xampl, rg rs
a lgh wrk, prss warg prcv clhg frm h uS Army
ex Cl Wahr Clhg Sysm ar hrmally cmfral a
ar al sspa mch f hr y ha hrgh swag mas
(exh 1). Hwvr, rg mr vgrs acvs, swag ras ca
achv lvls xcss f 1 L/h. t mmz hs cssary swa lsss,slrs shl ra s layrg a p vla ps hr
clhg lvl mmz swa prc rg cl wahr rag.
A frh facr ha ca affc war rqrms s h a
malc cs f mvm cl rra. th a f lky clh-
g rcs mchacal ffccy a ca cras h rgy cs f a
spcfc acvy a aal 10% 20%.99,100th malc cs f
mvm sf sw ca 2.5 4.1 ms grar ha prfrmg
h sam acvy a lackp srfac.
28 | water requirementsand soldier hydration
exhibit 1. Generation III Extended Cold Weather Clothing System
The Generation III Extended Cold Weather Clothing System consists of protectiveclothing developed by the US Army Natick Research, Development, and EngineeringCenter (Natick, Mass) to be functional in cold weather climates. This adjustable,
layered insulation system is comprised of the following 12 components:
1. Lightweight undershirt2. Lightweight underwear3. Midweight shirt4. Midweight underwear5. Fleece cold weather jacket6. Wind cold weather jacket7. Soft shell jacket8. Soft shell trousers
9. Extreme cold/wet weather jacket10. Extreme cold/wet weather trousers11. Extreme cold weather parka12. Extreme cold weather trousers
-
8/8/2019 Hydration PDF
39/72
Effect of Cold Weather on Thirst and Voluntary Dehydration
ivsgas syg h ffc f ar mprars hrs a rk-g havr cssly rpr prss vlary rkg rg
cl wahr acvs.96,101,102 exprms ras msra ha hs
spcs wll vlarly hyra rg cl xpsr, wll mafs
srkg hrs wh rr a warm rm.101 Smlar srvas
hav ma hmas.102 o sragy ha has mprv vlary
ak s h prvs f warm rks rahr ha cl rks rg
cl xpsr.103
A aal cl wahr prlm ccrs wh vals pr-
psflly rfra frm rkg av havg ra h cl. ths
havr ypcally ccrs la h ay wh slrs ry lav
a warm r slpg ag ra. if h mss scar rqrs
slrs rhyra la h ay, hr havral cs rfra
frm rkg aqa qas f fl ca la prss hyra-
rg h x ays acvs. o sl s sr ha slrs
rk rglarly rg cl wahr acvs av vlpm f
larg war fcs. Sack raks ca als smla aal fl
ak. ths parclar sragy wll hlp slrs av rhyrawh larg qas f war fr m a rc h lklh
f hr havg g p a ra rg s slp prs.
Effect of Cold Weather on Water Delivery
th ms mpra facr rgarg fl ak h cl s h lgs-
cal csra f pal war lvry. i arcc rgs, mlg swa c wll prv ly gh war fr mrgcy s y v-
als a small s. bcas f h xsv fl rqrms ml
sw a c, hs s a mpraccal war src fr largr mlary s.
Hwvr, h prmary war src s frz war rlyg frz
rvrs, laks, a wlls csrc y cvlas a mlary prsl.
th lm avalaly f war srcs graly crass sr
rqrms, a srag a sr lms ms agm
wh spcalz qpm prv r rar frzg f packag
war. if small s ms rly mlg sw a c fr hr war
spply, h prvs f aqa fl s ssal. i a, h war
ms aqaly ra sr ha s pal.
eFFectoF cold weather operationson water requirements | 29
-
8/8/2019 Hydration PDF
40/72
Daily Water Requirements
Ss xamg h vlary ak f war y slrs rgfl mavrs rpr aly fl aks ragg frm 2 4 L/.104106
Hwvr, wh rgy xprs ar hgh, hma war s ca
rag frm 4 6 L/. Accrgly, h Water Consumption Planning
Factors sy rpr rcmms h aly prvs f 7.6 L f rk-
g war pr slr fr accal har a fl rag xrcss
arcc vrms.93
30 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
41/72
effc f Hgh-Alopras WarRqrms
Mlary pras mas aras ca affc shr- a lg-rm
war alac. Fr xampl, ac xpsr mraly hgh als
ca f prc a slf-lm rc f y war rslg frm
rc fl ak a cras r vlm. ohr facrs ca als
affc vlary war ak a aly war rqrms, clg
h fllwg: (a) sympms f arxa a hyppsa; (b) cras
rsprary war lss frm rahg cl, ry ar; a (c) casvaprav lsss wh physcal acvy.
Effect of High-Altitude Operations on Water Balance
uacclma slrs xps mra, hgh-al hypxa
(3,5005,000 m) ypcally cm smwha hyra (lsg ap-
prxmaly 12 L f war frm h y, whch qals 3% 5%
f al y war) rg h frs 1 3 ays f xpsr.107,108thswar fc rsls cras xraclllar vlm, cras plasma
vlms, a sm lss f raclllar war. i ccrs as a csqc
f arral chmrcpr acva, whch prcs a slf-lm
-
8/8/2019 Hydration PDF
42/72
arrss a rss, as wll as spprss hrs a rc vl-
ary war ak.107 Ampg vrrk prv h war fc
s rcmm. drss a arrss ar csr fcalaapas cas (a) cras plasma hmgl ccra
crass arral xyg c a mprvs ss xyg lvry;
a (b) ppl wh vlp arrc a rc rspss hav lss
svr sympms a lss cc f ac ma sckss.107
th rlav hyra sa prc y mra--hgh al
xpsr ca prss fr svral wks. Ss xamg war alac
hmas xps lvas f 3,500 5,334 m rpr prss
rcs al y war fr p 14 ays.108,109 ovr m, hw-
vr, l vlm crass as h vlm f r l clls crass aal, wh plasma vlm rmag rc r rrg sa-lvl
vals.107 osrva f cras plasma vlm vr m sggss
sm rsra f al y war wh chrc hypxc xpsr.
Effect of Hypoxia on Thirst and Voluntary Water Intake
i s cmm fr vlary war ak cras apprxmaly1 L/ rg h frs 1 2 ays f mra, hgh-al xpsr.108
Spprss vlary war ak s prss cas, grally,
aly war ak rrs prplym lvls wh h frs wk
f al xpsr.
Other Factors Associated With High-Altitude Operations
That Affect Water Requirements
thr s a gral lf ha cras rsprary vaprav war lsss
accmpayg mas pras sgfcaly affc aly war
rqrms.110 ths may r a hgh-al xrms; fr xampl,
Pgh111 rpr ha clmrs a 5,500 m ha rsprary vaprav
war lsss f 2.9 g f war pr 100 L (y mprar a prssr,
sara wh war) f vla. Hwvr, a mr ms lva-
s, h cm ffcs f clr ar mprars, lwr hmy,
a h hghr vla ras rlav rgy xpr a
apprcavly aly war rqrms. ovr a ra rag f rgy
xprs (3,5007,000 kcal/), h sma rsprary war
32 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
43/72
lsss a 2,200 3,100 m ar vry smlar h sma rsprary
war lsss a sa lvl.110 dplym 4,300-m al wll cras
aly war rqrms apprxmaly 200 300 mL/ cmpsafr a rsprary war lss.
Cas swa lsss slrs wrkg a lw, mra, r hgh
als p clhg sla, am wahr cs, a
asl xrcs sy a ra. As cl wahr pras,
clhg sla a hgh als ms mach ha prc
kp slrs warm whl prvg xcssv ha srag a swa
lsss. Hwvr, vgrs physcal acvy ca prc rlavly hgh
ras f swag a cras aly war rqrms.
Effect of High-Altitude Operations on Water Delivery
War spply mas rgs ca cm frm laks, srams, a
lcal war sppls. bcas ma pras ar f assca
wh cl wahr, h sam rsras ca xs as hs scr fr
cl wahr pras. A a facr s ha hgh al crass
h m rqr prfy war y lg . thrfr, f mlarys rly ml sw acqr war, hs ca hav a sgfca
ffc h m rqr a pal war, as wll as h fl
rqrms f small s.
Water Requirements
Mlary grps prag hgh-al vrms hav grallyssa hyra y rkg 4 5 L/ lss wh gag havy
wrk ha wh prfrmg prmarly sary acvs.104,112 th
Water Consumption Planning Factors sy rpr rcmms h
prvs f 5.6 7.6 L/ f rkg war pr slr.93 thrfr, f
spply ls ar maa as pla, h war spply shl sf-
fc ssa hyra rg mlary mavrs.
eFFectoF high-altitude operationson water requirements | 33
-
8/8/2019 Hydration PDF
44/72
-
8/8/2019 Hydration PDF
45/72
effc f War immrs War Rqrms
War mmrs crass cral vs prssr a prcs aras rss a arrss. th mag s p war
ph, mprar f h war, a h al sa f hyra.113
th qay f war ls, hwvr, s sffc graly cras
aly war rqrms. Hwvr, cas mmrs ls h hrs
rsps,1618 may als affc vlary fl ak a h aly
ssa hyra rg prlg pras war vrms.
Whhr prlg paral mmrs wl sffcly affc rkg
havr a h aly ssa hyra hav s.
-
8/8/2019 Hydration PDF
46/72
-
8/8/2019 Hydration PDF
47/72
barrrs Rhyra
Water Availability
Lack f pal war s praly h gras arrr ssaghyra. if war s avalal, rhyra ca ak plac a
slrs wll sffr. Js havg pal war, hwvr, s sffc.
War ms ma avalal h rps. Slrs a wrk ar mr
lkly rfra frm rkg war f hy hav ravl sm s-
ac a . ths s spcally r sr a arcc cs,
cas h wahr xrms msh h sr aal
wrk.
th cllapsl lar wh rk- hyra sysms prvsa praccal xampl f hw avalaly crass vlary fl r-
placm. Wh hs sysms, h slr ca rk h g a ar
has-fr mar (Fgr 5). Wh carryg a raal 0.9-L rg
plasc ca, h slr ca asly accss h ca h g
parclarly wh carryg a apprach laa hs crass h
ak rs raks rk. Alhgh hsrcally h cllapsl-lar
hyra sysms sffr frm pr raly a wr ffcl
kp cla, avacs h mafacrg prcss hav lss hs
fccs.
-
8/8/2019 Hydration PDF
48/72
Figure 5.Hands-free drinking. Competitor Spc. Heyz Seeker gets a drink from a hydration
device during the Urban Warfare Orienteering Course event of the Department of the Army
Best Warrior competition at Fort Lee, Va.
Photograph: Courtesy of T. Anthony Bell, Fort Lee Public Affairs Office.
38 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
49/72
Palatability of Water
if war has a plasa as r r, vlary ak wll rc. effrs shl ma mak war as palaal as ps-
sl. Facrs ha affc palaaly cl r, as, mprar,
clr, a ry f h fl. th rs a ass f war
ar ms cmmly cas y alga, cmps rgac mar, a
sslv gass. Chlra a a h a as war
a ca cras palaaly. War clr s rv frm clr
ssacs (g, vgav mar ha s sslv frm rs, lavs,
a hms) r frm rgac cmps (g, r a magas
sals). try s cas y ssp clay, sl, rgac a rgac
mar, a plak a hr mcrrgasms. Warm war ass
fla a agms ay rs a flavrs . War ram a
sfc rmv mch f h parcla mar a rc war
clr. Clg war frhr spprsss rs a ass, a maks
war mr palaal.
drg h Prsa Glf War (19901991), h uS mlary rc
l war cma palaal war. Alhgh l war s
xpsv y a lvr h rps, parclarly warm wahrcs, avs h as sss assca wh mass-prc war
cag rsal chlr. Flavr avs ca mask h palaal
as f chlr, hy shl a h war js prr
csmp cas hs avs ca cmplly sry h ffc-
vss f h chlr.
Gastric Emptying
A pal arrr ssag hyra s gasrc mpyg a s-
al asrp. evc a, sggss ha, r ms cs
fac y h fghg slr, hr gasrc mpyg r sal
asrp shl hr h aly ssa hyra rg ply-
m. th smach a small s fc xrmly wll r
cs f xrcs a vrmal srss.114 Frhrmr, hr
gasrc mpyg r sal asrp ar lay r mpar
y xrcs ss ragg p 70% maxmm xyg pak,
v rg prlg, ssa physcal acvy.114,115 i shl
rcgz, hwvr, ha hr s a gra al f val varaly
barriersto rehydration | 39
-
8/8/2019 Hydration PDF
50/72
ras f gasrc mpyg a sal asrp. thrfr, sm
slrs may lss lra f rkg larg vlms f fl, a hr
ar hr slrs wh ar s lra ha hy ca acally rk fasgh mak hmslvs sck (s sc War ixca r
Hyparma). Schl rs raks a aqa malms shl
cl prv m rhyra.
Lost Solutes
Cmpl rsra f a fl vlm fc ca achv wh-
lcrly rplacm (prmarly sm) f r vrags.89
elcrlys, prmarly sm chlr a, a lssr x, pas-
sm, ar ls hrgh swa rg physcal acvy. th ccra
f sm swa avrags apprxmaly 30 50 meq/L, ca
vary, pg a vals sa f ha acclmaza, ,
a hyra.89 Frhrmr, h am a cmps ca als
vary, cg xrcs sy a vrmal cs.
Passm ccra swa s apprxmaly 4 5 meq/L. i
mpra cs, sm chlr ccra swa ca ragfrm 2 13 g/, avragg apprxmaly 6 g/ fr h acv slr.
Passm lsss wll rag frm 0.1 0.9 g/, avragg apprxmaly
0.5 g/ fr h acv slr. i h vrms, sm chlr a
passm lsss ca xc 17 a 1.9 g/, rspcvly. Csrg
ha hr Mals, Ray--ea ca 12.6 g f sm chlr a
2.7 g f passm, a ha ypcally ly w Mals, Ray--ea ar
prv rg fl pras, hr ar may sas whch
spplmal sal may rqr ffs h sm chlr ls swa. typcally, hs fc ca maag y salg f as.
Fgr 6 prvs smas f xpc aly sm lsss csq
wrkg ffr vrms.
40 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
51/72
Figure 6.Estimates of daily sodium requirements for varied weather conditions and energy
expenditures.
WBGT: wet-bulb globe temperature
Data source: Sawka MN, Wenger CB, Montain SJ, et al. Ha Srss Crl a Ha Casal-
y Maagm. Washington, DC: Headquarters, US Department of the Army and Air Force;
2003: 13. TB MED 507/AFPAM 48-152.
DailySodiumR
equirements,grams/day
Daily Means WBGT, F
Daily Means WBGT, C
50 60 70 80 90 100 110
105 15 20 25 30 35 40
5,500 kcal/day
4,500 kcal/day
3,500 kcal/day
2,500 kcal/day
12
10
8
6
4
2
0
barriersto rehydration | 41
-
8/8/2019 Hydration PDF
52/72
-
8/8/2019 Hydration PDF
53/72
Srags Ssa Hyra Harsh evrms
Do Not Skip Meals
Ss slrs wrkg h sr1 clarly msra ha h
majry f aly fl ak ccrs a malm. As llsra Fgr
7, slrs wrkg h ha vlarly hyra hmslvs rg
wrk prs, ma p h war fc rg malm. ths sam
par f rkg has sc cfrm y hrs.10,11 ths sr-
va s mpra cas mals ar a valal m fr rhyra
a maac f fl alac (Fgrs 7 a 8). thy als prva src f sls ffs h lcrlys ls rg prspra. As
scss prvsly, f mssg sls ar rplac, cmpl rhy-
ra ca achv.
Make Time to Drink
Slrs wll f rrk vlarly rlav h prspra hyprc rg wrk. Rs raks prv a ppry fr hr fl
ak cach p wh hr fc. ths s spcally rlva wh wrk
a wahr cs prc ssa, prfs swag. t achv
-
8/8/2019 Hydration PDF
54/72
hgh ras f rhyra, s avaags maa a hgh gasrc
vlm, cas h sp whch a ls f fl lavs h smach
falls xpally as h smach vlm crass. A rlavly fll
smach a hgh ras f gasrc mpyg ca achv y frqlyrkg small ams f fl rg wrk.114
Maximize Palatability
Hw a rk ass s a majr rma f h am f rk c-
sm. if h prv war ass sagral, slrs wll rk lss
a wll r grar hyra.1 May facrs play a rl pala-aly, clg clral ackgr, prvs xprc wh h rk,
a m f ay. ev pr val, palaaly s csa. th
cras plasass ca spcfc a parclar rk. thrfr,
Figure 7.Changes in body weight of one researcher during a day in the desert. The loss was
more rapid in warmer hours and fastest during an afternoon walk, reflecting change in evapo-
rative water loss with conditions of activity and exposure. Most of the fluid was taken withmeals.
Data source: E. F. Adolph and associates. Physlgy f Ma h dsr. New York, NY:
Interscience; 1947: 3940. Chap 3.
44 | water requirementsand soldier hydration
Urine
Urine
Walk
Food
Food
Thirst
Acute
Thirst
Drink
Drink
Drink
Drink
65
64
63
626 8 10 12 14 16 18 20 22
BodyWeight,Kg
Hour of Day
-
8/8/2019 Hydration PDF
55/72
Figure 8. US Army Air Force in Tunisia consuming their rations from defensive positions
(March 7, 1943). The largest daily fluid intake is generally associated with consumption of
meals.
Photograph: Courtesy of the National Archives, photo no. 208-AA-2U-7.
f h gal s cras vlary fl ak, h swchg a ffr-
rk ca hlp smla fl ak (Fgr 9). Rlls a Rlls116
f ha prss ffr a chc f hr ffr flavrs rak 22%
mr ha wh flavr rks wr prv, a hy csmmr f h flavr vrag ha h flavr vrag.
Ag swrs rks las cras fl ak.117 A-
g mch sgar ca cras accpaly rg physcal acvy.
strategiesto sustain hydrationin harsh environments | 45
-
8/8/2019 Hydration PDF
56/72
tra rac ahls rpr mr sympms f asa afllss wh rks ca 12% glcs cmpar wh rks
cag 6% glcs r war.118
Cara vrags ca plasral wh mals r wh s-
ary, hy mak a pr fl rplacm vrag rg acvy.
Shar a cllags119 f ha slrs rak lss f h cara
vrags ha hr war r flavr vrags. Slrs wh rak
h cara vrags cmpla ha cara ma ffcl
rk larg qas f fl.tmprar f h prfrr rk ps a mr f facrs,
clg clr a larg,120 clmac cs, a h physlg-
cal sa f h val.121 i h a mpra vrms, cl
Figure 9.Nutrient on-the-move delivery system attached to standard Army hydration devices.This new system, developed by researchers at the US Army Research Institute of Environ-
mental Medicine (USARIEM), provides the opportunity for soldiers to flavor their water,
combined with various drink mixes, and add nutrients (eg, carbohydrate mixes).
Photograph: Courtesy of the US Patent and Trademark Office (US Patent No. 7,533,786 B2),
Alexandria, Va.
46 | water requirementsand soldier hydration
-
8/8/2019 Hydration PDF
57/72
rks cras vlary ak.89,122 drk mprars f 15C
20C sm pmal wh prss rk larg vlms f fl.89
i cl vrms, vlary ak s hac wh rks arwarm.103 i h vrmal xrms, h hyra-c
rv rk wll vrcm ay al rssac rk warm r
vry cl war.123
Minimize Body Water Losses
thr ar svral havral acs ha slrs ca ak rc
swa lsss a maxmz fl r. Fr xampl, h, ar -
vrms, swag ras ca rc y wrkg a gh. drg
aylgh hrs, swag ras ca rc y cvrg h sk wh
lgh, vapr-prmal clhg. i cl vrms, machg clh-
g sla a/r clhg vla h ra f ha prc
rcs h fr swag sspa ha. drkg small qas
f fl frqly rsls lss r prc ha rkg larg
qas f fl lss frqly. Smlarly, ag small qas f
sal fl-rplacm vrags mprvs fl r cmparwh rkg war ly, parclarly wh may hrs f lar spa-
ra mals. thr s vc ha ha acclma prms war
csrva; fac, acclma las arlr s a mr prfs
swag. As sch, havral srags ar h s sl fr m-
mzg war rvr.
Provide Education
trp ca h mprac f hyra s ssal ply
slrs. Mlary plars a lgscs prsl ms sr ha
aqa qas f pal war ar avalal. Small lars
shl maxmz lvry a avalaly f pal war h slrs.
thrfr, hs slrs ms rsa h mprac f rkg,
makg m rk, a rkg h rgh am.
As prvsly scss, hyra xcss f 2% y wgh ca
hav rmal ffcs rp prfrmac. ths, s mpra ha
slrs mak m rk rg physcal acvy a rk sffc
qas mmz h lklh f hyra. i s ssal
strategiesto sustain hydrationin harsh environments | 47
-
8/8/2019 Hydration PDF
58/72
table 3. Fluid Replacement and Work/Rest Guidelines for Warm Weather Training Conditions*
Easy Work Moderate Work Hard Work
Heat WBGT, Work/Rest, Water,** Work/Rest Water Work/Rest WaterCategory Index (F) (min) Intake (qt/h) (min) Intake (qt/h) (min) Intake (qt/h)
1 7881.9 NL NL 40/20
2 8284.9 NL 50/10 30/30 1
(green)
3 8587.9 NL 40/20 30/30 1(yellow)
4 8889.9 NL 30/30 20/40 1(red)
5 >90 50/20 1 20/40 1 10/50 1(black)
Easy Work Moderate Work Hard Work
Weaponmaintenance Walkinginloosesand Walkingonhard Walkingonhardsurface at2.5mph,noload surfaceat3.5mph, at2.5mph,
-
8/8/2019 Hydration PDF
59/72
strategiesto sustain hydrationin harsh environments | 49
ha slrs flly ffs swa lsss rg physcal acvy. thy ca
mak p fr ay war fc rg rs raks a a malm. th
s mh prv xcssv hyra rg physcal acvy s g rkg arly a c rkg small ams f war
vry 15 20 ms f xrcs.
tal 3prvs crr Army h wahr gac fr fl r-
placm rps rag vrms whr wrk:rs ras ar
praccal fr prvg ha jry.124 th ams ach cll rflc h
xpc hrly fl ak flly rplac all swa ls rg acv-
y. As sch, h mrs ach cll ar h avrag prc swag
ras fr ach acvy lvl a vrmal c. bcas hr
s csral varaly w vals, h mrs ach cllms csr as apprxmas. As tal 3 fs,
acal swag ras (a 100% fl rplacm) may vary w
vals y qar pr hr. Smlarly, h wrk:rs ras ar a
g apprxmaly hw mch m shl ca ach hr
wrk vrss rs (assmg wrk wll ssa fr svral hrs)
prv y cr mprars frm rachg lvls assca wh
prmar fag a ha xhas. tal 3 als spcfs a ppr
lm fr hrly (1.5 qars) a aly (12 qars) war ak pr-v a safgar agas vrrkg a vlpg war xca
(hyparma) rg rag.
-
8/8/2019 Hydration PDF
60/72
-
8/8/2019 Hydration PDF
61/72
Smmary
i has lg kw ha vals ca srvv mch lgr wh
f ha hy ca wh war. oly rc cas has scc
al qafy h facrs ha flc h ys aly maa pmal war lvls a h physlgcal csqcs f
war malac. ths chapr has prs frma asss h
cargvrwhhr physca, mc, lar, r fllw slr
rsag h flc f vrm, physcal acvy, y sz
a gr, a la carrag maag war alac. i h -
s-sa pas, a lack f rsag f hs cmplx sysms l
h ahs f hsas f mlary prsl vars campags.
ul scc (hrgh h vlpm f mrcs) ca accralya saly vala h war alac f vry slr, rmas h
rspsly f ach valas wll as sppr prsl
vgla rcgzg h pal fr a h vlpm f war m-
alac sas a ffcvly s rhalav masrs.
-
8/8/2019 Hydration PDF
62/72
-
8/8/2019 Hydration PDF
63/72
R E F E R ENC E S
1. Alph eF a asscas. Physiology of Man in the Desert [by] E.F. Adolph
and Associates. 1s . nw Yrk, nY: irscc Plshrs; 1947.
2. echa LW, ba Wb, Ash WF, nls n. Prfrmac rla vr-
mal mprar. Bull Johns Hopkins Hosp. 1945;76:2558.3. F a nr bar f h is f Mc f h naal Aca-
ms. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and
Sulfate. Washg, dC: th naal Acams Prss; 2005.
4. Va La Md, bla RA. Ag, gr, a fl alac. i: bskrk eR,
Phl SM, s. Body Fluid Balance: Exercise and Sport. bca Ra, Fla: CRC
Prss; 1996: 215230.
5. Chvr Sn, Carr R 3r, Ma SJ, Sawka Mn. daly y mass var-
aly a saly acv m rgg xrcs-ha srss. Int J Sport
Nutr Exerc Metab. 2004;14:532540.6. Sawka Mn, Ma SJ, Lazka WA. by fl alac rg xrcs-ha
xpsr. i: bskrk eR, Phl SM, s. Body Fluid Balance: Exercise and
Sport. bca Ra, Fla: CRC Prss; 1996: 143161.
7. brk LM, Hawly JA. Fl alac am sprs: gls fr pmal
praccs. Sports Med. 1997;24:3854.
8. Magha RJ, Mrs SJ, bra nP, Shrrffs SM. Fl a lcrly ak
a lss l sccr playrs rg rag. Int J Sport Nutr Exerc Metab.
2004;14:333346.
9. Mha MR, brk LM. effc f flavr a awarss f kljl cf rks prfrc a fl alac am sprs. Int J Sport Nutr Exerc
Metab. 2002;12:8192.
-
8/8/2019 Hydration PDF
64/72
10. Phllps PA, Rlls bJ, Lgham JGG, Mr JJ. by fl chags, hrs a
rkg ma rg fr accss war.Physiol Behav. 1984;33:357363.
11. dCasr JM. A mcrrglary aalyss f spas fl ak y
hmas: vc ha h am f lq gs a s mg s maly
gvr y fg. Physiol Behav. 1988;43:705714.
12. Haml Mt, War dS, Was Pd. effc f plasma smlaly say-sa
fl shfs prfs ca sklal mscl. Am J Physiol. 1993;265:R1318
R1323.
13. ns H, Mrm t, ogra K. dsr f war lsss amg fl
cmparms f sss r hrmal hyra h ra.Jpn J Physiol.
1983;33:10191029.
14. Kca R, nls b, bs A, Rasmss ib, Sklsa J, Wlk b. Rla-
shp w plasma vlm rc a plasma lcrly chags afr
prlg cycl xrcs, passv hag a rc hyra. Acta
Physiol Pol. 1983;34:569579.
15. Say LC Jr. Rlashp f vaprav ras srm [na+], [K+], a sm-
lary ac ha srss.J Appl Physiol. 1968;25:149152.
16. Grlaf Je, Mrm t. Mchasms crllg fl gs: hrs a
rkg. i: bskrk eR, Phl SM, s. Body Fluid Balance: Exercise and Sport.
bca Ra, Fla: CRC Prss; 1996: 317.
17. Sagawa S, Mk K, tajma F, al. effc f hyra hrs a rkg
rg mmrs m.J Appl Physiol. 1992;72:128134.
18. Waa F, Sagawa S, Mk K, al. Mchasm f hrs aa rg ha-
war mmrs m. Am J Physiol. 1995;268:R583R589.
19. Fzsms Jt. effc f phrcmy h avy f cra sml f
rkg h ra.J Comp Physiol Psychol. 1969;68:308314.
20. Phllps Mi, Hffma We, balr SL. dhyra a fl alac: cral
ffcs f ags. Fed Proc. 1982;41:25202527.
21. blar-Ws JR, d dA, McKly MJ, Wsgr RS. Cral fs f
h At1 rcpr aags lsara hs hrs sm app
cal. Am J Physiol. 1997;272:R1940R1945.
22. Phllps Mi, Hgr F, tffl S. th rl f ra ags hrs a
AVP rlas c y hmrrhag. Regul Pept. 1996;66:311.
23. Maha M, evr Md, McKly MJ. iracrrvrclar lsara hs
pspraal rkg shp. Am J Physiol. 1997;272:R1055R1059.
24. Jhs AK, Cgham Jt, thhrs RL. igrav rl f h lama
rmals h rgla f carvasclar a y fl hmsass. Clin
Exp Pharmacol Physiol. 1996;23:183191.
25. Rlls bJ, W RJ, Rlls et, L H, L W, Lgham JG. thrs fllwg
war prva hmas. Am J Physiol. 1980;239:R476R482.
26. egll db, Mallr o, Sawka Mn, Fracsc Rn, drl L, Yg AJ. thrs
a fl ak fllwg gra hyphyra lvls hmas. Physiol
Behav. 1987;40:229236.
54 | reFerences
-
8/8/2019 Hydration PDF
65/72
27. Sawka Mn, Yg AJ, Fracsc RP, Mza SR, Palf Kb. thrmrgla-
ry a l rspss rg xrcs a gra hyphyra lvls.J Appl
Physiol. 1985;59:13941401.
28. Ma SJ, Cyl eF. iflc f gra hyra hyprhrma a
carvasclar rf rg xrcs.J Appl Physiol. 1992;73:13401350.
29. Srym nb, Hlswrh Ld. th ffcs f ffr lvls f war fc
physlgcal rspss rg ha srss. Int Z Angew Physiol Einschl
Arbeitsphysiol. 1968;26:95102.
30. Ma SJ, Sawka Mn, Lazka WA, Valr CR. thrmal a carvasclar
sra frm hyphyra: iflc f xrcs sy. Int J Sports Med.
1998;19:8791.
31. Ma SJ, Cyl eF. iflc f h mg f fl gs mprar
rgla rg xrcs.J Appl Physiol. 1993;75:688695.
32. obr C, Yg AJ, Sawka Mn. Hyphyra a hrmrgla
cl ar.J Appl Physiol. 1998;84:185189.
33. Rrs de, brrch JJ. th rl f hyra prphral rsps cl.
Mil Med. 1988;153:605608.
34. Rrs de, Pa JF, Pyck JW, al. Effects of Restricted Water Intake
on Performance in a Cold Environment. nack, Mass: uS Army Rsarch
is f evrmal Mc; 1984. Rpr t2-84.
35. obr C, Ma SJ. Hyphyra ffc fgr sk mprar a
l flw rg cl-war fgr mmrs.J Appl Physiol. 2002;94:598603.
36. Fry SM, Wgr Cb, bv JR, nal eR. effc f hyprsmlaly
crl f l flw a swag.J Appl Physiol. 1984;57:16881695.
37. Prpp dW. effcs f hyprsmlaly a rcs ha-c lm
vasla as. Am J Physiol. 1990;258:R309R317.
38. thr RM, Prpp dW. Aa f hlm vasla ha-
srss as rg hyra. Am J Physiol. 1986;250:R30R35.
39. Ma SJ, Lazka WA, Sawka Mn. Crl f hrmrglary swag s
alr y hyra lvl a xrcs sy.J Appl Physiol. 1995;79:1434
1439.
40. naks td, Aams bA, Myrgh KH, Grff C, Lz t, naha M. th a-
gr f a aqa war ak rg prlg xrcs: a vl ccp
rvs. Eur J Appl Physiol Occup Physiol. 1988;57:210219.
41. Kzlwsk S, Grlaf Je, trljska e, nazar K. exraclllar hyprsm-
laly a y mprar rg physcal xrcs gs. Am J Physiol.
1980;239:R180R183.
42. nal eR, Fry SM, Wgr Cb. effc f hyra sa crclary
a hrmal rglas.J Appl Physiol. 1980;49:715721.
43. Fry SM, nal eR, Wgr Cb, bv JR. effc f l vlm swag
ra a y fls xrcsg hmas.J Appl Physiol. 1981;51:15941600.
44. bla JA. thrmrgla. i: Mackwak PA, .Fever: Basic Mechanisms
and Management. Phlalpha, Pa: Lppc-Rav; 1997: 3558.
reFerences | 55
-
8/8/2019 Hydration PDF
66/72
45. thrashr tn. osmrcpr ma f hrs a vasprss scr
h g. Fed Proc. 1982;41:25282532.
46. Mack G, ns H, nal eR. Rl f carplmary arrflxs rg
yamc xrcs.J Appl Physiol. 1988;65:18271832.
47. Gas GM, elz RS. effc f cral l vlm cras p hrm-
rgla rspss xrcs h ha [asrac]. Fed Proc. 1984:43:627.
48. Sal b. Crclary rsps smaxmal a maxmal xrcs afr hrmal
hyra.J Appl Physiol. 1964;19:11251132.
49. Haml Mt, Gzlz-Als J, Ma SJ, Cyl eF. Fl rplacm a
glcs fs rg xrcs prvs carvasclar rf.J Appl Physiol.
1991;71:871877.
50. Srym nb, va Graa CH, Vlj JH, ba AJ. Physlgcal prfrmac
f m sjc ffr war rgms vr a w-ay pr. S Afr Med
J. 1968;42:9295.
51. Srym nb, Wyham CH, va Graa CH, Hlswrh Ld, Mrrs JF. th
flc f war rsrc h prfrmac f m rg a prlg
march. S Afr Med J. 1966;40:539544.
52. Armsrg Le, Csll dL, Fk WJ. iflc f rc-c hyra
cmpv rg prfrmac. Med Sci Sports Exerc. 1985;17:456461.
53. Sal b. Arc a aarc wrk capacy afr hyra.J Appl Physiol.
1964;19:11141118.
54. blyh CS, br JJ. effc f war alac aly prfrm hgh am
mprars. Res Q Exerc Sport. 1961;32:301307.
55. brg CM, Cary MF, Pay WR. Rwg prfrmac, fl alac, a
malc fc fllwg hyra a rhyra. Med Sci Sports
Exerc. 1993;25:13581364.
56. nls b, Kca R, bs A, Rasmss ib, Sklsa J, Wlk b. Phys-
cal wrk capacy afr hyra a hyprhrma. Scand J Sports Sci.
1981;3:210.
57. bjla RL, Sharma Kn. effc f hyra a a fw rgms f rhyra
hma prfrmac. Ind J Physiol Pharmacol. 1980;24:255266.
58. trra C, Smh dP, byr RJ. th ffc f ac hrmal hyra a
rap rhyra smrc a sc rac.J Sports Med Phys Fit-
ness. 1979;19:19.
59. Wsr S, R R, Wlma A. Physlgcal ffcs f a wgh lss rgm
pracc y cllg wrslrs. Med Sci Sports Exerc. 1990;22:229234.
60. Chvr Sn, Carr R iii, Caslla JW, Sawka Mn. Hyphyra mpars
rac xrcs prfrmac mpra cl ar.J Appl Physiol.
2005;99:19721976.
61. Sawka Mn, Yg AJ, Lazka WA, nfr Pd, Qgly Md, Palf Kb.
Hma lrac ha sra rg xrcs: flc f hyra.J Appl
Physiol. 1992;73:368375.
56 | reFerences
-
8/8/2019 Hydration PDF
67/72
62. Hppr MK, Cgga AR, Cyl eF. exrcs srk vlm rlav plasma-
vlm xpas.J Appl Physiol. 1988;64:404408.
63. ns H, Mack GW, Sh XR, Mrm K, nal eR. effc f sal f-
s rg xrcs hrmal a crclary rglas. J Appl Physiol.
1990;69:609616.
64. Sawka Mn, Har RW, Fracsc RP, Hrsma dH. effcs f ac
plasma vlm xpas alrg xrcs-ha prfrmac. Eur J Appl
Physiol Occup Physiol. 1983;51:303312.
65. dschamps A, Lvy Rd, Cs MG, Marlss eb, Magr S. effc f sal
fs y mprar a rac rg havy xrcs. J Appl
Physiol. 1989;66:27992804.
66. Lkmr MJ, thmas eL. Hyprvlma a cyclg m ral prfrmac.
Med Sci Sports Exerc. 1994;26:503509.
67. Lazka WA, Sawka Mn, Ma SJ, al. Hyprhyra: hrmrglary
ffcs rg cmpsal xrcs-ha srss.J Appl Physiol. 1997;83:860
866.
68. Rsl ML, All dY, Pak Gt, Al-Qaa K. Hyprhyra wh glycrl
sls.J Appl Physiol. 1987;63:22622268.
69. Fr bJ, Ma SJ, Yg AJ, al. Glycrl hyprhyra: hrmal,
ral, a vasclar fl rspss.J Appl Physiol. 1995;79:20692077.
70. Lys tP, Rsl ML, Ml Le, Chck tW. effcs f glycrl-c hy-
prhyra prr xrcs h ha swag a cr mprar.
Med Sci Sports Exerc. 1990;22:477483.
71. Kgsrg P, Lys tP, nagy R, Rsl ML. 40-Hr glycrl-c
hyprhyra [asrac]. Fed Proc. 1991;5:A768.
72. Mr P, Sark dM, Rsl ML, al. Pr-xrcs glycrl hyra m-Pr-xrcs glycrl hyra m-
prvs cyclg rac m. Int J Sports Med. 1996;17:2733.
73. Mar Fe, Kay d, Ca J. Glycrl hyprhyra fals mprv r-
ac prfrmac a hrmrgla hmas a warm hm vr-
m. Pflgers Arch. 2003;446:455462.
74. Sawka Mn, Lazka WA, Ma SJ, Skrar GS, Flg RA, Palf Kb.
Hyprhyra: hrmal a carvasclar ffcs rg cmpsal
xrcs-ha srss [asrac]. Med Sci Sports Exerc. 1997;29:S132.
75. uS Army Cr fr Halh Prm a Prvv Mc, Army Mcal
Srvllac Acvy. Hyparma assca wh ha srss a xcssv
war csmp: rak vsga a rcmmas. Med Surv
Monthly Rep. 1997;3:910.
76. Garga t, Rs de. dah frm hyparma as a rsl f ac war
xca a Army asc ra. Mil Med. 1999;164:234237.
77. uS Army Cr fr Halh Prm a Prvv Mc, Army Mcal
Srvllac Acvy. Hyparma assca wh ha srss a xcssv
war csmp: Fr bg, GA; Fr Lar W, Mo; Fr Jacks,
SC; JAgs 1997. Med Surv Monthly Rep. 1997;3:28.
reFerences | 57
-
8/8/2019 Hydration PDF
68/72
78. Ma SJ, Sawka Mn, Wgr Cb. Hyparma assca wh xrcs:
rsk facrs a pahgss. Exerc Sport Sci Rev. 2001;29:113117.
79. Spy db, naks td, Schr C. exrcs-assca hyparma: a
rvw. Emerg Med. 2001;13:1727.
80. Kchl JP. Clcal cmplcas f y fl a lcrly alac. i:
bskrk eR, Phl SM, s. Body Fluid Balance: Exercise and Sport. bca Ra,
Fla: CRC Prss; 1996: 297317.
81. Zamrask eJ. th ky a y fl alac rg xrcs. i: bskrk
eR, Phl SM, s. Body Fluid Balance: Exercise and Sport. bca Ra, Fla:
CRC Prss; 1996: 7595.
82. Prma C, Lvy L, Rgr d. tras xrcs-c war xca
a rhamylyss. Am J Kidney Dis. 1993;21:206-209.
83. Prmas J. exrcs a ral fc. Sports Med. 1984;1:125133.
84. b MJ, Sjhlm nt. effc f physcal rag prphral swa prc-
.J Appl Physiol. 1988;65:811814.
85. Pa JF, Kasza J, Mll RP, Ryls KL. Physiological and Perceptual
Responses to Prolonged Treadmill Load Carriage. nack, Mass: uS Army
Rsarch is f evrmal Mc; 1990. Rpr t11-90.
86. Grlaf Je, brck PJ, Kl LC, Mrs Jt. drkg a war alac rg
xrcs a ha acclma.J Appl Physiol. 1983;54:414419.
87. Ps GC, Jhs Re, Cslaz FC. Wrk h ha as affc y ak
f war, sal a glcs. Am J Physiol. 1944;142:253259.
88. Lall WS. th ffcs f war a sal ak p h prfrmac f m
wrkg h a hm vrms.J Physiol. 1955;127:1146.
89. Cvr VA, Armsrg Le, Cyl eF, al. Amrca Cllg f Sprs
Mc ps sa. exrcs a fl rplacm. Med Sci Sports Exerc.
1996;28:v.
90. Gzalz RR. bphyscs f ha rasfr a clhg csras. i: Pa-
lf Kb, Sawka Mn, Gzalz RR, s. Human Performance Physiology and
Environmental Medicine at Terrestrial Extremes. iaapls, i: bchmark
Prss; 1988: 4595.
91. Grlaf Je. evrmal sss ha flc ak f rplacm vr-
ags. i: Marr bM, . Fluid Replacement and Heat Stress. Washg,
dC: naal Acamy Prss; 1994: 195214.
92. Grlaf Je, brck PJ, Kl LC, Mrs Jt. drkg a war alac rg
xrcs a ha acclma.J Appl Physiol. 1983;54:414419.
93. drcra f Cma dvlpms, uS Army Cm Arms Sppr Cm-
ma. Water Consumption Planning Factors. Fr L, Va: Qarrmasr, uS
Army Cm Arms Sppr Cmma; 1999. Sy Rpr.
93a. Ma SJ, Lazka WA, Sawka Mn. Fl rplacm rcmmas fr
rag h wahr. Mil Med. 1999;164:502508.
94. Shrla A. of h rpsy. i:An Attempt to Ascertain and Extend the Virtues
of Bath and Bristol Waters. L: Frrch & Lak; 1764: 213218.
58 | reFerences
-
8/8/2019 Hydration PDF
69/72
95. Lqs S, Grarg Po, W b. Fl alac a physcal wrk capacy
hmas xps cl. Arch Environ Health. 1974;29:241249.
96. Cly CL, nckrs JL. effcs f mprar chag h war alac
ma. Am J Physiol. 1945;143:373384.
97. bra dR, Glma RF, bskrk eR. War vapr lss frm h rsprary
rac rg r xrcs h cl.J Appl Physiol. 1957;11:219222.
98. Mchll JW, nal eR, Slwjk JAJ. Rsprary wgh lsss rg xrcs.
J Appl Physiol. 1972;32:474476.
99. Amr AF, Vgl JA, Wrsly de. The Energy Cost of Wearing Multilayer
Clothing. Farrgh, egla: Ryal Arcraf esalshm; 1973. tchcal
Rpr APRe (tM) 18/73.
100. tlam A, Glma RF. icras rgy cs wh mlpl clhg layrs.
J Appl Physiol. 1972;32:743744.
101. Frgly MJ, Lhrr Lo, tylr Pe. effc f chrc xpsr cl, hypxa, a
h cm war xchag ras. Aerospace Med. 1974;45:12231231.
102. Rgrs tA, Slff JA, Klppg JC. ergy cs, fl a lcrly alac
sarcc srvval sas.J Appl Physiol. 1964;19:18.
103. da eJ, Glls S, brs R. effc f fl ak ral fc rg
xrcs h cl. Eur J Appl Physiol Occup Physiol. 1990;61:133137.
104. Js te, Hy RW, bakr CJ, Hla Cb, Walczak PS.Voluntary Consumption
of a Liquid Carbohydrate Supplement by Special Operations Forces During a
High Altitude Cold Weather Field Training Exercise. nack, Mass: uS Army
Rsarch is f evrmal Mc; 1990. Rpr t20-90.
105. Kg n, Mr SH, Rrs de, Askw eW, Yg AJ.Nutrition and Hydration
Status of Soldiers Consuming the 18-Man Arctic Tray Pack Ration Module With
Either the Meal, Ready-to-Eat or the Long Life Ration Packet During a Cold
Weather Field Training Exercise. nack, Mass: uS Army Rsarch is f
evrmal Mc; 1992. Rpr t4-92.
106. Rrs de, McGr bJ, egll db, Salr CA, Rs MS. The Role of Water
Consumption on Consumption of the Ration, Cold Weather. nack, Mass: uS
Army Rsarch is f evrmal Mc; 1989. Rpr t13-89.
107. Hy RW, Hg A. by fl a rgy malsm a hgh al. i:
Frgly MJ, blas CM, s. Environmental Physiology. Vl 2. i: Hand-
book of Physiology, Section 4. nw Yrk, nY: oxfr uvrsy Prss; 1996:
12771289.
108. Clayagh JR, Wa Ce, Ccll SA. Fl a lcrly alac a hr-
mal rsps h hypxc vrm. i: Clayagh JR, Wa Ce, s.
Hormonal Regulation of Fluid and Electrolytes: Environmental Effects. nw
Yrk, nY: Plm Plshg Crpra; 1989: 187213.
109. Sawka Mn, Yg AJ, Rck Pb, al. Al acclmaza a l
vlm: ffcs f xgs ryhrcy vlm xpas.J Appl Physiol.
1996;81:636642.
reFerences | 59
-
8/8/2019 Hydration PDF
70/72
110. Hy RW, Hg A. evrmal flcs y fl alac rg
xrcs: al. i: bskrk eR, Phl SM, s. Body Fluid Balance: Exercise
and Sport. bca Ra, Fla: CRC Prss; 1996: 183196.
111. Pgh LGC. Physlgcal a mcal aspcs f a Hmalaya scfc a
marg xp, 196061. Br Med J. 1962;2:621637.
112. Mrga te, Hgss LA, Schllg d, Hy RW, iwayk eJ. A Comparison of
the Meal, Ready to Eat, Ration, Cold Weather, and Ration, Lightweight Nutri-
ent Intakes During Moderate Altitude Cold Weather Field Training Operations.
nack, Mass: uS Army Rsarch is f evrmal Mc; 1988.
Rpr t5-89.
113. eps M. Ral, cr, a hmyamc ffcs f war mmrs
hmas. i: bskrk eR, Phl SM, s. Body Fluid Balance: Exercise and Sport.
bca Ra, Fla: CRC Prss; 1996: 197212.
114. Gslf CV, Rya AJ. Gasrsal physlgy rg xrcs. i: bskrk
eR, Phl SM, s. Body Fluid Balance: Exercise and Sport. bca Ra, Fla:
CRC Prss; 1996: 1951.
115. Mchll Jb, Vss KW. th flc f vlm gasrc mpyg a fl
alac rg prlg xrcs. Med Sci Sports Exerc. 1991;23:314319.
116. Rlls bJ, Rlls et. Thirst. Camrg, egla: Camrg uvrsy Prss;
1986.
117. Rlls bJ. Palaaly a fl ak. i: Marr bM, . Fluid Replacement
and Heat Stress. Washg, dC: naal Acamy Prss; 1994: 161168.
118. davs JM, brgss WA, Slz CA, barl WP, Pa RR. effcs f gsg 6%
a 12% glcs/lcrly vrags rg prlg rm cyclg
h ha. Eur J Appl Physiol Occup Physiol. 1988;57:563569.
119. Shar e, Kaly J, Aar R. th prv f vlary hyra. i: Proceed-
ings of the Lucknow Symposium (Symposium on Environmental Physiology
and Psychology in Arid Conditions). Pars, Frac: u nas ecaal
Scfc a Clral orgaza; 1962: 129135.
120. Zllr dA, Swar WF, Rz P, brw JM. effc f mprar a xpca-
s lkg f vrags. Physiol Behav. 1988;44:6168.
121. Sarck bL, egll db, Mallr o. Prcp f rkg war mprar
a ffcs fr hmas afr xrcs. Physiol Behav. 1984;32:851855.
122. Armsrg Le, Har RW, Szlyk PC, Mahw Wt, Sls iV. Vlary hy-
ra a lcrly lsss rg prlg xrcs h ha. Aviat Space
Environ Med. 1985;56:765770.
123. Gslf CV. War rqrms rg xrcs h ha. i: Marr bM, .
Nutritional Needs in Hot Environments. Washg, dC: naal Acamy
Prss; 1993: 8796.
124. Sawka Mn, Wgr Cb, Ma SJ, al. Heat Stress Control and Heat Ca-
sualty Management. Washg, dC: Haqarrs, uS dparm f h
Army a Ar Frc; 2003: 13. tb Med 507/AFPAM 48-152.
60 | reFerences
-
8/8/2019 Hydration PDF
71/72
-
8/8/2019 Hydration PDF
72/72
GPo: isr arc.