Fluid balance concepts in medicine: Principles and practice

doi:10.5527/wjn.v7.i1.1

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Nephrol. Jan 6, 2018; 7(1): 1-28
Published online Jan 6, 2018. doi: 10.5527/wjn.v7.i1.1

Table 1 Anthropometric formulas estimating body water

Adults, normal body water values

Hume and Weyers formulae[63]

Women: TBW = -35.270121 + 0.344547H + 0.183809W

Men: TBW = -14.012934 + 0.194786H + 0.296785W

Watson et al[64] formulae

….Women: TBW = -2.097 +0.1069H + 0.2466W

Men: TBW = 2.447 - 0.09516A + 0.1074H + 0.3362W

Chumlea et al[65] formulae

Women, African American: TBW = -16.71 - 0.05A + 0.24H + 0.22W

Women, Caucasian: TBW = -10.50 - 0.01A + 0.18H + 0.20W

Men, African American: TBW = -18.37 - 0.09A + 0.25H + 0.34W

Men, Caucasian: TBW = 23.04 - 0.03A + 0.50W - 0.62BMI

Children, normal body water values

Mellits, Cheek formulae[66]

Girls, H ≤ 110.8 cm: TBW = 0.076 + 0.013H + 0.507W

Girls, H > 110.8 cm: TBW = -10.313 + 0.154H + 0.252W

Boys, H ≤ 132.7 cm: TBW = -1.927 + 0.045H + 0.465W

Boys, H > 132.7 cm: TBW = -21.993 + 0.209H + 0.465W

Adults, pre-hemodialysis

Chertow et al[71] formula

TBW = 0.07493713A - 1.01767992G + 0.57894981D + 0.12703384H - 0.04012056W - 0.00067247W2 - 0.03486146 (A × G) + 0.11262857 (G × W) + 0.00104135 (A × W) + 0.00186104 (H × W)

Adults, peritoneal dialysis

Johansson et al[72] formulae

Women: TBW = -29.994 - 0.004A + 0.294H + 0.214W

Men: TBW = -10.759 - 0.078A + 0.192H + 0.312W

…. All patients: TBW = -42.879 - 0.033A + 0.372H + 0.274W

Note that the Watson formula for men has an age term while the Watson formula for women has no age term. Age effects on body water are more pronounced in men than in women. This is clearly indicated by the coefficients for age in the Chumlea and Johansson formulas. TBW: Total body water (L); H: Height (cm); A: Age (yr); BMI: Body mass index (kg/m²); G: Gender (male = 1, female = 0); D: Diabetes (present = 1, absent = 0).

Table 2 Formulas for treatment of dysnatremias with saline or water infusions

Hypotonic hyponatremia

Change in sodium concentration after infusion of 1 L of saline. Adrogué-Madias formula[41]:

[Na]_Final - [Na]_Initial = ([Na]_Infusate - [Na]_Initial)/(TBW_Initial + 1)

Volume of saline required for a targeted serum sodium concentration[84]:

V_Infusate = TBW_Initial × ([Na]_Targeted - [Na]_Initial)/[Na](_Infusate - [Na]_Targeted)

Hypernatremia

Volume of D5/W required for a targeted serum sodium concentration[37]:

V_Infusate = TBW_Initial × ([Na]_Initial - [Na]_Targeted)/[Na]_Targeted

Volume of hypotonic saline required for a targeted serum sodium concentration[37]:

V_Infusate = TBW_Initial × ([Na]_Initial - [Na]_Targeted)/([Na]_Targeted - [Na]_Infusate)

[Na]_Final: Final serum sodium concentration after infusion of 1 L of saline with a sodium concentration higher than the initial serum sodium concentration; [Na]_Initial: Initial serum sodium concentration; [Na]_Infusate: Sodium concentration in the infused saline; TBW_Initial: Initial volume of body water; V_Infusate: Volume of infused saline or dextrose required for a targeted change in serum sodium concentration; [Na]_Targeted: Targeted value of serum sodium concentration.

Table 3 Measurement of extracellular volume by tracer dilution

Extracellular marker	Ref.
Inulin	[101]
Sucrose	[102]
Thiosulfate	[103,104]
Mannitol	[105]
Radiosulfate (S³⁵)	[106,107]
Bromide	[108,109]
Radiochloride (Cl³⁸, Cl³⁶)	[109,110]
Stable chloride (Cl³⁵)	[111]
Radiosodium (Na²⁴)	[112]
Thiocyanate	[113]

Table 4 Measurement of extracellular volume by newer methods

Methodology	Ref.
Methods evaluating body composition
Bioelectrical impedance, bioelectrical impedance vector analysis	[115-123]
Dual-energy X-ray absorptiometry	[124-132]
Magnetic resonance imaging	[133]
Methods measuring total body water and intracellular volume
Simultaneous measurement of total body water and potassium	[134-136]
Methods using GFR markers
Inulin	[138,139]
Polyfructosan	[140]
51cromium ethylenediamine tetra-acetic acid (⁵¹Cr- EDTA)	[141-143]
Iohexol	[144]
Technetium diethylene triamine penta-acetic acid (⁹⁹mTC-DTPA)	[145,146]
Iothalamate	[147]

GFR: Glomerular filtration rate.

Table 5 Factors affecting cell- and organ-perfusion (effective arterial blood volume)

Blood volume

Red blood cell mass

Plasma volume

Cardiac output

Vascular capacity

Arterial resistance, total

Arterial resistance, regional

Venous capacity

Starling forces in blood capillaries

Endothelial barrier integrity

Gravity

Citation: Roumelioti ME, Glew RH, Khitan ZJ, Rondon-Berrios H, Argyropoulos CP, Malhotra D, Raj DS, Agaba EI, Rohrscheib M, Murata GH, Shapiro JI, Tzamaloukas AH. Fluid balance concepts in medicine: Principles and practice. World J Nephrol 2018; 7(1): 1-28
URL: https://www.wjgnet.com/2220-6124/full/v7/i1/1.htm
DOI: https://dx.doi.org/10.5527/wjn.v7.i1.1