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15 Dec 2017 dr. Ni Wayan Desy Lestari Articles 92


Fact: drinking water is a vital activity for your bodily functions.  According to Dr. dr. Yenny Kandarini, Sp.PD-KGH (Internal Medicine and a Consultant in Nephrology and Hypertension) 70% of your adult body is made of water (decreasing to around 55% in the elderly).  This 70% of water includes the fluids that is in your cells and that runs in your blood vessels.  Keeping hydrated is essential for your body to work properly.  Consuming water hydrates your cells and your body.

Amongst being one of the main composition of your cells, water in your body also provides:

  • carries metabolic waste through urine, feces, and sweat

  • keeps the body temperature at a range

  • lubricates joints

  • protects soft tissues as a “bumper”

Lacking fluids also known as dehydration surely disturbs the cell functions.  Generally cases of dehydration can be managed with replacing the fluids by increasing the intake of fluids, but in sever cases, medical management may be necessary.

Ideal Consumption of Water

The amount of water you need to drink daily varies between ages and of course activity.  

Generally speaking the basic guideline are as follows (according to the WHO):

  • babies aged 0-6 months needs fluids as many as 0.7 liters / day (assuming they are breastfed)

  • babies aged 7-12 months needs 0.8 liters / day

  • children aged 1-3 years needs up to 1.3 liters/day

  • children aged 4-8 years needs up to 1.7 liters/day

Based on age and gender:

  • children aged 9-13 years old females: 2.1 liters/day; males: 2.4 liters/day

  • teenagers aged 14-18 years old females: 2.3 liters/day; males 3.3 liters/day

  • adults 19 year old and older females: up to 2.7 liters/day; males 3.7 liters/day

???????Your body will need to consume more fluids if you are doing strenuous activities and when you live in a hotter climate.  When doing strenuous activities or when you are in a hotter climate, there is an increased water loss by sweating, and also by breathing out.  As your activity increases, your breath rate will also increase, and this increases the loss of water.  Intake of fluids should be equal to output of fluids.  As a reference, losing 1 kg of body weight after exercising or competitions is equivalent to losing 1 liter of fluids.

Losing fluids can also be from diarrhea and vomiting which is a common case in Indonesia.  If you a traveller or visiting Bali as a tourist, this may be known as Bali Belly.  You will need to replace the fluids that you lost with isotonic fluids (which contains electrolytes, as compared to hypotonic fluids such as water).  Losing fluids can also be from bleeding or burn accidents like after a motorcycle accident.  When you have a major burn injury, your body loses the fluids that are protected by the skin.  The degree of dehydration may show different signs and symptoms.  When you lose 5% of your body weight, it may be hard to concentrate, you may experience headaches and drowsiness.  Some people may feel tingling sensations in their extremities when they lose 6% of their fluids.  Losing as much as 10% of fluids can be fatal to the human body.

The elderly does not need as much water as a young adult.  Do note that when someone has chronic health problems such as heart failure, kidney failure, or liver failure (cirrhosis) then water consumption restriction may be instructed by your doctor.  Swelling of the legs can sometimes be a sign of volume overload (too much fluids in your body) that can be caused by heart, kidney, or liver conditions and you should go get that checked.   

Are you adequately hydrated?

There are a few signs you can see for yourself if your body is well hydrated or not.  The first and logical way to see: if you’re thirsty then you need more water.  When the body lacks water, your body through sensors in the blood vessels, heart, and kidney is able to sense this and sends signals to the brain to cause the sensation of thirst.

Another way to check your hydration status is to simply see the color of your pee.  Your kidneys work by filtering waste, electrolytes and water.  When you are lacking water, your kidneys (through hormones called the antidiuretic hormone) work by reabsorbing more water.  This causes your urine or pee to be more concentrated and the color will be a darker yellow.

When you are adequately hydrated, your kidneys are able to excrete or produce more urine, as they will not reabsorb as many fluids.

When dehydration becomes severe, the kidneys do not even produce urine.  If your body does not produce any urine for over 6 hours, this is called anuria or oligouria and is a serious problem.

Is there such thing as water poisoning?

Yes there is.  Electrolytes such as sodium (natrium) and potassium (kalium) amongst others are regulated in your body.  The concentration of these electrolytes, mainly sodium, are kept in a range so that it is neither too dilute or concentrated (the osmolality is kept in a range).  When you are dehydrated, the concentration of sodium rises.  As you are dehydrated, you become thirsty and drink more water, and this will normalize the concentration of sodium.

When you chug a lot of water in one go (such as drinking 5-10 L of fluids in an hour), the water dilutes the concentration of sodium.  As this happens, your body will try to adapt by moving water into the cells which causes cell swelling.  When the brain cells swell, this is dangerous as parts of the brain gets pressed on your skull.  As water intoxication happens and the brain swells (increasing something called the intracranial pressure, or pressure within the skull), this may cause symptoms such as headaches, changes in personality and behavior, confusion, and drowsiness.  If the swelling worsens, it may even apply pressure on the brain stem which may cause seizures, coma, or death.


To conclude, yes it is important to stay hydrated.  To check your hydration levels, it’s simple if you’re thirsty you’re probably dehydrated.  Pay attention to your urine or pee color too.  In most cases, if you’re in perfect health, you won’t have to strictly restrict your water consumption.  If you have a heart, kidney, or a liver condition, ask your doctor for recommendations on fluid consumption.  Swollen limbs may be one of the signs of a volume overload.  Note that heat, such as living in Bali, increases the amount of fluid you will need to drink.

Remember not to chug massive amounts of water or fluids in one go, as this may cause water poisoning that causes swelling in your brain and may be fatal.