Manual of Clinical Nutrition

Manual of Clinical Nutrition Management A- 32 Copyright © 2013 Compass Group, Inc.

NUTRITION MANAGEMENT OF FLUID INTAKE AND HYDRATION

Description
Adequate fluid intake is necessary to maintain optimum hydration or to correct a state of dehydration or
overhydration. The amount of fluid required to maintain the optimum hydration level varies with the
medical condition of the patient. The vast majority of healthy people adequately meet their daily hydration
needs (1). When assessing total water intake, all food and beverage sources providing water should be
included in estimating daily fluid intake (1). The Dietary Reference Intake for water and daily fluid
requirements of older adults is based on water consumed in the diet from a variety of sources including foods
and beverages such as milk, tea, coffee, juice and water (1). Recommendations for daily water intake for all
age groups can be found in Dietary Reference Intakes (DRIs): Recommended Intakes For Individuals,
Macronutrients on page A- 4 (1). The Dietary Reference Intake (DRI) for women is approximately 2.7 liters (91
ounces daily) and 3.7 liters (125 ounces daily) for men (1).

Indications
In the healthy individual, normal sensations of thirst promote the consumption of adequate fluid and the
maintenance of optimum hydration (1). However, some patients may not recognize thirst, may not be able to
communicate thirst, or may not freely consume liquids. Risk factors for dehydration include any of the
following:

 unconscious; semiconscious and confused state

 severe depression

 tranquilizer or sedative use

 enteral feeding

 must be fed or require assistance with feeding

 diarrhea

 poor appetite

 immobility

 diuretic use

 frequent laxative use

 perspiration (in hot weather where air

conditioning is unavailable)

 dysphagia/swallowing difficulties

 increased respiratory rate

 salivation decreased by medications or radiation

 therapy

 fever

 fistulous drainage

 high output ileostomy

 vomiting

 severe burns

 polyuria (e.g., glycosuria, ketonuria)

 high renal solute load (e.g., High-Protein Diet)

 denuded body surface

 hyperpnea

While consumption of beverages containing caffeine and alcohol have been shown in some studies to have
diuretic effects, available information indicates that this may be transient in nature, and that such beverages
can contribute to total water intake and thus can be used in meeting recommendations for dietary intake of
total fluid (1). Evidence indicates that consuming up to six mg of caffeine per kilogram of body weight per day
does not impact the hydration status of healthy adults, above that of a placebo or non-caffeine-containing
beverage (Grade 1)*(2).

Nutritional Adequacy
See statement pertaining to diet order.

How to Order the Diet
The patient’s usual diet can be amended as follows: diet, ____ ml/day, or ____
diet, restrict fluids to _____ ml/day. Order should include amount of fluid to be given by Food and Nutrition
Services with meals and snacks and amount of fluid to be given by nursing (i.e., with medications or between
meals).

Planning the Diet
When the dietitian calculates the intake of fluids, foods that are liquid at room temperature should be counted
by millileters. Such foods include water, carbonated beverages, coffee and tea, gelatin, milk, water ices and
popsicles, soups, supplements, eggnog, ice cream and sherbet, and milk shakes.