154 Daily Water Needs for Adults* Daily water needs should be tailored to the patient and their medical condition. Example equations: 1. 1 mL water/kcal/day 2. Holliday-Segar formula 1 To calculate the total additional water needed per day for hydration and flushing 2,3 1. Calculate daily water needs 2. Calculate water in prescribed amount of formula/day 3. Total water needed for flushing each day = daily fluid needs - water provided from prescribed formula/day 4. The remaining total water needed should be divided throughout the day and provided as flushes between feedings and medication administration Estimating Energy Needs Resting energy expenditure (REE) is most accurately measured by indirect calorimetry, which requires equipment to measure inhaled and exhaled oxygen and carbon dioxide. In the clinical setting, however, indirect calorimetry may not be feasible; therefore, predictive equations are available to estimate the REE of adults (not suitable for infants and children). Two widely used equations are 1) the original Harris-Benedict equation and 2) the Mifflin-St. Jeor equation. To address catabolism and other considerations in the clinical setting, the REE is multiplied by activity factors and/or injury factors to estimate the total energy expenditure of the patient. No equation is perfect and clinical judgment is required to estimate the final required energy and nutrient intakes. HARRIS-BENEDICT EQUATION 4 Men: REE = 66.473 + (13.752 x W) + (5.003 x H) - (6.755 x A) Women: REE = 65.096 + (9.563 x W) + (1.850 x H) - (4.676 x A) MIFFLIN-ST. JEOR EQUATION 5 Men: REE = (10 x W) + (6.25 x H) - (5 x A) + 5 Women: REE = (10 x W) + (6.25 x H) - (5 x A) - 161 W = weight in kg; H = height in cm; A = age in years * Please refer to Product Nutrition Information pages for water content values. References: 1. Holliday MA, Segar WE. Pediatrics . 1957;19(5):823-832. 2. Lipp J, et al. Nutr Clin Pract . 1999;14(5):232-237. 3. Johnson TW, et al. Nutr Clin Pract . 2019;34(2):186-195. 4. Harris JA, et al. A Biometric Study of Basal Metabolism in Man. Washington, DC: Carnegie Institute of Washington; 1919. Publication No. 279. 5. Mifflin MD, et al. Am J Clin Nutr. 1990;51(2):241-247.