WATER BALANCE

Input A constant supply is needed to replenish the fluids lost through normal physiological activities, such as respiration, sweating and urination. Water generated from

the biochemical metabolism of nutrients provides a significant proportion of the daily water requirements for some arthropods and desert animals, but provides only a small fraction of a human's necessary intake. In the normal resting state, input of water through ingested fluids is approximately 1200 ml/day, from ingested foods 1000 ml/day and from aerobic respiration 300 ml/day, totaling 2500 ml/day.[9]

Regulation of input Input of water is regulated mainly through ingested fluids, which, in turn, depends on thirst. An insufficiency of water results in an increased osmolarity in the extracellular fluid. This is sensed byosmoreceptors in the organum vasculosum of the lamina terminalis, which trigger thirst. Thirst can to some degree be voluntarily resisted, as during fluid restriction.

Output

The majority of fluid output occurs via the urine, approximately 1500 ml/day (approx 1.59 qt/day) in the normal adult resting state.[9][10]

Some fluid is lost through perspiration (part of the body's temperature control mechanism) and as water vapor in expired air. These are termed "insensible fluid losses" as they cannot be easily measured. Some sources say insensible losses account for 500 to 650 ml/day (0.5 to 0.6 qt.) of water in adults,[9][11] while other sources put the minimum value at 800 ml (0.8 qt.).[12] In children, one calculation used for insensible fluid loss is 400ml/m2 body surface area.

In addition, an adult loses approximately 100ml/day of fluid through feces.[9][13] For females, an additional 50 ml/day is lost through vaginal secretions. These outputs are in balance with the input of ~2500 ml/day.[9]

DEHYDRATION

Dehydration means your body does not have as much water and fluids as it should. Dehydration can be mild, moderate, or severe based on how much of the body's fluid is lost or not replenished. When it is severe, dehydration is a life-threatening emergency.

Causes, incidence, and risk factors Dehydration can be caused by losing too much fluid, not drinking enough water or fluids, or both. Your body may lose too much fluids from:

Excessive sweating (for example, from exercise) Excessive urine output, such as with uncontrolled diabetes or diuretic use Fever Vomiting or diarrhea

You might not drink enough fluids because of:

Loss of appetite due to illness Nausea Sore throat or mouth sores Dehydration in sick children is often a combination of refusing to eat or drink anything and

losing fluid from vomiting, diarrhea, or fever. Infants and children are more likely to become dehydrated than adults because they weigh less and their bodies turn over water andelectrolytes more quickly. The elderly and people with illnesses are also at higher risk.

Symptoms

Dry or sticky mouth Lethargy or coma (with severe dehydration) Low or no urine output; urine looks dark yellow No tears Sunken eyes Sunken fontanelles (the soft spot on the top of the head) in an infant

You may also have vomiting, diarrhea, or the feeling that you "can't keep anything down." All of these can be causing the dehydration.

Signs and tests A physical examination may also show signs of:

Blood pressure that drops when you go from lying down to standing Delayed capillary refill Low blood pressure Poor skin turgor -- the skin may not be as elastic as normal and sag back into position slowly when the health care provider pinches it up into a fold (normally, skin springs right back into place)

Rapid heart rate Shock

Tests include:

Blood chemistries (to check electrolytes, especially sodium, potassium, and bicarbonate levels)

Blood urea nitrogen (BUN) Complete blood count (CBC) Creatinine Urine specific gravity

Other tests may be done to determine the cause of the dehydration (for example, blood sugar level to check for diabetes).