assessing total body water using the diluted isotope (deuterium oxide) technique

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Fluid requirements and replacement strategies within a military context

The Research and Technology Organisation (RTO) of the North Atlantic Treaty Organisation (NATO) states in the executive summary of their Human Factors and Medicine Panel Specialists’ meeting held in Boston 2003 that: “There is a need to provide more precise estimates of fluid requirements to lessen the loads that the soldier might have to carry and reduce costs associated with water transport and re-supply” (RTO-MPHFM- 086).
The extent to which humans need to replace their fluid losses during exercise remains contentious despite more than 60 years of focused research (Adolph 1947; Ladell 1947; Ladell 1955; Ladell 1965; Montain et al. 2001; Noakes 2003; Passe et al. 2007; Sawka and Noakes 2007; Sawka et al. 2007; Gonzalez et al. 2009). While it is now accepted that exercisers should not be encouraged to drink “as much as tolerable” there is still no consensus of the optimum rate of fluid ingestion during
exercise
The recently modified ACSM guidelines advise that exercisers should drink sufficiently to ensure that their body mass loss during exercise is less than 2% (Sawka et al. 2007). More recently the US Army Research Institute of Environmental Medicine (USARIEM) proposed sweat loss prediction equations ranging from ~575 g/hr to ~1092 g/hr (based on an individual with a body surface area of 1.9 m2) for various workloads, environmental and clothing configurations in order to more accurately predict fluid replacement volumes during work and exercise (Gonzalez et al. 2009). Others (Noakes 2003; Noakes 2007) argue that drinking to the dictates of thirst is the biologically appropriate behaviour that optimises performance and is unrelated to heat illness regardless of the exact level of dehydration that develops during exercise.
This debate has special relevance for the military since soldiers ingesting fluid ad libitum will drink less that those who are forced to drink in order to lose less than 2 % of their body mass during exercise. Many soldiers drinking ad libitum according to the dictates of their thirst will drink less, develop “voluntary dehydration” and will therefore need to carry less water during military operations. In order to investigate these possibilities, there is a need for field studies to establish the optimum rates at which soldiers should ingest fluid during exercise.

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Chapter 1: General Introduction 
1.1 FLUID REQUIREMENTS AND REPLACEMENT STRATEGIES WITHIN A MILITARY CONTEXT
1.2 STATEMENT OF THE PROBLEM
1.3 AIMS AND OBJECTIVES
1.4 ABSTRACT .
1.5 PUBLICATIONS.
1.6 REFERENCES
Chapter 2: Effect of ad libitum and restricted fluid replacement strategies during prolonged
exercise on various hydration markers and performance of selected military tasks in soldiers
2.1 INTRODUCTION .
2.2 MATERIALS AND METHODS
2.3 RESULTS .
2.4 DISCUSSION .
2.5 REFERENCES .
Chapter 3: Overview of assessing total body water using the diluted isotope (deuterium oxide)
technique
3.1 INTRODUCTION
3.2 GENERAL OVERVIEW
3.3 CORRECTIONS AND TBW CALCULATIONS
3.4 ISOTOPE ADMINISTRATION
3.5 CHOICE OF PHYSIOLOGICAL FLUID AS SAMPLE MEDIUM
3.6 COLLECTION AND STORAGE OF SAMPLES
3.7 SUMMARY OF TBW METHOD AS APPLIED DURING STUDIES PRESENTED IN CHAPTERS
3.8 DEUTERIUM ABUNDANCE ANALYSIS .
3.9 REFERENCES
Chapter 4: Ad libitum fluid replacement maintains total body water, plasma osmolality and
serum sodium concentrations in military personnel during a 4 hour route march .
4.1 INTRODUCTION .
4.2 METHOD
4.3 RESULTS
4.4 DISCUSSION
4.5 REFERENCES .
Chapter 5: Protection of total body water content and absence of hyperthermia despite 2%
body mass loss (“voluntary dehydration”) in soldiers drinking ad libitum during prolonged
exercise in cool environmental conditions 
Chapter 6: Appropriately trained humans can safely perform vigorous, competitive self-paced
exercise in extreme heat (44°C) when drinking water ad libitum

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