Diagnostic efficacy of bedside ultrasound to detect dehydration in older patients attending an emergency care unit

Diederich, Helen; Burkhardt, Heinrich

doi:10.1007/s00391-020-01711-8

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…Although, various laboratory tests (e.g., serum lactate acid and urine studies), physical examination and invasive monitoring (e.g., CVP) can be used for the assessment of hydration status as a reference value, 12,13,34 in these studies, only the BUN/creatinine ratio was measured. Unlike the above two studies, Diederich et al 35 asserted that IVC-US was only moderately efficacious in diagnosing dehydration. However, this study used only the clinical assessment of hydration status as a reference value and did not exclude patients with right ventricular dysfunction.…”

Section: Ivc Measurements In Dehydration and Hypovolemiamentioning

confidence: 96%

“…IVC-US measurements have also been extensively applied for the prompt diagnosis of dehydration and hypovolemia (Table 2), [35][36][37][38][39][40][41][42] with the studies primarily conducted in spontaneously breathing patients in the ED setting (Table 2). Orso et al 36 and Riccardi et al 37 reported that the BUN/creatinine ratio can be used to identify dehydration, and both found a good correlation between IVC-US indices and this ratio.…”

Section: Ivc Measurements In Dehydration and Hypovolemiamentioning

confidence: 99%

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Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: A critical analysis review

Spiliotaki

Saranteas

Moschovaki

et al. 2022

J of Clinical Ultrasound

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Rapid evaluation of intravascular volume status is vital; either excessive or limited fluid administration may result in adverse patient outcomes. In this narrative review, critical analysis of pertinent diagnostic accuracy studies is developed to delineate the role of inferior vena cava ultrasound measurements in the assessment of both intravascular volume status and fluid responsiveness in the emergency department and intensive care unit. In addition, limitations, and technical considerations of inferior vena cava ultrasound measurements as well as directions for future research are thoroughly discussed.

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Section: Ivc Measurements In Dehydration and Hypovolemiamentioning

confidence: 96%

Section: Ivc Measurements In Dehydration and Hypovolemiamentioning

confidence: 99%

Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: A critical analysis review

Spiliotaki

Saranteas

Moschovaki

et al. 2022

J of Clinical Ultrasound

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“…While serum osmolality may be used to diagnose hypertonic dehydration, it has been proposed that inferior vena cava (IVC) diameter and IVC collapsibility may be used as a test for isotonic dehydration [ 6–9 ]. In one recent study, based in a nursing home in Japan, 89 residents were assessed for dehydration (defined as serum osmolality ≥295 mOsm/kg) and underwent assessment of IVC by ultrasonography [ 9 ].…”

Section: Diagnosismentioning

confidence: 99%

“…In contrast, a study based in Germany evaluated IVC diameter and collapsibility index in a series of older adults (>65 years) attending the Emergency Department [ 6 ]. Participants were classed as dehydrated ( n = 78) or euhydrated ( n = 121) based on clinical examination; those with fluid overload or uncertainty of fluid balance were excluded.…”

Section: Diagnosismentioning

confidence: 99%

New horizons in the diagnosis and management of dehydration

Frith

2023

Age and Ageing

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Hydration is a fundamental aspect of clinical practice and yet it is an under-researched topic, particularly in older people, leading to many areas of uncertainty. There are two types of dehydration; hypertonic, which is a water deficit, and isotonic, which is a deficit of both water and salt. Individual clinical signs and bedside tests are poor diagnostic tools, making dehydration difficult to identify. However, the diagnostic value of a holistic clinical approach is not known. The gold-standard clinical test for dehydration is serum osmolality, but this cannot diagnose isotonic dehydration and may delay diagnosis in acute situations. Salivary osmolality point-of-care testing is a promising and rapid new diagnostic test capable of detecting both hypertonic and isotonic dehydration in older people, but further evidence to support its clinical utility is needed. Daily fluid requirements may be less than previously thought in adults, but the evidence specific to older people remains limited. Hydration via the subcutaneous route is safer and easier to initiate than the intravenous route but is limited by infusion speed and volume. Prompting older adults more frequently to drink, offering a wider selection of drinks and using drinking vessels with particular features can result in small increases in oral intake in the short-term. The ongoing clinically-assisted hydration at end of life (CHELsea II) trial will hopefully provide more evidence for the emotive issue of hydration at the end of life.

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“…In contrast, the utility of IVC for evaluating dehydration in older patients remains controversial. Two studies reported a significantly lower maximal IVC diameter in hypovolemic groups compared with euvolemic groups, with a mean difference of 4 mm [ 18 , 19 ], whereas another study reported no difference in IVC diameter between the two groups [ 20 ]. One reason for this disparity may be that these studies used the BUN/Cr ratio or clinical signs as a surrogate marker of dehydration rather than serum osmolality.…”

Section: Introductionmentioning

confidence: 99%

Chronic Dehydration in Nursing Home Residents

et al. 2020

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Chronic dehydration mainly occurs due to insufficient fluid intake over a lengthy period of time, and nursing home residents are thought to be at high risk for chronic dehydration. However, few studies have investigated chronic dehydration, and new diagnostic methods are needed. Therefore, in this study, we aimed to identify risk factors for chronic dehydration by measuring serum osmolality in nursing home residents and also to evaluate whether examining the inferior vena cava (IVC) and determining the IVC collapsibility index (IVC-CI) by ultrasound can be helpful in the diagnosis of chronic dehydration. A total of 108 Japanese nursing home residents aged ≥65 years were recruited. IVC measurement was performed using a portable handheld ultrasound device. Fifteen residents (16.9%) were classified as having chronic dehydration (serum osmolality ≥295 mOsm/kg). Multivariate logistic regression analysis showed that chronic dehydration was associated with dementia (odds ratio (OR), 6.290; 95% confidential interval (CI), 1.270–31.154) and higher BMI (OR, 1.471; 95% CI, 1.105–1.958) but not with IVC or IVC-CI. Cognitive function and body weight of residents should be considered when establishing a strategy for preventing chronic dehydration in nursing homes.

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Diagnostic efficacy of bedside ultrasound to detect dehydration in older patients attending an emergency care unit

Cited by 5 publications

References 24 publications

Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: A critical analysis review

Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: A critical analysis review

New horizons in the diagnosis and management of dehydration

Chronic Dehydration in Nursing Home Residents

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