Determinants of water and sodium intake and output

Physiological regulation of sodium and water intake and output is required for the maintenance of homeostasis. The behavioral and neuroendocrine mechanisms that govern fluid and salt balance are highly interdependent, with acute and chronic alterations in renal output tightly balanced by appropriate changes in thirst and, to a lesser extent in humans, sodium appetite. In healthy individuals, these tightly coupled mechanisms maintain extracellular fluid volume and body tonicity within a narrow homeostatic range by initiating ingestive behaviors and the release of hormones necessary to conserve water and sodium within the body. In this review, the factors that determine output of sodium and fluid and those that determine "normal" input (i.e., matched to output) are addressed. For output, individual variability accompanied by dysregulation of homeostatic mechanisms may contribute to acute and/or chronic disease. To illustrate that point, the specific condition of salt-sensitive hypertension is discussed. For input, physical characteristics, physiological phenotypes, genetic and developmental influences, and cultural and environmental factors combine to result in a wide range of individual variability that, in humans, is compensated for by alterations in excretion.