Space sickness and fluid shifts: a hypothesis

In a sample of 64 first-time Space Shuttle crew members, 9 preflight variables related to fluid, electrolyte, and cardiovascular status were previously found to be significantly related to space sickness. The nine variables are serum uric acid, red cell count, environmental temperature at the launch site, serum phosphate, urine osmolality, serum thyroxine, sitting systolic blood pressure, calculated blood volume, and serum chloride. Using discriminant analysis, these preflight variables were used to correctly classify the 64 astronauts according to their space sickness incidence (NOTSICK or SICK) with 80% success, using two methods of pseudo-crossvalidation. Symptoms of motion sickness may be induced on Earth, either with a sufficiently high level of vestibular stimulation or with less vestibular stimulation after reducing the threshold for motion sickness induction. Some of the nine predictor variables support a fluid shift hypothesis of space sickness etiology by which central volume expansion in weightlessness may lower the threshold required for novel vestibular stimulation to cause space sickness. According to this hypothesis, some astronauts suffer a greater central volume expansion than do others, causing them to have greater physiologic responses to fluid shifts, which, in turn, proportionally reduces their threshold for induction of space sickness. The hypothesis is supported by preflight and postflight echocardiographic comparisons of heart volumes in 19 shuttle astronauts. The postflight left ventricular diastolic volume index was decreased by 34 +/- 3% in the astronauts with MODERATE or SEVERE space sickness, but only 9 +/- 5% (P < .05) in the NONE or MILD group, indicating that an exaggerated physiologic adaptation to fluid shifts is associated with space sickness.