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Original Article
45 (
); 1-4

Salivary electrolyte changes in response to flying stress

Sc F, Dept. of Biochemistry, 1AM, IAF, Vimanapura, Bangalore-560 017
Graded Specialist (Av Med), AF Station, Panagarh


Changes in salivary K+, Na+ and K7Na+ ratio were investigated in twenty pilots after a test flight of 45 min. Fighter pilots (FP, n = 14) performed the mission in MiG-21 supersonic aircraft whereas helicopter pilots (HP, n=6) performed the sorties in Mi-17 helicopter. Pre flight salivary K+ and K7 Na+ ratio of all pilots did not show any significant post flight change. However, pre and post flight salivary K+ and K7Na+ ratio were found to be significantly related to aircraft types (AC) and flying experience (FE). In FP, salivary K+ showed significant post flight rise while in HP no such changes were noted. In pilots with FE of <2370 h preflight salivary K+ showed a post flight rise while in pilots with FE of >2370 h, salivary K+ showed no significant change. The rise in the delta value of K7Na+ ratio in pilots with <2370 h of FE were significantly higher than the reduction in the delta value of K+/Na+ ratio noted in pilots with >2370h of FE. Pilots with FE of >2370 h exhibited a significantly higher pre flight K+, and K7Na+ ratio than the pilots with <2370 h of FE. Results show usefulness of salivary K+, Na+, K+/Na+ ratio for assessing the stress response of pilots in relation to AC and FE


Salivary electrolytes
flying stress

Various studies have demonstrated that the measurement of salivary K+ and Na+ level could be used as practical method for - monitoring the change in sympatho-adreno-corti-cal activity (SACA). Enhanced SACA as caused by acute stressor results in rapidly increased secretion of K and some lowering of Na+ in the saliva [1-14].

Significant relative changes in the ionic concentration of salivary K+ and Na+ have been reported following experimental task demands in the form of university work, lectures in the final examination, academic work in students, increased arousal in anesthetics in operation theatre and in pilots after exposure to simulated air combat manoeuvre (SACM) [3, 4, 8, 12, 15].

Salivary K+ has mainly been linked with psychological stressor, while salivary Na+ has been related to physical stressor [3, 4, 8, 15, 16]. Aviation stress has a component of both the stressors hence measurement of salivary K+ and Na+ could serve the purpose of assessing psycho physiological variation in the stress response of pilots during a flight trial.


Twenty healthy male Air Force pilots (Mean age : 31.3 yrs. ht: 173.3 cm. wt: 66.7 kg) with a mean flying experience (FE) of 2370±751 h participated in this study. An informed consent was obtained from each subject. They performed a test flight mission of 45 min. The test flight included sorties such as system testing, performance testing, flight quality testing, directional flying and spin exercise. The basic purpose of the test flight was to evaluate the effect of any addition or alteration in the aircraft system. During the sorties the fighter pilots (FP) were exposed to acceleration (+Gz) forces which did not exceed +5Gz. All the sorties were performed between 0900 to 1300 h. FP (n=14) performed the mission in MiG-21 supersonic aircraft whereas the helicopter pilots HP (n=6) performed the sorties in Mi-17 helicopter. Salivary samples were collected twice, once before the start and another after completion of the mission in a wide mouthed plastic centrifuge tube. Subjects were asked to dribble only that saliva which was in the mouth. They were instructed not to produce any saliva by mouth manipulation. Salivary samples were analysed for K+ and Na+ by flame photometry (EEL. London). Students paired and unpaired 't' test were applied for analysing the statistical significance for the changes in salivary electroytes.


Salivary K+ and Na+ and K7Na+ ratio of all pilots did not show any significant post flight changes. The FE of all pilots ranged from 1248-4147h. Their mean flying experience (MFE) was 2370 ± 751 h. The salivary K+, Na+ and K+/Na+ ratio were found to be significantly affected by aircraft type (AC) and FE. In FP salivary K+ showed a significant post flight rise. In HP this was insignificant. In less experienced pilots (LEP) with FE <2370 h with MFE of 1762 ± 265 h, salivary K+ exhibited a significant post flight rise. In more experience pilots (MEP) with FE >2370h with MFE of 2979 ± 546 h salivary K+ showed no significant post flight change. The rise and reduction observed in the delta value of K7Na+ ratio for LEP and MEP were significantly higher for one group than the other. The MEP had a significantly higher pre flight K+ and KVNa+ ratio than the LEP. The rest of changes in salivary ionic constituents between the various group of pilots were not significant (Table-1).

Table 1: Flying experience (FE), pre and post flight, difference of salivary K+, Na+ and K7Na+ ratio of all pilots (AP), fighter pilots (FP), helicopter pilots (HP), less experienced pilots (LEP) and more experienced pilots (MEP). All values are expressed as mean ±SD.
AP (n = 20) FP (n = 14) HP (n = 6) LEP (n = 10) MEP (n = 10)
FE (h) 2370 + 751 2182 ±533 J2809 ± 1036 1762 ± 265
Salivary K+ (mmol/1)
Pre 22.3 ±7.5 20.9 ± 8.3 25.8 + 3.9 18.4 ±7.8@
Post 27.3 ± 8.2 28.5 ± 7.9 24.4 ± 8.8 28.4 ± 9.0 10.0
Difference 5.0 ± 11.9 7.6 ± 12.7* -1.4 ± 6.9 ± 13.4*
Salivary Na+ (mmol/1)
Pre 8.5 ± 4.7 8.9 ± 5.2 7.6 ± 3.6 9.0 ± 4.0 12.0
Post 9.8 ± 7.4 11.0 ± 8.6 7.1 ± 2.7 ± 10.2 3.0 ±
Difference 1.3 ± 6.6 2.1 ± 7.8 -0.5 ± 1.6 7.5
K7Na+ ratio
Pre 3.7 ±2.9 3.6 ± 3.2 4.1 ±2.1 2.4 ±1.2® 3.9
Post 3.7 ± 1.8 3.7 ± 2.0 3.6 ± 1.3 ± 2.4
Difference 0.0 ± 3.3 0.1 ± 3.7 -0.5 ± 1.9 1.4 ± 2.5*
2979 ± 546
26.3 ± 5.0@
26.2 ± 7.7 -0.1
± 7.9
8.0 ± 5.5 7.7 ±
1.6 -0.3 ± 5.4
5.0 ± 3.4® 3.5
± 1.1 -1.6 ±


The composition of saliva is subject to hormonal modulation by adrenocortical steroids [2, 5, 13, 17, 18]. The adrenocortical steroids act directly on the salivary glands to increase the reabsorption of Na+ and secretion of K+. Increased activity of sympathetic system as caused by acute stressor also results in rapidly enhanced secretion of K* and some lowering of Na+ in saliva [3, 4, >. 12, 15]. As flying stress is likely to be associated with significant increase in the SACA, a post flight increase in the secretion of salivary K+ and reabsorption of Na+ were expected, but no such changes were noted in all group of pilots, demonstrating adaptation of SACA to flying stress.

In this study the level of salivary K+ and K7 Na+ ratio appeared to be influenced by AC and FE. In FP, flight induced significant post flight rise in salivary K+ while in HP no such changes were noted. The post flight rise in salivary K+ in FP may be related to greater stress associated with high +GZ exposure. The unresponsiveness in HP indicates reduced physiological activity or diminished SACA due to adaptation to flying. In the LEP, flight induced significant elevation in salivary K+ and greater rise in the delta value of K7Na+ ratio than MEP. As compared to the above in MEP post flight variations in salivary K+ and Na+ were indistinct while the delta value of K+/Na+ ratio showed a greater reduction than LEP. This difference apparently relates to FE and shows that as the FE increases the response of SACA diminish in magnitude. The diminished response of SACA in MEP may be an indicator of higher flight proficiency and greater flight capability [6, 9, and 11].

This study has also demonstrated significantly higher pre flight salivary K+ and K+/ Na+ ratio in MEP than in LEP. March banks et al [9, 10] and Kramer et al [7], have reported a higher preflight urinary level of neither epinephrine (E), nor epinephrine (NE) and 17-hydroxycorticosteroid (17-OHCS) in fliers than in non-fliers. Burton et al [1] have reported that the pilots engaged in aerial combat manoeuvres (ACM), who were regularly subjected to high +Gz exhibited a significantly higher urinary levels of E, NE and 17-OHCS both on flying and non flying days as against the controls. They further observed that the preflight urinary levels of these parameters in ACM pilots were even higher than the pilots engaged in lengthy flights without any significant increase in G load. Our observation of significantly higher preflight salivary K+ and K+/Na+ ratio in MEP indirectly demonstrated the presence of heightened SACA in them. These findings suggest adaptive changes in SACA and may be the result of repeated exposure to flying stress in MEP.

It can thus be summarized, that the determination in the variability of salivary ionic composition could be used as a practical method for assessing the effects of 'real life' stressors under various conditions.


  1. , , , and , et al. Stress response of pilots flying high performance aircraft during aerial combat manoeuvres. Aviat Space Environ Med. 1977;48:301-7.
    [Google Scholar]
  2. , . The relation of Salivary NaVK+ ratio to adrenal cortical activity. In: , ed. Proceedings of the second clinical ACTH conference. Vol Vol 1. New York: Blakiston; .
    [Google Scholar]
  3. , , . Relative changes in salivary Na+ and K+ in relation to exposure to high G stress. Med J Armed Forces Ind. 1994;50:261-5.
    [Google Scholar]
  4. , , , , , , , et al. Relative changes in salivary Na+ and K* concentration in relation to stress induction. Biological Psychology. 1992;33:63-71.
    [Google Scholar]
  5. , , , , . Crew workload in JASDF C-l Transport flights: 1. Changes in heart rate and salivary Cortisol. Aviat Space Environ Med. 1988;59:511-6.
    [Google Scholar]
  6. . Trace element and hormonal responses during flight aptitude test. Aviat Space Environ Med. 1996;67:333-7.
    [Google Scholar]
  7. , , . Physiological effects of 18 hour flight in 4-C aircraft. Aerospace Med. 1966;37:1095-8.
    [Google Scholar]
  8. , . Dynamics of the mental work capacity and salivary electrolyte excretion in 4th and 6th grade pupils as affected by the academic workload. Gigiena Sanitaria. 1984;35:52-3.
    [Google Scholar]
  9. . Effect of flying stress on 17-OHCS levels. J Aviat Med. 1958;29:676-82.
    [Google Scholar]
  10. . Flight stress and urinary 17-OHCS during 20 hour mission. Aerospace Med. 1960;31:639-43.
    [Google Scholar]
  11. , , . Stress response of pilots flying 6 hour over water mission in F-100 and F-104 aircraft. Aerospace Med. 1963;34:15-8.
    [Google Scholar]
  12. , , , . Changes in salivary K+, Na* and KVNa* ratio with varied test demands. Biological Psychology. 1995;39:131-42.
    [Google Scholar]
  13. , . Saliva Cortisol : A good indicator for acceleration stress. Aviat Space Environ Med. 1987;58:573-5.
    [Google Scholar]
  14. , . Hormonal responses of pilots flying high performance aircraft during seven repetitive flight missions. Aviat Space Environ Med. 1991;62:1127-31.
    [Google Scholar]
  15. . Na+ content of saliva during certain types of emotionally disturbing work in students. Gigiena Sanitaria. 1982;33:29-32.
    [Google Scholar]
  16. , . Effect of exercise on Na+ and K+ concentrations in human saliva and serum. J Appl Physiol. 1963;18:812-1.
    [Google Scholar]
  17. , , . The salivary K7Na+ ratio-A useful screening test for aldosteronism in hypertensive subjects. New Eng J Med. 1962;267:1136-7.
    [Google Scholar]
  18. , , , . Salivary electrolytes, rennin and aldosterone during Na+ loading and depletion. J Appl Physiol. 1973;35:322-4.
    [Google Scholar]

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