Essentials of fluid management

Water is a vital component of all body fluids, both intracellular and extracellular and makes about 60% of human body. Optimum fluid levels are needed for maintaining vital body functions. About 2.5 liters of fluid is needed every day, for an average adult, to maintain the metabolic demands of the body. This number is just arbitrary and is subjective to change, based on number of factors influencing the fluid loss from the human body.


Functions of fluids in the body

  • Fluid volume is needed to maintain skin turgor and integrity. Diminished fluid volume can predispose an individual to risk for skin integrity, dryness of skin, and even skin breakdown in extreme cases leading to development of pressure ulcers.
  • Water forms a significant component of blood, which is the medium carrying all the essential nutrients and oxygen to all the vital organs of the body, in order to meet their usual metabolic needs. Transport of essential nutrients and oxygen to various vital organs would suffer secondary to low fluid volume, thus compromising their metabolic needs and thereby, leading to their compromised function.
  • Fluid volume is also needed to maintain the blood pressure in the circulatory system, which is the major factor maintain blood flow to vital organs such as, heart, brain, and kidney, and thereby, maintaining their normal function. Low fluid volume contributes to low blood pressure, leading to episodes of hypotension, dizziness, increased confusion, compensatory increase in heart rate, and altered function of many vital organs.
  • Water is very essential for the metabolism essential nutrients, such as, glucose, fat, and protein. Low fluid volume in individuals will contribute to overall compromised metabolism of essential nutrients and thereby, lead to compromised energy levels.
  • Water is a significant component of urine and sweat, which are the media of excretion of waste products and toxins from the body. Water also forms a significant component of stool and helps promote regular bowel movements and prevent constipation.
  • Also, sweat and perspiration with consequent peripheral cooling, helps maintain ideal body temperature.


Major routes of fluid loss from the body are as follows:

  • Kidneys, through the formation of urine, eliminates significant portion of fluid from the body along with the metabolic wastes.
  • Skin is another major route of fluid loss, secondary to perspiration and sweating.
  • Respiration consumes a lot of water, as the gases need to be dissolved in water, to be able to diffuse across the membranes, thus contributing to fluid loss with every cycle of breathing.
  • Water is also significantly consumed for the basic metabolic needs of the body.
  • Apart from these major routes of fluid loss from the body, there are other minor routes, such as, loss of fluid in the stool.
  • As water is lost from the body through both sensible and insensible routes, the need for fluid replacement is paramount, in order to maintain homeostasis and function of vital organs.


Other reasons for increased fluid loss and fluid deficit in the body

  • Apart from the normal routes for fluid loss discussed above, there are some special situations contributing to increased fluid loss from the body, which are frequently ignored. While considering the aspect of fluid loss from the body, including these special situations, most of which apply to our senior citizens, would definitely offer more meaning and complement this discussion.
  • Diabetic individuals with poorly controlled blood sugars, often lose more fluid, secondary to increased frequency of urination.
  • Individuals with HTN and congestive heart failure could be placed on diuretics, to control the BP and prevent fluid retention. Diuretics can result in increased frequency of urination and excessive fluid loss.
  • Individuals with increased intake of caffeinated drinks can also present with increased frequency of urination, as caffeine can act as a bladder irritant, thus increasing the risk for fluid volume deficit.
  • Individuals placed on colostomy could lose excess fluid into the stool, as the function of water reabsorption by the large intestine is obsolete.
  • Individuals with compromised kidney function could lose the capacity to form concentrated urine and consequently, lose excess fluid in the urine and precipitate risk for fluid volume deficit.
  • Individuals with history of frequent urinary tract infections can also present with increased frequency of urination, leading to excessive fluid loss. This fluid volume deficit in the body can act as a major predisposing factor for further urinary tract infections, thus precipitating a vicious cycle of urinary tract infections and fluid deficit influencing each other.
  • Individuals with excessively draining wounds could be losing more fluid in the wound drainage, thus contributing to fluid loss.
  • High environmental temperatures, especially during the summer season, could increase sweating and loss of body fluid.
  • Cold weather conditions can also increase the frequency of urination and thereby result in increased fluid loss from the body.
  • Individuals on supplemental oxygen, are at increased risk for fluid loss, secondary to the oxygen drying up the mucus membranes. Also, individuals with respiratory complaints, such as asthma and COPD, with increased respiratory rate, could be at risk for dehydration, secondary to fluid loss from humidification of air with each breath.
  • Muscle mass is needed to hold the fluid content in the body. Owing to their age, senior citizens slowly lose their muscle mass and consequently, lose their ability to hold the fluid, thus precipitating risk for dehydration.
  • Senior citizens, owing to their forgetfulness and reduced cognition, are likely to ignore the need for rehydration. Their reduced sensitivity to symptoms of fluid deficit in the body adds to the risk for dehydration.


Measures to prevent excessive fluid loss from the body

  • Diabetics should observe compliance with their dietary recommendations and medication intake. Maintaining blood sugar readings in normal ranges can help control the polyuria and so, prevent the excessive fluid loss and risk for dehydration.
  • Observing moderation with intake of caffeinated drinks can reduce the bladder irritation and thereby, reduce the frequency of urination and risk for excessive fluid loss.
  • Encourage individuals with colostomy, compromised kidney function, breathing complaints and oxygen supplementation, and excessively draining wounds, upon measures for replacement of fluid lost.
  • Maintaining ideal room temperature can help with preventing excessive fluid loss in sweat and urine and reduce risk for dehydration.
  • Exercise extra care in attending to atypical symptoms of UTI, such as, increased urination and/or increased episodes of confusion, even though individuals do not present with the typical symptoms of UTI, such as, burning sensation of the urethra, foul smelling urine, fever, and chills. Encourage senior citizens for a small cup of cranberry juice every, which can be a prophylactic measure towards preventing an UTI.
  • Offer frequent reminders for senior citizens frequent reminders on a timely basis with regards to hydration. Make sure that they have access to drinking water always, both indoors and outdoors. Encourage them to fall into the habit of carrying a bottle of water with them always.
  • Encourage senior citizens towards having regular physical activity and exercise, as their endurance permits.


Signs and symptoms of fluid volume deficit to watch for

Evaluate any of the following conditions for possible fluid volume deficit and dehydration

  • Any dryness of mouth and mucus membranes.
  • Any decrease in the level of consciousness and increase in confusion.
  • Any increase in the frequency of urinary tract infections.
  • Any increase in the frequency of constipation episodes.
  • Any complaint of reduced urine formation or formation of dark concentrated urine.
  • Any consistent decrease in the blood pressure.
  • Any consistent increase in the heart rate.
  • Any increase in episodes of elevated body temperatures, with no reason identified.
  • Any scaling of the skin with dry mucus membranes.
  • Any risk for skin integrity, especially with the skin on dependent body parts.
  • Any compromised skin turgor with tenting of skin.
  • Any sudden increase in the frequency of confusion and episodes of irritability.
  • Any sudden compromise with endurance and increased exhaustion.