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Type: Journal article
Title: Understanding Clinical Dehydration and Its Treatment
Author: Thomas, D.
Cote, T.
Lawhorne, L.
Levenson, S.
Rubenstein, L.
Smith, D.
Stefanacci, R.
Tangalos, E.
Morley, J.
Citation: Journal of the American Medical Directors Association (JAMDA): long-term care: management, applied research and clinical issues, 2008; 9(5):292-301
Publisher: Elsevier
Issue Date: 2008
ISSN: 1525-8610
Statement of
David R. Thomas, Todd R. Cote, Larry Lawhorne, Steven A. Levenson, Laurence Z. Rubenstein, David A. Smith, Richard G. Stefanacci, Eric G. Tangalos, John E. Morley and Dehydration Council
Abstract: 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.
Keywords: Dehydration
long-term care
hyperosmolar dehydration
hyponatremia dehydration
recombinant hyaluronidase
subcutaneous infusion of fluid
DOI: 10.1016/j.jamda.2008.03.006
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