hydration pdf

8/8/2019 Hydration PDF

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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


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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


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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.


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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.


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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


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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


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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


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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


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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.


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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.


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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


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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.


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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.



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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


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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.



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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


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



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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.


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



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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


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



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).



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


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.



28/72


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.


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



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


32/72


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


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



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


36/72


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


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.


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


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


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



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


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



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


44/72


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.


46/72


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.


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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.



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


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.



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


52/72


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


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.


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


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


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.



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



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,


59/72


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.


60/72


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.


62/72


63/72

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