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Dementia
Published in Henry J. Woodford, Essential Geriatrics, 2022
Weight loss is common in advanced dementia. Neurodegenerative changes may lead to reduced appetite, but also consider depression and medication adverse effects (e.g. metformin), or swallowing problems. People with dementia may not remember how to prepare or access food, including opening packaging. They may have a change in food preference, now liking sweeter or spicier foods and finding that other things taste bland. Some people start trying to eat non-food items, such as soap. There may be a communication problem, e.g. they don't like the food offered. They may have agnosia and no longer recognise food and drink. There may be apraxia leading to problems using cutlery. Over-eating is also possible. There is a higher risk of dehydration due to reduced thirst sensation (may be made worse by medications and infections), which can lead to constipation further reducing appetite and leading to a spiral of deterioration.
Managing Diabetes and Prediabetes
Published in Ruth Chambers, Paula Stather, Tackling Obesity and Overweight Matters in Health and Social Care, 2022
Some people with diabetes have no symptoms. Others may have symptoms which include increased thirst or passing a lot of urine. Some may feel more tired than usual or may have blurred eyesight or genital itching or thrush. People with type 2 diabetes may mistakenly believe that their condition is trivial because they have no symptoms when they are first identified as having diabetes.
Diabetes
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Type 1 diabetes is caused by a lack of insulin. The most common reason for Type 1 diabetes is the autoimmune destruction of the beta cells. Genetic and environmental factors are thought to influence susceptibility10. Type 1 diabetes usually develops in a younger age group, and pregnant women with Type 1 diabetes may have managed their condition for a number of years. Symptoms of undiagnosed Type 1 diabetes can be severe and have a sudden onset. Without insulin the cells cannot utilise available glucose, and blood sugar levels rise. High blood glucose levels pass into the kidneys and filter into the urine (glycosuria). Glucose pulls water after it, resulting in polyuria (excess urination) and consequently dehydration and loss of electrolytes. Thirst increases to maintain body fluids. Weight loss occurs as the body tries to mobilise energy from fats and protein. The breakdown of body fat causes an excess production of ketone bodies. These are acidic, and when they accumulate in the blood, the pH drops, causing ketoacidosis11. Diabetes is treated by using insulin injections to control blood glucose levels to within the normal range. Adjustments to doses of insulin are made according to carbohydrate intake and levels of activity. The changes to carbohydrate metabolism in pregnancy present a challenge to women with Type 1 diabetes to maintain their normal blood sugars. There are a number of acute and long-term complications of Type 1 diabetes including the risk of hypoglycaemia, hyperglycaemia (leading to ketoacidosis) and damage to blood vessels.
‘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
The South African food-based dietary guidelines for people aged seven years and older include a guideline entitled ‘Drink lots of clean, safe water’. Although this guideline also included the elderly population group,3 a revised guideline was developed specifically for the elderly not only to include drinking clean and safe water, but specifically to address the issues commonly experienced by the elderly and the reasons why the elderly may not consume enough fluids throughout the day. The purpose of this review paper was thus to examine and summarise the information in the literature regarding the importance of fluid intakes, including water, to provide evidence for justifying the food based dietary guideline ‘Drink Clean, Safe Water and/or Other Fluids Through-Out the Day Even if You Do Not Feel Thirsty’ for the elderly. During the testing of the guidelines it was accepted that the age for the elderly be set at 60 years and older. This is because the pensionable age for SA adults is set at that age.4 The elderly are a heterogeneous group and include people above the age of 60, which includes healthy free-living individuals as well as institutionalised patients with acute or chronic conditions.
Atropine in topical formulations for the management of anterior and posterior segment ocular diseases
Published in Expert Opinion on Drug Delivery, 2021
Ines García Del Valle, Carmen Alvarez-Lorenzo
Side effects are the result of vagal depression and their severity and frequency are dose related [12]; doses over 65 mg of atropine may be fatal. The most common adverse reactions are thirst, xerostomia (dryness of the mouth), urinary retention, constipation, mydriasis, photophobia, cycloplegia, tachycardia and palpitations. Focusing on the cardiovascular system, atropine alters the heart rate, producing predominantly palpitations, atrial arrhythmias and tachycardia at high doses, but transient bradycardia at low doses without changes in cardiac output [4]. In the nervous system, mental manifestations mainly happen with toxic doses and include irritability, disorientation, delirium-like states, or hallucinations [1]. At the gastrointestinal level nausea, dysphagia, vomiting and inhibition of gastric secretions are frequent. The inhibition of sweating may cause pyrexia and skin flush [13] and the skin can also suffer from rash. In addition to hypersensitivity, that is rare, atropine is contraindicated in cases of primary glaucoma or predisposition to narrow anterior chamber angle glaucoma.
Heat strain in children during unstructured outdoor physical activity in a continental summer climate
Published in Temperature, 2021
Gregory W. McGarr, Samah Saci, Kelli E. King, Serena Topshee, Brodie J. Richards, Mohamed R. Gemae, Emma R. McCourt, Glen P. Kenny
Although most of the children (78%) started testing in a euhydrated state, only 28% remained so by the end of free play. This pattern is consistent with observations in adult workers performing physically demanding jobs (e.g. mining, electric utilities) wherein the majority were severely hypohydrated by the end of a day-long work shift [27]. Elevated hypohydration states are not uncommon in exercising children who do not always adequately replenish fluids during prolonged physical activity in the heat [28]. The children reported mean thirst sensation scores of 5 (“Moderately Thirsty”) and average peak scores of 7 (“Very Thirsty”) during free play, with 44% reporting maximal scores of 9 (“Very, very thirsty”). Although the children clearly perceived elevated levels of thirst, they only drank 61% of the available water on average (200 ml/hr), with only one child drinking the full amount. This may be due to the majority of children not asking for water in the first hour of testing. While some children stated a preference for more water during the latter half of testing, several commented that they did not like the temperature of the water provided (maintained at 37°C to avoid confounding influences on Tco), with some opting not to drink at times for this reason. The observation that some children prioritized palatability over rehydration at times is consistent with prior work showing that adding grape flavoring to water reduced voluntary dehydration in children exercising in the heat over unflavored water, which was further reduced with the addition of carbohydrates and salt [29].