Clinical indicators of dehydration severity in elderly patients

Gross, Cynthia R.; Lindquist, Ruth; Woolley, Anthony C.; Granieri, Rosanne; Allard, Karen; Webster, Beth

doi:10.1016/0736-4679(92)90331-m

Cited by 177 publications

(130 citation statements)

References 15 publications

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“…However the evidence for using conventional methods is weak [9]. In previous studies physical signs including poor skin turgor, postural variation in blood pressure and heart rate, and dry oral mucosa were unable to accurately predict the volume status [10–12]. Despite the lack of evidence, these measures are commonly used in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of inferior vena cava collapsibility with point of care ultrasound and urine sodium and FENa in patients with early stage acute kidney injury

Singh

Noor

Sabath

2017

Journal of Community Hospital Internal Medicine Perspectives

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Early stage acute kidney injury (AKI) is an independent risk factor for an increase in mortality. Accurate assessment of volume status is a major challenge during the early stages of acute renal injury. Determining volume status based on the history and physical exam lacks accuracy. Urine sodium and free excretion of sodium (FENa) provide objective evidence of intravascular volume status when interpreted carefully and is helpful to delineate prerenal from intrinsic renal failure. In recent years point of care ultrasound has been used to assess volume status. Our team conducted a retrospective chart review to assess the association of inferior vena cava collapsibility by point of care ultrasound (POCUS) and urine electrolytes (urine sodium, fractional excretion of sodium) during early stage AKI (Stage 1–2 of KDIGO guidelines). We reviewed 150 cases based on the provisional diagnosis. 36 patients met the criteria for further review. Using bivariate analysis, we found a strong association between >50% IVC collapsibility with FENa < 0.4% with an odds ratio 5.3 (CI 1.1–24.5, p = 0.04), and urine sodium <20 meq/dl with an odds ratio of 6.7 (Cl 1.5–30, p = 0.02). Subsequently, multivariate analysis and Spearman correlation showed an inverse relation between IVC collapsibility and fractional excretion of sodium FENa (β = −0.4, p = 0.001) and (r = −0.44, p = 0.01). These findings suggest the role of POCUS and urinary markers in determining the intravascular volume status in AKI. POCUS is also valuable to assess volume status in cases of renal failure where urine studies are difficult to interpret.

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Section: Discussionmentioning

confidence: 99%

Retrospective analysis of inferior vena cava collapsibility with point of care ultrasound and urine sodium and FENa in patients with early stage acute kidney injury

Singh

Noor

Sabath

2017

Journal of Community Hospital Internal Medicine Perspectives

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“…To indicate the correlation, 0.6 was used as threshold because a correlation of [0.6 corresponds roughly to more than 50 % shared variance between correlated variables (Gross et al 1992).…”

Section: Discussionmentioning

confidence: 99%

Moral Values and Attitudes Toward Dutch Sow Husbandry

Bergstra

Gremmen

Stassen

2015

J Agric Environ Ethics

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Attitudes toward sow husbandry differ between citizens and conventional pig farmers. Research showed that moral values could only predict the judgment of people in case of culling healthy animals in the course of a disease epidemic to a certain extent. Therefore, we hypothesized that attitudes of citizens and pig farmers cannot be predicted one-on-one by moral values. Furthermore, we were interested in getting insight in whether moral values can be useful in bridging the gap between attitudes toward sow husbandry of citizens and pig farmers. Based on a questionnaire, it was found that pig farmers and citizens, when considered as one group, shared the valuation of most moral values. However, when studying the four clusters of citizens with different attitudes toward sow husbandry, determined in a previous study, a variation in valuation of the moral values between the clusters of citizens and farmers came to the fore. This means that moral values are interpreted differently by groups of people when forming attitudes toward sow husbandry. The results of our study give an indication of which moral values are weighed differently between clusters of citizens and pig farmers. This information can be useful in future research on attitudes toward animal husbandry in order to understand why attitudes differ between groups of people. Besides, our results can Ethics (2015) 28:375-401 DOI 10.1007 be useful for the pig sector and citizens to learn to understand each other's attitudes. With this understanding it is possible to invest in a husbandry system that can build on societal support.

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“…[57][58][59] Dehydration and hypovolemia can have an influence on the salivary flow in the mouth and be associated with dry mouth (Figure 1, page 13). 3,50,52 An increase of the body fluids stretches the walls of the heart and release natriuretic peptides, such as the N-terminal of the prohormone brain natriuretic peptide (NT-proBNP). 3 NT-proBNP affects the kidneys to increase the excretion of salt and water.…”

Section: Increased Sympathetic Activitymentioning

confidence: 99%

“…51 Other phar-macological treatments, such as opioids, beta blockers and diuretics are also associated with thirst. 20,50,51,66 Heart failure Definition and diagnosis HF is an irreversible and progressive condition with typical symptoms and signs resulting from an abnormality of cardiac structure. 12 The abnormalities in HF lead to a failure to pump enough blood to deliver sufficient levels of oxygen to body tissues.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

“…71,73,74 Not surprisingly, thirst has been defined as a sensation of dryness in the mouth. 25 Considering the relation between dry mouth and dehydration 50 and thirst and dehydration 3,47 it seems logical that these two sensations are associated with each other. About half of the patients admitted to hospital were bothered by thirst every day, and their thirst could be very troublesome.…”

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confidence: 99%

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Thirst in Patients with Heart Failure : Description of thirst dimensions and associated factors with thirst

Waldréus

2016

Linköping University Medical Dissertations

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Introduction: Nurses and other health care professionals meet patients with heart failure (HF) who report they are thirsty. Thirst is described by the patients as a concern, and it is distressing. Currently there are no standardized procedures to identify patients with increased thirst or to help a patient to manage troublesome thirst and research in the area of thirst is scarce. In order to prevent and relieve troublesome thirst more knowledge is needed on how thirst is experienced and what factors cause increased thirst. Aim: The aim of this thesis was to describe the thirst experience of patients with HF and describe the relationship of thirst with physiologic, psychologic and situational factors. The goal was to contribute to the improvement of the care by identifying needs and possible approaches to prevent and relieve thirst in patients with HF. Methods: The studies in this thesis used a cross-sectional design (Study I) and prospective observational designs (II-IV). Studies include data from patients with HF who were admitted to the emergency department for deterioration in HF (I, IV) or visited an outpatient HF clinic for worsening of HF symptoms (III); others were patients who were following up after HF hospitalization (II), and patients with no HF diagnosis who sought care at the emergency department for other illness (I). Patients completed questionnaires on thirst intensity, thirst distress, HF self-care behaviour, feeling depressive and feeling anxious. Data on sociodemographic, clinical characteristics, pharmacological treatment and prescribed fluid restriction were retrieved from hospital medical records and by asking the patients. Data were also collected from blood, urine and saliva samples to measure biological markers of dehydration, HF severity and stress. Results: Thirst was prevalent in 1 out of 5 patients (II) and 63% of patients with worsening of HF symptoms experienced moderate to severe thirst distress at hospital admission (IV). Patients at an outpatient HF clinic who reported thirst at the first visit were more often thirsty at the follow-up visits compared to patients who did not report thirst at the first visit (II). Thirst intensity was significantly higher in patients hospitalized with decompensated HF compared to patients with no HF (median 75 vs. 25 mm, visual analogue scale [VAS] 0-100 mm; P < 0.001) (I). During optimization of pharmacological treatment of HF, thirst intensity increased in 67% of the patients. Thirst intensity increased significantly more in patients in the high thirst intensity group compared to patients in the low thirst intensity group (median +18 mm vs. -3 mm; P < 0.001) (III). Patients who were admitted to the hospital with high thirst distress continued to have high thirst distress over time (IV). A large number of patients were bothered by thirst and feeling dry in the mouth when they were thirsty (III, IV). Patients with a fluid restriction had high thirst distress over time and patients who were feeling depressed had high thirst intensity over time...

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Clinical indicators of dehydration severity in elderly patients

Cited by 177 publications

References 15 publications

Retrospective analysis of inferior vena cava collapsibility with point of care ultrasound and urine sodium and FENa in patients with early stage acute kidney injury

Retrospective analysis of inferior vena cava collapsibility with point of care ultrasound and urine sodium and FENa in patients with early stage acute kidney injury

Moral Values and Attitudes Toward Dutch Sow Husbandry

Thirst in Patients with Heart Failure : Description of thirst dimensions and associated factors with thirst

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