Water balance and its estimation. Collecting an accumulated urine specimen for 24 hours.

Authors: Brikez Yu. I.

Editor: Rednenko V.V.

equipment:

• Dimensional glass graduated urine collection reservoir (dry and clean)
• a pan or a pencil
• WATER BALANCE SHEET
• date__________

• department ________

  ward №_________

  patient s name

  • age    weight  

  Diagnosis: examination

  time	intake liquid	Amount of gained  liquid (ml)	the time	Excreted urine (ml)
  9.00	breakfast (buckwheat porridge,cheese )	250.0	10.40	220.0
  10.00	IV infusion	400.0	12.00	350.0
  14.00	Lunch (first course, second course)	350.0	17.00	200.0
  15.00	a pear	200.0	19.00	150.0
  16.00	brunch (yogurt)	150.0	20.00	200.0
  18.00	supper (first course, second course)	200.0	3.00	80.0
  21.00	kefir	200,0	6.00	100,0
  In one day	Total intake	1.750 (amount of fluids taken)	Total exctered:	1.300 (diuresis per day)

   In the example, the water balance is calculated by the formula: 1.750 (amount of fluids taken) x 0,8 (80%  from amount of fluids taken) = 1400 мл (should be excreted as normal)

   

  The difference between daily diuresis and the calculated fluid according to the formula is 100 ml (urine was excreted 100 ml less than normal) This means the water balance is negative.

• Indications: monitoring a patient with edema. Detecting hidden edema, increasing edema and monitoring the effect of diuretics.
   

• Description of clinical situation:

  You are a wardnurse in the cardiology department. Patient Ivanov A. A. has been ordered to determine the water balance with calculation of daily diuresis in order to detect hidden edema. Prepare the patient and teach the algorithm for collecting daily diuresis and calculating water balance.

  Procedure to follow:

  Preparatory stage:

  • Ensure that the patient is able to record fluids (for serious ill patients, the nurse will do the recording)
  • Provide a detailed briefing on how to record on the water balance sheet, give  to the patient urine collection container, water balance sheet and a pen.
  • Inform the patient about the purpose and the order of the procedure 
  • Explain the need to follow the usual water, food regimen
  • Ensure that the patient has not taken diuretics for three days prior to the test
  • Explain the approximate percentage of water content of food (fruits, vegetables contain approximately 80% water)
  • Teach the patient how to convert solid foods to liquids (solid foods can contain 60 to 80% water)

  Main stage:

  • in the morning after sleep, the patient release urine into the toilet
  • to measure body weight, make a record in the water balance accounting sheet
  • collect urine after each urination in a graduated container, measuring the amount of urine excreted (diuresis).
  • record the amount and time of urine excreted on the water balance sheet
  • record the amount and time of fluid intake on the water balance sheet and the amount of fluid administered parenterally (intravenous infusions)
  • explain that it is necessary to record the time of fluid intake or administration and the time of urine excretion on the water balance sheet during the day until 6.00 am the following morning.
  • to measure body weight again
  • at 6.00 a.m. the next morning, give the water balance sheet to the ward nurse.

  Final stage:

  • Determine the normal amount of fluid that should be excreted:
  • The water balance is calculated by the formula: amount of fluids taken × 0,8 (80%) = The amount of urine that should be excreted normally
    Compare the amount of diuresis on the water balance calculation sheet with the amount of fluid calculated using the formula in (normal)
    Calculate the difference, record it on the water balance sheet
  • Consider a negative water balance if less fluid is excreted than calculated (indicates hidden edema, increasing edema, or ineffectiveness of diuretic treatment dose).
    Consider the water balance positive, if the excretion of urine is more than calculated (this may be the result of the action of diuretics, diuretic foods, the effect of cold weather, indicates the effectiveness of treatment with diuretics, convergence of edema), which is a variant of the norm.
  • Consider the water balance to be zero if the same amount of fluid is excreted as calculated (normal)
  • Physiologic fluid losses: excretion through lungs (500 ml/24 hours), skin (500 ml/24 hours), losses with feces - 150-200 ml