Am I Drinking Enough? Yes, No, and Maybe

Abstract

Adequate fluid intake can be dually defined as a volume of fluid (from water, beverages, and food) sufficient to replace water losses and provide for solute excretion. A wide range of fluid intakes are compatible with euhydration, whereby total body water varies narrowly from day to day by 600 to 900 mL (<1% body mass). One measure of fluid intake adequacy involves enough fluid to prevent meaningful body water deficits outside this euhydration range (i.e., dehydration). Another measure of fluid intake adequacy involves enough fluid to balance the renal solute load, which can vary widely inside the euhydration range. The subtle but important distinction between the 2 types of adequacy may explain some of the ambiguity surrounding the efficacy of hydration status markers. Both perspectives of fluid intake adequacy are discussed in detail and a simple tool is reviewed that may help healthy, active, low-risk populations answer the question, "Am I drinking enough?" Key Teaching Points • Adequate fluid intake can be dually defined as a volume of fluid (from water, beverages, and food) sufficient to replace water losses and provide for solute excretion. • Fluid needs can differ greatly among individuals due to variation in the factors that influence both water loss and solute balance; thus, adequacy is consistent with a wide range of fluid intakes and is better gauged using hydration assessment methods. • Adequacy of fluid intake for replacing meaningful water losses (dehydration) can be assessed simply, inexpensively, and with reasonable fidelity among healthy, active, low-risk individuals. • Adequacy of fluid intake for solute excretion per se can also be assessed among individuals but is more difficult to define and less practical to measure.

Keywords: dehydration; hydration assessment; hydration status; hypohydration; plasma osmolality; urine osmolality.