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High Yield Notes
7 pages


6 flashcards

Content Reviewers:

Rishi Desai, MD, MPH

Water is essential for human life, (shocking I know) but it’s why human civilizations historically sprouted up along the banks of rivers, lakes, and oceans.

Water is the main substance in our bodies, making up more than 50% of a person’s body weight, and it’s directly involved in every biochemical reaction in each cell in our body.

Ultimately maintaining the right balance of water is what keeps us alive.

Water is a V-shaped molecule made up of two hydrogen atoms that bind to a single oxygen atom, and it’s commonly referred to by its chemical composition of H20.

The bond between hydrogen and oxygen is a way of representing the fact that the two atoms share a single electron that zips around in the space between them. The space where it moves around is called an electron cloud and it’s a bit lopsided, since the sharing isn’t completely balanced.

Because the electron spends a bit more time on the side nearest the oxygen, the oxygen has a partial negative charge and the hydrogens have a partial positive charge. That’s called a dipole, with the hydrogen end of the bond having a slight positive charge, and the oxygen end having a slight negative charge.

In fact, it’s this dipole that really explains the magic of water, because it allows the slightly positive hydrogens to line up with slightly negative oxygen atoms from other water molecules. That attraction between water molecules is called a hydrogen bond, and ultimately it’s the reason that water molecules huddle up together.

Think about the dew droplets that form on leaves early in the morning, that bead is huddled up because of millions of hydrogen bonds within it.

Also, having lots of slightly positive hydrogens and slightly negative oxygens is what allows water to be a great solvent for other molecules like sugar and salt which can easily dissolve right into it.

Total body water can be subdivided into two major compartments, intracellular fluid which is fluid inside cells, and extracellular fluid which is fluid outside of cell like in the blood and in the interstitial tissue between cells.

Let’s say that a person’s total water makes up 60% of their body weight. Two-thirds of that 60%, or 40% of body weight, is intracellular fluid. And the other 1/3 or 20% of body weight is extracellular fluid.

Both inside and outside the cells, water acts as a solvent for electrically charged molecules called ions or electrolytes.

When water dissolves electrolytes, the slightly negatively charged oxygen attracts positive ions like sodium and the slightly positively charged hydrogen attracts negative ions like chloride. That’s how table salt or NaCl dissolves into water

In our bodies, the main positive electrolytes are sodium, potassium, calcium, and magnesium, and the main negative electrolytes are chloride, bicarbonate, phosphate, and sulfate. These are kept at very specific concentrations both within and outside of the cell, through a variety of processes.

One mechanism is osmosis, where water moves from the more dilute compartment or one with low concentration, to the more concentrated compartment.

So blood osmolarity, which is the overall concentration of all substances dissolved in the blood like electrolytes, glucose, and urea, is a good measure of hydration status, and it’s normally around 300 (milliosmoles) mOsm per liter.

When blood osmolarity is high, a common reason is that there’s not enough water in the body, like in dehydration.

When blood osmolarity is low, a common reason is that there’s too much water - like when it’s being retained by the kidneys.

Normally, the amount of total body water is balanced through ingestion and elimination of water - ins and outs.

About 80% of our water intake comes from drinking fluids - the other 20% comes from food we eat.

Water content in food varies - but some fruits and vegetables, like watermelon or strawberries, are 90% water by weight.

As far as water output goes, we eliminate water through breathing, as humidified air leaves the body, as well as through sweating, urinating, and with bowel movements.

In addition to the water we get from foods, the recommended daily amount of fluid intake for women is around 11 glasses of water, or 2.2 L, and for men it’s about 13 glasses, or 3L. But as we’ll soon see, the amount of water needed per day can vary depending on many different factors.

Plain water is the ideal choice when it comes to hydration, but all fluids, including caffeinated drinks like coffee and tea, or flavored waters and juices, contribute to water intake.

After we drink water, it travels all the way through our digestive tract until it reaches the small and large intestines, where water is absorbed into the bloodstream.

When we’re at rest, each heartbeat propels about 25% of our blood to the kidneys, where millions of nephrons filter it to produce urine.

When we’re properly hydrated, the kidneys produce between 800 and 2000 milliliters of urine every day, and the urine has a pale yellow shade – like lemonade. (I hope you’re not drinking any right now)

Some water, around 200 milliliters per day, is also lost during bowel movements.

Sweat glands in the skin produce small amounts of sweat, and their production increases when we’re nervous, when it’s really hot outside, or during exercise.

The amount of sweat we lose each day varies quite a lot based on the level of activity and the person, so let’s say that on average it’s 500-700 milliliters per day, even though some athletes can sweat more than a liter in an hour when it’s really hot!

Finally, there’s the “insensible” water losses. They’re called insensible because we’re not aware of them.


Proper hydration is key for overall health and well-being. Water makes up more than 50% of our body weight and plays a vital role in many bodily processes, including circulation, digestion, nutrient absorption, wastewater removal, and a lot of cellular biochemical processes.

It's important to stay hydrated, so make sure to drink fluids before you get thirsty because once the thirst sensation is present, dehydration is already underway. The recommendation is to drink around 2 liters of water per day, especially for people in dry or hot environments, people who exercise, or people who perform heavy physical labor.

  1. "Medical Physiology" Elsevier (2016)
  2. "Physiology" Elsevier (2017)
  3. "Human Anatomy & Physiology" Pearson (2018)
  4. "Principles of Anatomy and Physiology" Wiley (2014)
  5. "Total body water volumes for adult males and females estimated from simple anthropometric measurements" The American Journal of Clinical Nutrition (1980)
  6. "Interstitial Fluid and Lymph Formation and Transport: Physiological Regulation and Roles in Inflammation and Cancer" Physiological Reviews (2012)