Critically ill patients often report distressful episodes of severe thirst, but the complex biochemical, neurohormonal mechanisms that regulate this primal sensation still elude clinicians. The most potent stimuli for thirst are subtle increases in plasma osmolality. These minute changes in osmolality stimulate central osmoreceptors to release vasopressin (also known as antidiuretic hormone). Vasopressin in turn acts on the kidneys to promote the reabsorption of water to correct the increased osmolality. If this compensatory mechanism fails to decrease osmolality, then thirst is triggered to motivate drinking. In contrast, thirst induced by marked volume loss, or hypovolemic thirst, is subject to the tight osmoregulation of the renin-angiotensin aldosterone system and accompanying adrenergic agonists. Understanding the essential role that thirst plays in salt and water regulation can provide clinicians with a better appreciation for the complex physiology that underlies this intense sensation.
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1 July 2013
Critical Care Evaluation|
July 01 2013
Thirst in Critically Ill Patients: From Physiology to Sensation
Shoshana Arai, RN, PhD;
Shoshana Arai is an assistant adjunct professor in physiological nursing, Nancy Stotts and Kathleen Puntillo are professors at University of California San Francisco, School of Nursing, San Francisco, California.
Corresponding author: Shoshana Arai, rn, phd, University of California San Francisco, School of Nursing, 2 Koret Way, San Francisco, CA 94143-0610 (e-mail: shoshana.arai@nursing.ucsf.edu).
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Nancy Stotts, RN, EdD;
Nancy Stotts, RN, EdD
Shoshana Arai is an assistant adjunct professor in physiological nursing, Nancy Stotts and Kathleen Puntillo are professors at University of California San Francisco, School of Nursing, San Francisco, California.
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Kathleen Puntillo, RN, PhD
Kathleen Puntillo, RN, PhD
Shoshana Arai is an assistant adjunct professor in physiological nursing, Nancy Stotts and Kathleen Puntillo are professors at University of California San Francisco, School of Nursing, San Francisco, California.
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Am J Crit Care (2013) 22 (4): 328–335.
Citation
Shoshana Arai, Nancy Stotts, Kathleen Puntillo; Thirst in Critically Ill Patients: From Physiology to Sensation. Am J Crit Care 1 July 2013; 22 (4): 328–335. doi: https://doi.org/10.4037/ajcc2013533
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