BACKGROUND Dehydration is common in hospitals and is associated with increased mortality and morbidity. Clinical assessment and diagnostic measures of dehydration are unreliable. We sought to investigate the novel concept that individuals might control their own intravenous rehydration, guided by thirst. METHODS We performed a single-blind, counterbalanced, randomised cross-over trial. Ten healthy male volunteers of mean age 26 (standard deviation [sd] 10.5) yr were dehydrated by 3-5% of their baseline body mass via exercising in the heat (35°C, 60% humidity). This was followed by a 4 h participant-controlled intravenous rehydration: individuals triggered up to six fluid boluses (4% dextrose in 0.18% sodium chloride) per hour in response to thirst. Participants undertook two blinded rehydration protocols which differed only by bolus volume: 50 ml (low volume [LV]) or 200 ml (high volume [HV]). Each hour during the rehydration phase, plasma osmolality (pOsm) was measured and thirst score recorded. Nude body mass was measured at baseline, after dehydration, and after the rehydration phase. RESULTS In both conditions, the mean dehydration-related body mass loss was 3.9%. Thirst score was strongly associated with pOsm (within-subject r=0.74) and demand for fluid decreased as pOsm corrected. In the HV condition, participants rapidly rehydrated themselves (mean fluid delivered 3060 vs 981 ml in the LV condition) to body mass and pOsm no different to their euhydrated state. CONCLUSION Healthy individuals appear able to rely on thirst to manage intravenous fluid intake. Future work must now focus on whether patient-controlled intravenous fluids could represent a paradigm shift in the management of hydration in the clinical setting. CLINICAL TRIAL REGISTRATION NCT03932890.

中文翻译：

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口渴引导的参与者控制的静脉补液：一项单盲，随机交叉研究。

背景技术脱水在医院中很普遍，并且与死亡率和发病率增加有关。脱水的临床评估和诊断措施不可靠。我们试图研究一种新颖的概念，即人们可以在口渴的情况下控制自己的静脉补液。方法我们进行了单盲，平衡，随机交叉试验。十名平均年龄为26岁（标准偏差[sd] 10.5）年的健康男性志愿者通过在高温下（35°C，60％湿度）锻炼而使其基线体重降低了3-5％。随后进行4小时的参与者控制的静脉补液：个体因口渴而每小时触发多达6次补液（4％葡萄糖于0.18％氯化钠中）。参加者进行了两个盲注的补液方案，仅在推注量上有所不同：50毫升（小体积[LV]）或200毫升（大体积[HV]）。在补液阶段的每个小时，都要测量血浆渗透压（pOsm）并记录口渴评分。在基线，脱水后和再水化阶段后测量裸体体重。结果在两种情况下，与脱水有关的平均体重减轻为3.9％。口渴评分与pOsm密切相关（受试者内r = 0.74），并且随着pOsm校正，对液体的需求减少。在HV状态下，参与者迅速补充水分（在LV条件下，平均液体输送量为3060 vs 981 ml）至体重和pOsm，与他们的正常水合状态没有区别。结论健康个体似乎能够依靠口渴来控制静脉输液。现在，未来的工作必须集中在患者控制的静脉输液是否可以代表临床环境中水化管理的模式转变上。临床试验注册NCT03932890。