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Copyright (c) 2025 Boshra Hassan Bbakri, Salihah Hussain M. Domayan, Daifallah Zaid Alotaibi, Abdullah Fahad Al-Sahli, Mohammed Ali M. Almutairi, Sahar Ahmad Albishi, Nada Nazeh Almustafa, Saffanah Abdulrahman Almutair, Maliha Ahmad Aqeel Tomahy, Eman Ali Mohammed, Amal Obeid Alhoilan, Tahani Ali Jaboor, Maryam Mohammed Harthi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Assessment and Management of Insensible Fluid Loss in Nursing Practice
Corresponding Author(s) : Boshra Hassan Bbakri
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Water constitutes about 60% of body weight and is vital for homeostasis, nutrient transport, and metabolic processes. Insensible fluid loss—water lost through skin, respiration, and minimal fecal excretion—accounts for 30–50% of daily water loss and is clinically significant, especially in perioperative and critical care settings.
Aim: To explore the physiological basis, clinical implications, and management strategies for insensible fluid loss in nursing and interprofessional practice.
Methods: A comprehensive review of fluid physiology, perioperative fluid management protocols, and evidence-based interventions was conducted, emphasizing the “4-2-1” rule for maintenance fluids and strategies for estimating insensible losses in high-risk patients.
Results: Insensible losses range from 400–800 mL/day in healthy adults but increase markedly with fever, burns, hyperventilation, or mechanical ventilation. Failure to account for these losses can lead to hypovolemia, impaired perfusion, and delayed recovery. Crystalloids remain first-line for fluid replacement, while colloids are reserved for specific indications such as severe hypoalbuminemia or burns. Advanced monitoring tools, including POCUS and hemodynamic devices, enhance accuracy in fluid assessment.
Conclusion: Effective management of insensible fluid loss requires proactive estimation, individualized fluid therapy, and interprofessional collaboration. Integrating bedside assessment, laboratory data, and dynamic monitoring ensures optimal fluid balance and patient outcomes.
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- Winata AS, Jen WY, Teng ML, Hing WC, Iyer SG, Ma V, Chua HR. Intravenous maintenance fluid tonicity and hyponatremia after major surgery- a cohort study. International journal of surgery (London, England). 2019 Jul:67():1-7. doi: 10.1016/j.ijsu.2019.04.019.
- Heming N, Lamothe L, Jaber S, Trouillet JL, Martin C, Chevret S, Annane D. Morbidity and Mortality of Crystalloids Compared to Colloids in Critically Ill Surgical Patients: A Subgroup Analysis of a Randomized Trial. Anesthesiology. 2018 Dec:129(6):1149-1158. doi: 10.1097/ALN.0000000000002413.
- HOLLIDAY MA, SEGAR WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957 May:19(5):823-32
- Doherty M, Buggy DJ. Intraoperative fluids: how much is too much? British journal of anaesthesia. 2012 Jul:109(1):69-79. doi: 10.1093/bja/aes171.
- Rich K. Review of article: Effects of fluid resuscitation with colloids versus crystalloids on mortality in critically ill patients presenting with hypovolemic shock the CRISTAL randomized trial by Djillali Annane, Shidasp Siami, Samir Jaber, et al (JAMA 2013;310:1809-17). Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing. 2014 Jun:32(2):70-1. doi: 10.1016/j.jvn.2014.03.002.
- Vermeulen LC Jr, Ratko TA, Erstad BL, Brecher ME, Matuszewski KA. A paradigm for consensus. The University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. Archives of internal medicine. 1995 Feb 27:155(4):373-9
- Liamis G, Filippatos TD, Elisaf MS. Correction of hypovolemia with crystalloid fluids: Individualizing infusion therapy. Postgraduate medicine. 2015 May:127(4):405-12. doi: 10.1080/00325481.2015.1029421.
- Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. The New England journal of medicine. 2004 May 27:350(22):2247-56
- Bampoe S, Odor PM, Dushianthan A, Bennett-Guerrero E, Cro S, Gan TJ, Grocott MP, James MF, Mythen MG, O'Malley CM, Roche AM, Rowan K, Burdett E. Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures. The Cochrane database of systematic reviews. 2017 Sep 21:9(9):CD004089. doi: 10.1002/14651858.CD004089.pub3.
- Boldt J. New light on intravascular volume replacement regimens: what did we learn from the past three years? Anesthesia and analgesia. 2003 Dec:97(6):1595-1604. doi: 10.1213/01.ANE.0000089961.15975.78.
References
Winata AS, Jen WY, Teng ML, Hing WC, Iyer SG, Ma V, Chua HR. Intravenous maintenance fluid tonicity and hyponatremia after major surgery- a cohort study. International journal of surgery (London, England). 2019 Jul:67():1-7. doi: 10.1016/j.ijsu.2019.04.019.
Heming N, Lamothe L, Jaber S, Trouillet JL, Martin C, Chevret S, Annane D. Morbidity and Mortality of Crystalloids Compared to Colloids in Critically Ill Surgical Patients: A Subgroup Analysis of a Randomized Trial. Anesthesiology. 2018 Dec:129(6):1149-1158. doi: 10.1097/ALN.0000000000002413.
HOLLIDAY MA, SEGAR WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957 May:19(5):823-32
Doherty M, Buggy DJ. Intraoperative fluids: how much is too much? British journal of anaesthesia. 2012 Jul:109(1):69-79. doi: 10.1093/bja/aes171.
Rich K. Review of article: Effects of fluid resuscitation with colloids versus crystalloids on mortality in critically ill patients presenting with hypovolemic shock the CRISTAL randomized trial by Djillali Annane, Shidasp Siami, Samir Jaber, et al (JAMA 2013;310:1809-17). Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing. 2014 Jun:32(2):70-1. doi: 10.1016/j.jvn.2014.03.002.
Vermeulen LC Jr, Ratko TA, Erstad BL, Brecher ME, Matuszewski KA. A paradigm for consensus. The University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. Archives of internal medicine. 1995 Feb 27:155(4):373-9
Liamis G, Filippatos TD, Elisaf MS. Correction of hypovolemia with crystalloid fluids: Individualizing infusion therapy. Postgraduate medicine. 2015 May:127(4):405-12. doi: 10.1080/00325481.2015.1029421.
Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. The New England journal of medicine. 2004 May 27:350(22):2247-56
Bampoe S, Odor PM, Dushianthan A, Bennett-Guerrero E, Cro S, Gan TJ, Grocott MP, James MF, Mythen MG, O'Malley CM, Roche AM, Rowan K, Burdett E. Perioperative administration of buffered versus non-buffered crystalloid intravenous fluid to improve outcomes following adult surgical procedures. The Cochrane database of systematic reviews. 2017 Sep 21:9(9):CD004089. doi: 10.1002/14651858.CD004089.pub3.
Boldt J. New light on intravascular volume replacement regimens: what did we learn from the past three years? Anesthesia and analgesia. 2003 Dec:97(6):1595-1604. doi: 10.1213/01.ANE.0000089961.15975.78.