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Assessment – Nutrition-Focused Physical Exam to Detect Micronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Skin turgor refers to the elasticity of the skin. To assess turgor, pinch the skin on the arm or hand to form a tent; it should spring back within one to two seconds. Poor skin turgor may be a sign of dehydration; however, skin loses elasticity with age, thus poor turgor in adults over 65 years of age may occur in the absence of dehydration. Therefore, a thorough diet history and in-depth assessment of hydration status should be conducted to correctly identify the underlying etiology.
The Follow-Up Metabolic Medicine Hospital Consultation
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
As you examine the patient look at the volume status carefully. Examine the skin turgor, eyes, lips, tongue and oral mucosa for signs of dehydration. Check the lungs for rales that may indicate fluid overload. Listen for cardiac signs of congestive heart failure (CHF). Check the abdomen for ascites, the trunk for anasarca and the lower extremities for edema.
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Although vomiting may begin before the first missed menstrual period, persistent vomiting requiring hospitalization usually peaks between 8 and 12 weeks of gestation (40,51). Majority of the symptoms resolve by 20 weeks. Patients usually describe typical “morning sickness,” which then becomes more severe and persists throughout the day. Intractable vomiting may lead to development of complications including dehydration and oliguria. Weight loss of more than 5% of prepregnancy weight is usually one of the diagnostic criteria. Physical examination may reveal signs of dehydration with poor skin turgor and tachycardia. Jaundice is occasionally present and the odor of ketones may be noted in the patient’s breath. Neurologic symptoms include changes in mental status ranging from drowsiness to coma, and evidence of peripheral neuropathy due to vitamin B6 or B12 deficiency.
‘Drink clean, safe water and/or other fluids through-out the day even if you do not feel thirsty’: a food-based dietary guideline for the elderly in South Africa
Published in South African Journal of Clinical Nutrition, 2021
Upasana Mukherjee, Carin Napier, Wilna Oldewage-Theron
Small reductions in fluid intake or increased output can lead to severe dehydration.2 A reduction of total body water (TBW) is defined as dehydration and it can be brought about mainly by two mechanisms: water loss or electrolyte or salt loss.23 Water is also stored in the muscle mass of the body so a loss in muscle mass and increase in fat mass (which is associated with ageing) also leads to a decline in TBW.10 Chronic use of certain drugs like diuretics, corticoids and metformin as well as their route of administration have been shown to affect hydration status of the elderly in clinical studies.25,26 The elderly are particularly at risk of unrecognised dehydration because, in many cases, in the early stages of dehydration, no signs are present and dehydration is only detected when it is in the severe stage.26 Clinical signs of dehydration include oral dryness (tongue furrows, dry mucous membranes), weight loss, skin turgor, constipation, orthostatic hypotension and urine concentration.
Bacteremia with Staphylococcus pseudintermedius in a 4 month old pediatric oncology patient
Published in Journal of Chemotherapy, 2020
Leah D. Blondeau, Joseph E. Rubin, Harry Deneer, Rani Kanthan, Stephen Sanche, Nicole Beshard, Chris Mpofu, Joseph M. Blondeau
Patient JH, born in December, 2017, was diagnosed with an adrenal neuroblastoma (Stage L1) and underwent resection for such in February, 2018. He did not receive any chemotherapy. On April 29th, 2018 he was admitted through the emergency department with a 2 day history of fever (38.9 °C) and hematuria. He had been administered acetaminophen at home by his parents. On examination he was quiet and lethargic, continuously licking his lips which were dry along with his tongue and oral mucosa. His skin was uniformly dry and scaly, consistent with eczema, which had been noted since birth. His fontanelle was slightly sunken and skin turgor was significantly reduced. Cardiovascular and abdominal examinations were unremarkable. Two days earlier he developed loose frequent stools and vomiting and his oral intake over the past 24 hours was poor. None of his family members were sick. He was not on any medications. The patient was noted to have eczema on his face, arms and legs in a follow-up visit in October, 2018 with many areas broken from scratching. Eczema was noted from birth and appears important with this case.
Handgrip Strength and Its Association With Hydration Status and Urinary Sodium-to-Potassium Ratio in Older Adults
Published in Journal of the American College of Nutrition, 2020
Joana Mendes, Patrícia Padrão, Pedro Moreira, Alejandro Santos, Nuno Borges, Cláudia Afonso, Rita Negrão, Teresa F. Amaral
In relation to the methodology used in the present study, previous research showed that urinary indices, such as urinary osmolality and particularly FWR, represented body water loss as well as, or better than, plasma osmolality (46). Among the urinary indices, FWR is more advantageous than urinary osmolality, because FWR represents a volume, considering the loss of renal capacity with aging, while urinary osmolality is only a measure of concentration, which depends on gender and diet (22). On the other hand, some authors defend serum measures as the gold standard for a definitive diagnosis (47), but there is a lack of consensus regarding the relative efficacy of plasma osmolality versus other hydration status indices (22, 33). In fact, there is no universally accepted method for measuring the hydration status (22), particularly in older people, in whom the early diagnosis of dehydration can be difficult. In older adults, classical physical signs of dehydration, such as weight loss, skin turgor, dry mouth, and capillary refill time may be absent or misleading (48).