TY - JOUR
T1 - Understanding Clinical Dehydration and Its Treatment
AU - Thomas, David R.
AU - Cote, Todd R.
AU - Lawhorne, Larry
AU - Levenson, Steven A.
AU - Rubenstein, Laurence Z.
AU - Smith, David A.
AU - Stefanacci, Richard G.
AU - Tangalos, Eric G.
AU - Morley, John E.
N1 - Funding Information:
The formation of The Dehydration Council was funded by an unrestricted educational grant from Baxter, Inc. to Boomer Educational Consultants. The process included a review of the literature and an original 2-day meeting at which the major themes were developed. The manuscript was then developed and circulated electronically to all Council members and multiple changes were made based on suggestions of the members. A final manuscript was then circulated and a Web conference was held to reach agreement on the final manuscript.
PY - 2008/6
Y1 - 2008/6
N2 - Dehydration in clinical practice, as opposed to a physiological definition, refers to the loss of body water, with or without salt, at a rate greater than the body can replace it. We argue that the clinical definition for dehydration, ie, loss of total body water, addresses the medical needs of the patient most effectively. There are 2 types of dehydration, namely water loss dehydration (hyperosmolar, due either to increased sodium or glucose) and salt and water loss dehydration (hyponatremia). The diagnosis requires an appraisal of the patient and laboratory testing, clinical assessment, and knowledge of the patient's history. Long-term care facilities are reluctant to have practitioners make a diagnosis, in part because dehydration is a sentinel event thought to reflect poor care. Facilities should have an interdisciplinary educational focus on the prevention of dehydration in view of the poor outcomes associated with its development. We also argue that dehydration is rarely due to neglect from formal or informal caregivers, but rather results from a combination of physiological and disease processes. With the availability of recombinant hyaluronidase, subcutaneous infusion of fluids (hypodermoclysis) provides a better opportunity to treat mild to moderate dehydration in the nursing home and at home.
AB - Dehydration in clinical practice, as opposed to a physiological definition, refers to the loss of body water, with or without salt, at a rate greater than the body can replace it. We argue that the clinical definition for dehydration, ie, loss of total body water, addresses the medical needs of the patient most effectively. There are 2 types of dehydration, namely water loss dehydration (hyperosmolar, due either to increased sodium or glucose) and salt and water loss dehydration (hyponatremia). The diagnosis requires an appraisal of the patient and laboratory testing, clinical assessment, and knowledge of the patient's history. Long-term care facilities are reluctant to have practitioners make a diagnosis, in part because dehydration is a sentinel event thought to reflect poor care. Facilities should have an interdisciplinary educational focus on the prevention of dehydration in view of the poor outcomes associated with its development. We also argue that dehydration is rarely due to neglect from formal or informal caregivers, but rather results from a combination of physiological and disease processes. With the availability of recombinant hyaluronidase, subcutaneous infusion of fluids (hypodermoclysis) provides a better opportunity to treat mild to moderate dehydration in the nursing home and at home.
KW - Dehydration
KW - education
KW - hyperosmolar dehydration
KW - hypodermoclysis
KW - hyponatremia dehydration
KW - long-term care
KW - prevention
KW - recombinant hyaluronidase
KW - subcutaneous infusion of fluid
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U2 - 10.1016/j.jamda.2008.03.006
DO - 10.1016/j.jamda.2008.03.006
M3 - Review article
C2 - 18519109
AN - SCOPUS:44449132748
SN - 1525-8610
VL - 9
SP - 292
EP - 301
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 5
ER -