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Biomedicine & Preventive Nutrition 3 (2013) 193–195

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Review

A comprehensive review on water balance

Muhammad Akram a,∗ , Abdul Hamid b
a
Department of Eastern Medicine and Surgery, Faculty of Medical and Health Sciences, The University of Poonch, Rawalakot, Azad Jammu and Kashmir, Pakistan
b
Department of Horticulture, Faculty of Agriculture, The University of Poonch, Rawalakot, Azad Jammu and Kashmir, Pakistan

a r t i c l e i n f o a b s t r a c t

Article history: Water is more important than any other single compound to life. It is involved in several body functions.
Received 28 September 2012 Water acts as a vehicle for transport of solutes. Water is the major body constituent. An adult human
Accepted 23 October 2012 contains about 60% water (men 55–70%, women 45–60%). A 70 kg man contains 42 L of water. This is
distributed in intracellular (inside the cells 28 L) and extracellular (outside the cells 14 L) compartments,
Keywords: respectively known as intracellular fluid and extracellular fluid. The body has tremendous capacity to
Water balance regulate its water content. In a healthy individual, this is achieved by balancing the daily water intake
Regulation of water
and water output.
ICF
ECF © 2012 Elsevier Masson SAS. All rights reserved.

1. Introduction conjuctiva, etc. The fluidity of blood is due to water. Makino et al. [1]
have studied the physiological functions of the water-water cycle
Water intake is normally by mouth and absorption is from all (Mehler reaction) and the cyclic electron flow around PSI in rice
parts of gastrointestinal tract. Water is the solvent of life. Undoubt- leaves.
edly, water is more important than any other single compound to
life. It is involved in several body functions. Water provides the
3. Total body water
aqueous medium to the organism which is essential for the vari-
ous biochemical reactions to occur. Water directly participates as a
It is the amount of water content present in the body. It is 75%
reactant in several metabolic reactions. It acts as a vehicle for trans-
of total body weight in a newborn. It is 55% of total body weight
port of solutes. Water is closely associated with the regulation of
in adult males. It is 50% of total body weight in adult females. The
body temperature. Water is the major body constituent. An adult
difference in the percentage of body water is due to excess amount
human contains about 60% water (men 55–70%, women 45–60%).
of fat depot in the females. The amount of total body water content
The women and obese individuals have relatively less water which
(60% of total body weight or 42 L in 70 kg patient) is an accepted
is due to the higher content of stored fat in an anhydrous form. A
average in adults for clinical calculations [2].
70 kg man contains 42 L of water. This is distributed in intracellu-
lar (inside the cells 28 L) and extracellular (outside the cells 14 L)
compartments, respectively known as intracellular fluid and extra- 4. Intracellular fluid
cellular fluid. The ECF is further divided into interstitial fluid and
plasma. Two third (66%) of total body weight (40% of total body weight)
is present in the intracellular compartments. Largest proportion
of this water is present in female; the percentage of intracellular
2. Physiological functions of water
water is lower than in males. The principle cations of intracellular
compartments are potassium and magnesium and principle anion
It acts as solvent for transportation of substances inside and
are phosphates and proteins.
outside the cells. It is an essential constituent of cell structures.
It provides media for biochemical reactions. It regulates body
temperature by losing heat through water lost from the body. It 5. Extracellular fluid
provides a lubricating action to prevent friction in joints, pleura and
One third (33%) of the total body water (20% of body water) is
present in the extracellular compartment. It is further subdivided
∗ Corresponding author.
into intravascular and interstitial fluid compartments. In the ECF,
E-mail addresses: makram 0451@hotmail.com, makram 0451@yahoo.com
sodium is the principle cation and chloride and bicarbonate are the
(M. Akram). principle anions.

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194 M. Akram, A. Hamid / Biomedicine & Preventive Nutrition 3 (2013) 193–195
6. Intravascular fluid
It is the part of extracellular fluid present in intravascular com-
partment. It is 5% of body weight or ¼ of ECF (2.8 L in 70 kg adult).
Intravascular fluid is present in the blood which is composed of cells
(red cells, white cells, platelets and plasma [fluids into dissolved
protein]).
7. Interstitial fluids
It is the part of the extracellular fluid present in the intersti-
tial space (15% of body weight or ¾ of ECF). The interstitial fluid
is further complicated by having a rapidly equilibrating or func-
tional compartment as well as several more slowly equilibrating
or relatively non-functioning components. These non-functioning
components comprise connective tissue water as well as transcel-
lular water including:
• cerebrospinal fluid;
• peritoneal fluid;
• joint fluids;
• secretions of the gastrointestinal tract;
• fluid in renal tubules.
This non-functioning component normally represents only 10%
of the interstitial fluid volume (1–3% of body weight).
8. Water turns over and balance
The body has tremendous capacity to regulate its water content.
In a healthy individual, this is achieved by balancing the daily water
intake and water output.
9. Water intake
Water is supplied to the body by exogenous and endogenous
sources.
10. Exogenous water
Ingested water and beverages, water content of solid foods
constitute the exogenous source of water. Water intake is highly
variable which may range from 0.5–5 L. It largely depends on the
social habits and climate. In general, people living in hot climate
drink more water. Ingestion of water is mainly controlled by a thirst
center located in the hypothalamus. Increase in the osmolality of
plasma causes increased water intake by stimulating thirst centre.
11. Endogenous water
The metabolic water produced within the body is the endoge-
nous water. This water is derived from the oxidation of foods stuffs.
It is estimated that 1 g each of carbohydrate, protein and fat, respec-
tively, yield 0.6 mL, 0.4 mL and 0.1 mL of water. On an average, about
125 mL of water is generated for 1000 Cal consumed by the body.
12. Water output
Water losses from the body are variable. There are different
routes for the elimination of water from the body, urine, skin, lungs,
feces, tears, milk and vomiting. Amount of water intake or loss
depends upon temperature and other environmental conditions.
13. Urine
This is the major route for water loss from the body. In a healthy
individual, the urine output is about 1–2 L/day. Water loss through
kidneys although highly variable, is well regulated to meet the body
demands–to get rid of water or to retain, it should, however, be
remembered that man cannot completely shut down urine pro-
duction, despite there being no water intake. This is due to the fact
that some amounts of water (about 500 mL/day) are essential as
the medium to eliminate the waste products from the body.
14. Hormonal regulation of urine production
It is indeed surprising to know that about 180 L of water is fil-
tered by the glomeruli into the renal tubules every day. However,
most of this is reabsorbed and only 1–2 L are excreted as urine.
Water excretion by the kidney is tightly controlled by vasopressin
also known as antidiuretic hormone of the posterior pituitary gland.
The secretion of ADH is regulated by the osmotic pressure of
plasma. An increase in osmolality promotes ADH secretion that
leads to increased water reabsorption from the renal tubules (less
urine formation). On the other hand, a decrease in osmolality sup-
presses ADH secretion that results in reduced water reabsorption
from the renal tubules (more urine output). Plasma osmolality
is largely dependent on the sodium concentration, hence sodium
indirectly controls the amount of water in the body [3].
15. Diabetes insipidus
Diabetes insipidus is a disorder characterized by the deficiency
of ADH which results in an increased loss of water from the body
[4].
16. Skin
Loss of water (450 mL/day) occurs through the body surface by
perspiration. This is an unregulated process by the body which
mostly depends on the atmospheric temperature and humidity.
The loss is more in hot climate. Fever causes increased water loss
through the skin. It is estimated that for every 1 centigrade rise in
body temperature, about 15% increase is observed in the loss of
water (through skin).
17. Lungs
During perspiration, some amount of water (about 400 mL/day)
is lost through the expired air. The latter is saturated with water and
expelled from the body. In hot climates and/or when the person is
suffering from fever, the water loss through lungs is increased. The
loss of water by perspiration (via skin) and respiration (via lungs)
is collectively referred to as insensible loss.
18. Feces
Most of the water entering the gastrointestinal tract is reab-
sorbed by the intestine. About 150 mL/day is lost through feces in
a healthy individual. Fecal loss of water is tremendously increased
in diarrhea.
19. Water intoxication
This occurs in the following conditions: hypersecretion of ADH:
this occurs after anesthesia for surgery, administration of nar-
cotic drugs such as morphia and stress due to any cause including
surgery. There is usually a period of water retention for 12–36 hours
 Author's personal copy
M. Akram, A. Hamid / Biomedicine & Preventive Nutrition 3 (2013) 193–195
following a surgical operation; renal failure due to any cause
can lead to water retention; excessive administration of fluids by
mouth or parenterally. Gardner has reported death by water intox-
ication [5].
20. Symptoms of intoxication
The subject becomes mentally confused, develops aphasia, in
co-ordination, delirium, muscular weakness, nausea and vomiting.
He may finally develop convulsions and coma [6].
21. Clinical changes
The PCV, hemoglobin and plasma protein concentrations are all
decreased. Urine volume is usually increased and is of low specific
gravity. Okura et al. [7] have reported the electroencephalographic
changes during and after water intoxication.
22. Role of Withania somnifera in dehydration
Dehydration or water deprivation in the body decreases urine
output and urea and other waste products are accumulated in the
blood. A study was conducted to evaluate the association of uremia
and oxidative stress by applying the herbal plant Withania som-
nifera (W. somnifera) (Aswagandha). The study was performed on
dehydrated male rats. Eighteen rats were selected for study and
were randomly divided into three groups: Group-1, control, Group-
2, only dehydration and Group-3, dehydration + administration of
aqueous root extract of W. somnifera, orally. After 25 days of treat-
ment, it was observed that the body weight of Group-3 animals had
increased significantly, while that in Group-2 had decreased signif-
icantly. In Group-2 animals, the serum urea and creatinine levels
increased significantly when compared with animals in Groups-1
and 3.
The low levels of serum urea and creatinine in Group-3 ani-
mals indicate the protective effect of the plant extract against
renal injury caused by dehydration. Dehydration-induced oxida-
tive stress was established in our study by noting the low activities
of super-oxide dismutase and catalase, both important antioxidant
enzymes, in Group-2 animals; both enzymes were stabilized in ani-
mals of Groups-3 and 1. As a conclusion, it was hypothesized that
W. somnifera has antioxidant activity that is responsible in reducing
the extent of renal injury as a result of oxidative stress [8].
23. Discussion
Water balance is maintained mainly by two mechanisms that
are thirst mechanism and ADH mechanism. Thirst sensation often
referred to the mouth and throat, interpreted as a conscious desire
for water. Thirst center is located in lateral preoptic area of the
195
hypothalamus anterior to the supraoptic nuclei. Thirst center is
stimulated by hypertonicity of ECF, hypovolemia, decrease cardiac
output, drying of mouth. ADH is secreted in supraoptic nuclei of
hypothalamus. When hypertonicity occurs then ADH is increased.
Pure water deprivation occurs when water loss is not completely
replaced by water intake. If subject fails to receive water, cellular
proteins undergoes breakdown liberating K into body fluid which
ultimately excreted in exchange of NA. All these effects result in
depressed cell function, if these processes continue, death ensues.
Water intoxication occurs when water content of body increases
without proportional increase in electrolytes [9,10].
24. Conclusion
Water is involved in several body functions. Water is closely
associated with the regulation of body temperature. Water is the
major body constituent. Water is supplied to the body by exoge-
nous and endogenous sources. Ingested water and beverages, water
content of solid foods constitute the exogenous source of water.
The metabolic water produced within the body is the endogenous
water. There are different routes for the elimination of water from
the body, urine, skin, lungs, feces, tears, milk and vomiting. Amount
of water intake or loss depends upon temperature and other envi-
ronmental conditions.
Disclosure of interest
None of the individuals compiling this information has any
affiliations or financial involvement that conflicts with the material
presented in this article.
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