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Water Balance
• 70-kg man
The minimum obligate water requirement to maintain homeostasis (if temperature and
renal-concentrating ability are normal and solute [urea, salt] excretion is minimal) is
about 800 mL/d, which would yield 500 mL of urine.
“Normal” Intake:
2500 mL/d (about 35 mL/kg/d baseline)
“Normal” Output:
1400–2300 mL/d
Urine: 800–1500 mL
Stool: 250 mL
Insensible loss: 600–900 mL (lungs and skin). (With fever, each degree above
98.6°F [37°C] adds 2.5 mL/kg/d to insensible losses; insensible losses are
decreased if a patient is undergoing mechanical ventilation; free water gain can
occur from humidified ventilation.)
Electrolyte Requirements
• 70-kg adult, unless otherwise specified
Chloride:
80–120 mEq/d as NaCl
Potassium:
50–100 mEq/d (children, 2–3 mEq/kg/24 h). In the absence of hypokalemia and with
normal renal function, most of this K is excreted in the urine. Of the total amount of K,
98% is intracellular, and 2% is extracellular.
If the serum K level is normal, about 4.5 mEq/L, the total extracellular pool of K+= 4.5 ×
14 L = 63 mEq. K is easily interchanged between intracellular and extracellular stores
under conditions such as acidemia or alkalemia. K demands increase with diuresis and
building of new body tissues (anabolic states).
Calcium:
1–3 g/d, most of which is secreted by the GI tract. Routine administration is not needed
in the absence of specific ..