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Free Water Deficit
Free Water Deficit
Estimates fluid loss in hypernatremia to guide safe rehydration

Free Water Deficit
Free Water Deficit
Estimates fluid loss in hypernatremia to guide safe rehydration
Instructions
To calculate, input the patient’s weight, sex, and serum sodium into the standard formula. Replacement should be gradual to avoid cerebral edema. Divide the calculated deficit over 48–72 hours, tailoring correction rates based on severity and comorbidities. Always monitor electrolytes and volume status closely during therapy.
Overview
When to use
Why use
Evidences
Interpretation
Free water deficit in L = (% total body water in fraction)*(Weight in kg)*([Current Na/Ideal Na] – 1)
Pediatric and specialty guidance use algebraically equivalent versions such as FWD = TBW × [1 − (140/Na)], emphasizing the same concept of the “pure water” needed to normalize sodium
https://www.sciencedirect.com/science/article/pii/S0002916523053753
Practical protocols recommend calculating the water needed to reach the next day’s target Na (e.g., −10 to −12 mmol/L), then adding allowances for insensible and ongoing renal/GI losses; deliver via enteral water if possible, or IV D5W if not
https://emcrit.org/ibcc/hypernatremia/
FWD gives the total free water to replace; actual replacement is spread over 48–72 hours, and the daily target is usually a 6–12 mmol/L fall in Na for chronic hypernatremia, with close monitoring and adjustments for ongoing losses
https://www.ncbi.nlm.nih.gov/books/NBK441960/
Change in serum sodium fundamentally follows the Edelman relationship, where [Na] is determined by exchangeable Na + K divided by TBW; formulas that predict ΔNa with any infusate volume based on Edelman can outperform older fixed-volume Adrogué–Madias approximations
Overview
When to use
Why use
Evidences
The Free Water Deficit calculation is an important clinical tool for assessing how much water needs to be replaced in patients with hypernatremia. Hypernatremia occurs when the concentration of sodium in the blood is abnormally high, usually because of excessive water loss compared to sodium. This can be caused by dehydration, renal water loss, gastrointestinal fluid loss, or impaired thirst response.
The tool helps clinicians approximate the volume of water the body is missing to restore normal sodium balance. By estimating the water deficit, healthcare providers can plan fluid replacement strategies tailored to the patient’s needs. Importantly, correction of hypernatremia must be done gradually, as overly rapid fluid replacement can cause cerebral edema, neurological complications, or even death.
This tool is especially valuable in critically ill patients, elderly individuals, and those with impaired renal or endocrine function. While it provides a helpful estimate, the final clinical decision also requires consideration of ongoing fluid losses, comorbidities, and overall clinical context. The Free Water Deficit calculation does not replace clinical judgment but rather supports it by quantifying the severity of fluid loss.
Overview
When to use
Why use
Evidences
Interpretation
Free water deficit in L = (% total body water in fraction)*(Weight in kg)*([Current Na/Ideal Na] – 1)
Pediatric and specialty guidance use algebraically equivalent versions such as FWD = TBW × [1 − (140/Na)], emphasizing the same concept of the “pure water” needed to normalize sodium
https://www.sciencedirect.com/science/article/pii/S0002916523053753
Practical protocols recommend calculating the water needed to reach the next day’s target Na (e.g., −10 to −12 mmol/L), then adding allowances for insensible and ongoing renal/GI losses; deliver via enteral water if possible, or IV D5W if not
https://emcrit.org/ibcc/hypernatremia/
FWD gives the total free water to replace; actual replacement is spread over 48–72 hours, and the daily target is usually a 6–12 mmol/L fall in Na for chronic hypernatremia, with close monitoring and adjustments for ongoing losses
https://www.ncbi.nlm.nih.gov/books/NBK441960/
Change in serum sodium fundamentally follows the Edelman relationship, where [Na] is determined by exchangeable Na + K divided by TBW; formulas that predict ΔNa with any infusate volume based on Edelman can outperform older fixed-volume Adrogué–Madias approximations
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AI-powered medical documentation platform revolutionizing clinical workflows through intelligent patient management and secure documentation.