We inadvertently perpetuated a misconception about water requirements during parenteral nutrition. Concentrated glucose solutions containing as little as 75% water by volume should not lead to dehydration if all the glucose is catabolised, as the water produced is sufficient to bring their ‘effective’ water content to almost 100%.1 If glucose is supplied faster than it can enter cells, plasma glucose rises and an osmotic diuresis may lead to dehydration.2 If, however, more glucose enters cells (with the help of administered insulin if necessary) than can be catabolised, intracellular accumulation can lead to a state of intracellular overhydration clinically resembling dehydration. The two conditions should be distinguished:1 extracellular dehydration requires fluid replacement, and intracellular overhydration calorie restriction. Calorie requirements are often overestimated, particularly in seriously ill patients, and too much can be harmful.3
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