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Assessing Hydration Status: The Elusive Gold Standard

Human Performance Laboratory, Departments of Kinesiology and Nutritional Sciences, University of Connecticut, Storrs, Connecticut

Address reprint requests to: Lawrence E. Armstrong, Ph.D., FACSM, University of Connecticut, Human Performance Laboratory, Departments of Kinesiology and Nutritional Sciences, Unit 1110, 2095 Hillside Road, Storrs, CT 06269-1110. E-mail: lawrence.armstrong{at}uconn.edu

Acknowledging that total body water (TBW) turnover is complex, and that no measurement is valid for all situations, this review evaluates 13 hydration assessment techniques. Although validated laboratory methods exist for TBW and extracellular volume, no evidence incontrovertibly demonstrates that any concentration measurement, including plasma osmolality (P_osm), accurately represents TBW gain and loss during daily activities. Further, one blood or urine sample cannot validly represent fluctuating TBW and fluid compartments. Future research should (a) evaluate novel techniques that assess hydration in real time and are precise, accurate, reliable, non-invasive, portable, inexpensive, safe, and simple; and (b) clarify the relationship between P_osm and TBW oscillations in various scenarios.

Key words: dehydration, osmolality, total body water, extracellular fluid, intracellular fluid