From Big Medical Encyclopedia

DRINKING MODE — the order of use of drinking water established taking into account a type of activity of people, conditions of the environment and a condition of an organism. Is of particular importance P. of river at a lack of water, changes of vodnosolevy exchange as a result of action of thermal and exercise stresses, a gipobariya, zero gravity, at diseases of kidneys, hearts, went. - kish. path etc.

Rational P. the ruble shall provide optimum water and electrolytic balance at the person (see. Water salt metabolism ) and high performance. The item of river shall be connected with drinking norm of water consumption which represents the minimum quantity of water necessary for the person for maintenance of normal life activity. This quantity depends on age, sex, body weight, physical activity, ambient temperature, a type of clothes and a food allowance. In days children need 80 — 160 ml of water, to the adults who are in rest in comfortable conditions, 35 — 40 ml/kg; the feeding women in addition need about 1 l of water. In the conditions of high thermal loading water requirement can increase up to 10 — 15 l a day. At t ° 30 — 33 ° the people who are in a shadow at rest in days consume 5 l of water, during the moderately severe work — 7 — 8 l, at hard work — to 10 — 11 l. In all cases standard daily drinking rates shall provide completely a water discharge with an organism on formation of urine, sweat, a calla, on evaporation from upper respiratory tracts, skin.

At deficit of water in an organism (see. Dehydration of an organism ), the equal 1 — 1, 5% of the weight (weight) of a body, appear thirst and dryness in a mouth, appetite decreases, the diuresis decreases; at deficit of 4 — 5% decrease in sweating, erubescence and increase in its temperature, increase of breath and heartbeat, decrease in secretion of digestive glands, unquenchable thirst and considerable weakness are observed; at deficit of 8 — 10% working capacity falls to a minimum, department of saliva stops, skin becomes flabby, dry and wrinkled. At further increase of deficit skin becomes covered by cracks, because of an esophagospasm the act of swallowing is violated, the mocheotdeleniye stops, sight and hearing are broken, hallucinations develop. Loss of 20% of water of body weight leads to death.

The condition of excess water content in an organism can arise at disturbance of work of the system including osmoregulation, feeling of thirst and secretory function of kidneys. This system works for the healthy person reliably; the condition of excess water content is observed only at renal and heart failure, dysfunction of bark of adrenal glands, a hypophysis, pancreas etc. Cases of «water poisoning» owing to disturbance of thermal control and excess water consumption in a hot humid climate are described. At the same time weakness, a headache, dizziness, spasms, hypersalivation, nausea, vomiting and quite often mental disorders were noted.

The item of river is closely connected with the mode food (see) since meal and waters is regulated uniform food center (see). Dehydration of an organism leads to decrease in consumption of food and, therefore, to further increase of deficit of water since with food from 1 to 3 l of water come to an organism, and as a result of assimilation of food 200 — 500 g of so-called endogenous water are formed. With food osmotically active agents arrive (see. Osmotic pressure ), which quantity in an organism defines water requirement and ability to hold it in blood and fabrics. Consumption of food, protein-rich or mineral salts, increases water requirement.

In the conditions of hot climate of P. of river it has to be combined with the unusual (displaced) diet and special diets, to-rye provide food with the increased content of the vitamins and extractives stimulating appetite and secretion, meal in the most cool time of day, consumption of the main part of the proteins possessing high specific dynamic action, at breakfast and a dinner, inclusion of liquid and semi-fluid dishes during the lunchtime.

P.'s observance by the river in the conditions of high thermal loading (in hot climate, in hot workshops is especially important, at hard physical work, especially in special protective clothes, etc.). A consensus on this matter does not exist. There were two opposite points of view. It agrees one of them it is recommended to limit strictly reception of water in operating time, only periodically to moisten an oral cavity, proceeding from the fact that thirst does not reflect true water requirement, and attempts to satisfy thirst lead only to increase in sweating, to overflow went. - kish. a path, to fluidifying of blood, strengthening of demineralization and dehydration (the concept of «vicious circle») and, eventually, to decrease in working capacity. On this basis various drinks and structures intended for suppression of feeling of thirst are offered.

However the pilot studies conducted in 1940 — 1960 by Adolf (E. Adolf), P.E. Kalmykov, F. T. Eronin and others, showed that the size of sweating before loss about 4 — 5% of body weight does not depend on amount of the consumed water, and is defined by the size of thermal loading; thirst quite an utolima if to drink water in process of its emergence; even at a full satisfying of thirst the amount of the drunk water at intensity of sweating of St. 250 — 300 ml an hour is less than its losses with then (a situation of unindemnifiable sweating), restriction of drink leads to decrease in working capacity and deterioration in health of people. Unquenchable thirst arises only in case of restriction of drink, owing to reirritation of the food center. On the basis of these researches it is recommended to drink in process of emergence of thirst to its full satisfying and not to resort to artificial means of its suppression. Practice shows that at such mode of water consumption the one-time amount of the drunk water usually does not exceed 300 ml, and therefore does not overload went. - kish. path, cardiovascular system, etc.

Since 4 — 5% of loses of weight of a body, the amount of sweat in case of limited water consumption decreases, but body temperature begins to increase. However this increase not in proportion to the size of reduction of sweating, and lags behind it because of reduction of heat generation a little as a result of decrease in work of sweat glands which heat production makes about 255,8 kcal (1071 kJ) on 1 l of sweat. Therefore in the conditions of the complicated evaporation of sweat (a hot humid climate and a microclimate) it is reasonable to maintain during the working day some water deficit at the level of 3 — 4% of body weight by restriction of water consumption. However in all cases it shall be filled during rest.

The main drinking means normalizing a water salt metabolism is high-quality water t ° 7 — 15 °. At lower temperature water has the sharp cooling effect and can promote developing of diseases, at higher — its refreshing effect decreases. For improvement of taste water is saturated with carbonic acid, add to it various syrups, use tea, dry and fresh fruit, vegetables decoctions, a dogrose, etc. Many of the offered drinks contain tonic substances, vitamins, organic to - you, the microelements useful to an organism; nek-ry drinks are counted on providing with these substances, including and nutritious, napr, protein-vitamin drinks, koumiss, the acid milk divorced water, kvass, beef-infusion broth, etc.

Increase in consumption of salt and a podsalivaniye of drinking water is necessary at a potovydeleniya St. 5 — 6 l a day; in other cases of loss of salt with then and urine are compensated by salt reserves of an organism and intake of salt with food.

In hot workshops at big exercise stresses when the potovydeleniye reaches 8 — 10 l and more during the shift, it is necessary to drink also in process of emergence of thirst. For the prevention of acute salt insufficiency use added some salt (0,2 — 0,8% NaCl solution) the water aerated by carbonic acid and also the drinks of more complex structure offsetting losses of various components with then.

Drinking regime of the athlete is defined by sports specialization and conditions of holding trainings and competitions. Restriction of water consumption at short sports competitions (boxing, fencing, gymnastics, fight) is admissible. For elimination of dryness of a mouth and thirst rinse a mouth or suck the slices of a lemon, acid lollipops causing salivation. At longer competitions (soccer, volleyball, hockey) it is sharp it is not necessary to limit water consumption since it worsens overall health and promotes to overheating of an organism (see). The use of the special drinks containing electrolytes and other components is necessary at long loadings in the conditions of high temperature (cycle racings, walking, run on long and super and long distances). Water deficit is partially compensated by reception of liquid and semi-fluid food, milk, broths, sweet tea or fruit juice.

After the training occupations and competitions it is necessary to drink 20 — 30 min. later 2 — 3 glasses of hot tea with a lemon, cranberry drink or 1 — 2 glass of hot milk. Also mineral «Borjomi» waters possessing a big set of electrolytes, especially to athletes whose work is followed by substantial increase of concentration milk to - you in blood and desalting (run on average distances, rowing, sports) are recommended.

At ascension on hardly accessible mountain tops (see. Mountaineering ) water deficit can reach 2 — 3 l and more in days. Therefore climbers shall have at themselves enough liquid (tea, soup, water). For fight against anorexia and improvements of tastes of water add to it lemon to - that, cranberry extract, sugar. Especially it is recommended at consumption of a melt water, to-ruyu it is useful to add some salt to taste.

Drinking regime of staff of Armed Forces. Rational P. of river in troops (on the fleet) — one of the most important conditions of preservation of health and fighting capacity of the military personnel. The amount of water, consumed by the military personnel for drink, fluctuates from 1,5 to 10 l a day depending on the size of exercise and thermal stress, a type of clothes, structure of a diet and other reasons. In midlatitudes on a march soldiers lose up to 2,5 — 3 l of water due to sweating, in hot climate — to 5 — 6 l. According to it, e.g., in the conditions of Central Asia in the summer soldiers at easy exercise stresses drink up to 5 l of water a day, at averages — 6 — 7 l, at heavy loadings — 8 — 9 l. Water consumption can increase in cases of use of individual protection equipment of skin of the isolating type for 30%.

To the middle of the 50th of P. the ruble of the military personnel in the conditions of thermal loading was based on the theory of a so-called vicious circle — strict restriction of water consumption in operating time, especially on a march, and compensation lost from then salt.

Modern P.'s organization by ruble taking into account new data on vodnosolevy exchange is based on the following provisions: providing staff with high-quality water in enough; full satisfaction of drinking water requirement in process of emergence of thirst, including during exercise and thermal stresses (on a march); prohibition of drink of water from accidental unchecked water sources; gradual saturation of an organism water after forced restriction of water consumption.

In most armies of the world restriction in drink is allowed only in the absence of a sufficient deposit of moisture and for a short time (to 3 days) with a condition of the subsequent compensation of water deficit. In our army drinking norms provide 10 — 15 l of water on 1 person a day; under trying conditions water supply in a temperate and frigid climate the norm is reduced to 2,5 l (for the term of no more than 5 days), in hot climate to 4 i (for the term of no more than 3 days).

Each serviceman during the march is obliged to have a flask with high-quality water, at emergence of thirst to drink in the small portions to its full satisfying. On halts water in flasks shall be replenished from portable stocks. Crews of tanks and armored vehicles are provided with special tanks for drinking water. The same tanks for water shall be in transit troops by cars. The item of river of staff of troops in hot climate shall be coordinated to a feeding schedule. At the same time it is necessary to consider that in the conditions of overheating the strengthened sweating leads to loss of salts and water-soluble vitamins. For compensation of these losses it is necessary to plan consumption svezhnkh vegetables, fruit, the vitaminized drinks.

The item of river of pilots and astronauts considers the dehydrational processes connected with a profound diuresis and lack of the expressed thirst, to-rye lead to insufficient completion of losses of water during flight. Pilots in a set of an emergency stock have high-quality water in number of 2,2 — 2,8 l, for hot climate — to 3,5 l on the person. Daily need of the astronaut for drinking water under normal microclimatic conditions makes 2,2 l, during the flights by the ships «Union» astronauts received 1,6 l of drinking water and to 0,95 l of water came to an organism with food.

The item of river of staff of the underwater fleet has the features. During the swimming in low latitudes in P. of river the possibility of considerable dehydration and desalting as a result so is considered. naz. a noncompensated potovydeleniye — the desalinated water is added some salt by special salt mixes or addition of outside water. In autonomous swimming the vitaminized drinks, fruit and juice are used. Emergency rations include drinking water in cans.

At systematic losses of a large amount of sweat (more than 5 — 6 l a day) constant control behind intake of mineral salts with food and water, first of all sodium, potassium, magnesium and chlorides is required. Otherwise, especially at the faces which are not adapted to a heat disturbances of a water salt metabolism in the form of so-called simple dehydration at the expense of an unindemnifiable potovydeleniye and the salt insufficiency which is shown in the form of muscular spasms and spasms are possible. For prevention of these states, especially during acclimatization, in some armies it is recommended to use 0,9 — 1,0% the salt drinks containing the listed above elements; they are used for a regidratation at considerable dehydration. It is not recommended to offset loss of salts one sodium chloride since it can lead to potassium exhaustion. Intended consumption of salt and its addition to drinking water is inexpedient if it is less than 4 — 5 l of loss of sweat in day or water consumption is limited owing to its shortcoming.

Bibliography: Vankhanen V. D., Shaptala A. A. and Shaptala V. A. About rationing of water consumption and qualitative structure of drinks during the work in the conditions of the elevated temperature of the environment, in book: A balanced diet, under the editorship of P. N. Maystruk, century 11, page 3, Kiev, 1976; Vladimirov G. E. and Gaiman E. Ya. A water salt metabolism and the drinking mode in the conditions of hot climate, M., 1952; Eronin F. T. A water salt metabolism and the drinking mode in the conditions of thermal loading, Voyen. - medical zhurn., No. 4, page 46, 1977, bibliogr.; Kassirsky I. A., etc. Guide to tropical diseases, M., 1974; JI and in N and to about in A. A. Fundamentals of air and space medicine, M., 1975; JI and to about m to both N A. I. and Myagkov I. F. Hunger and thirst (in physiological aspect), M., 1975; Minkh A. A. and Malysheva I. N. Bases of the general and sports hygiene, M., 1972; The General and military hygiene, under the editorship of N. F. Koshelev, JI., 1978; Fundamentals of bioastronautics and medicine, under the editorship of O. G. Gazenko and M. Calvin, t. 3, page 35, M., 1975; Pavlov I. P. Complete works, t. 3, book 1, page 147, M. — JI., 1951; Ecological human physiology, Adaptation of the person to various klimato-geographical conditions, under the editorship of O. G. Gazenko, JI., 1980; Andersson B. Regulation of water intake, Physiol. Rev., v. 58, p. 582, 1978, bibliogr.; Clinical disorders of fluid and electrolyte metabolism, ed. by M. H. Maxwell a. C. R. Kleeman, N. Y., 1972; Gos-ti ll D. L. a. S p a r k s K. E. Rapid fluid replacement following thermal dehydration, J. appl. Physiol., v. 34, p. 299, 1973; Ellis F. P. Heat illness, Trans, roy. Soc. trop. Med. Hyg., v. 70, p. 402, 1977, bibliogr.; Francis K. T. a. Me Gregor R. Effect of exercise in the heat on plasma renin and aldosterone with either water or a potassium-rich electrolyte solution, Aviat., space environ. Med., v. 49, p. 461, 1978.

H. F. Koshelev, K. K. Silchenko.