The patient with acute cardiovascular problems
Peate Ian, Dutton Helen in Acute Nursing Care, 2020
As the name suggests, hypovolaemic shock is a problem with the blood or volume component of the circulation. Hypovolaemia is one of the most common causes of shock and is the most easily reversed. Volume can be lost from the circulation in a number of ways. External blood loss can easily be identified as long as a comprehensive assessment is performed, internal bleeding, though, is not so easily discernible, and information gained from the past medical history and pharmacological therapy contributes to diagnosis. Fluid can also be lost from the circulation into the gut, as with paralytic ileus, or the peritoneal space, as with liver failure (see Chapter 10). Dehydration can occur from excessive vomiting, diarrhoea, sweating, infection, burns and wound exudate/drainage. Hidden losses are not always easy to estimate and may not be obvious, even when accurate fluid balance monitoring is recorded. Insensible losses in health can be 500–900mL per day (Norris 2019). As they increase with pyrexia, increased respiratory rate and diarrhoea, they need to be taken into account when calculating fluid requirements.
The patient with acute cardiovascular problems
Ian Peate, Helen Dutton in Acute Nursing Care, 2014
As the name suggests, hypovolaemic shock is a problem with the blood or volume component of the circulation. Hypovolaemia is the most common cause of shock and the most easily reversed (Smith 2003, Jevon et al. 2008). Volume can be lost from the circulation in a number of ways. External blood loss can easily be identified as long as a comprehensive assessment is performed, internal bleeding is not so easily discernible and information gained from the past medical history and pharmacological therapy contributes to diagnosis. Fluid can also be lost from the circulation into the gut as with paralytic ileus, or the peritoneal space as with liver failure (see Chapter 10). Dehydration can occur from excessive vomiting, diarrhoea, sweating, infection, burns and wound exudate/drainage. Hidden losses are not always easy to estimate and may not be obvious even when accurate fluid balance monitoring is recorded. Insensible losses in health can be around 900mL per day (Porth 2007). As they increase with pyrexia, increased respiratory rate and diarrhoea they need to be taken into account when calculating fluid requirements.
Electrolyte and Acid-Base Disturbances
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
The goal of fluid therapy for dehydration is to restore euvolemia without inducing or worsening electrolyte disorders. The treatment includes controlling precipitating factors, replacing the fluid deficit, and providing sufficient maintenance fluid to prevent a recurrence of dehydration. Depending upon the primary cause, pharmacotherapy with antidiarrheal agents, antisecretory drugs, or antiemetics may be indicated. Fluid deficit generally can be replenished using oral rehydration therapy; however, IV fluid is preferred in patients with significant cardiovascular signs/symptoms (e.g., severe hypotension), altered mental status, inability to tolerate oral/enteral fluid due to refractory nausea and vomiting, or uncontrolled diarrhea. Importantly, oral rehydration therapy is more effective in preventing and delaying dehydration rather than treating dehydration associated with severe diarrhea [16].
A survey of speech pathologist practice patterns for consulting registered dieticians when recommending diet alterations
Published in Speech, Language and Hearing, 2022
Ed M. Bice, Kristine E. Galek, Alicia K. Vose
Dehydration in clinical practice refers to the loss of body water at a rate greater than the body can replace it. Clinically, it cannot be defined by a single symptom, sign, or laboratory value (Thomas et al., 2008). Dehydration is a frequently diagnosed fluid and electrolyte disorder of frail elders, both in long-term care settings and in the community (Lavizzo-Mourey, Johnson, & Stolley, 1988). It is one of the ten most frequent diagnoses reported for Medicare hospitalizations (DiBardino & Wunderink, 2015). Dehydration may contribute to underlying disabilities by causing orthostatic hypotension resulting in dizziness, confusion, delirium, and weakness (J. Mukand, Cai, Zielinski, Danish, & Berman, 2003). In addition, there is an increased risk of death in patients who are dehydrated at the time of hospitalization (Warren et al., 1994).
A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications
Published in Annals of Medicine, 2019
Jonathan Lacey, Jo Corbett, Lui Forni, Lee Hooper, Fintan Hughes, Gary Minto, Charlotte Moss, Susanna Price, Greg Whyte, Tom Woodcock, Michael Mythen, Hugh Montgomery
“Dehydration” is a term which, in clinical use, refers to a deficiency in total body water. Whilst no standard means of defining its presence or severity exists (see below), it appears to be both prevalent and costly within the healthcare setting. In 2015, 37% of patients aged over 65 years old admitted to a large UK hospital were dehydrated [1]. Of 370,758 patients in the 2004 US National Hospital Discharge Survey, there were 518,000 hospitalizations primarily due to dehydration, incurring healthcare costs in excess of 5 billion dollars [2]. The problem is not restricted to hospitalized patients, a recent UK study found one in every five older people living in long-term care to be dehydrated (serum osmolality >300 mOsm/kg) and half to be either dehydrated or at risk of becoming so (≥295–300 mOsm/kg) [3]. Furthermore, it has been repeatedly shown that dehydration is associated with increased mortality and morbidity [3–8].
Colonoscopy adverse events: are we getting the full picture?
Published in Scandinavian Journal of Gastroenterology, 2020
Lasse Pedersen, Nina Sorensen, Karen Lindorff-Larsen, Charlotte Green Carlsen, Nina Wensel, Christian Torp-Pedersen, Inge Bernstein
Bowel preparation is known to cause dehydration and electrolyte disturbances like hyponatraemia. Dehydration (with or without hyponatraemia) usually occurs due to excess sodium loss caused by bowel preparation combined with insufficient water intake. Normal hydration with hyponatraemia, known as ‘bowel prep hyponatraemia’, can also occur. It results from non-osmotic arginine vasopressin release, high-speed water intake and temporarily restricted diets found in patients undergoing bowel preparation [16]. The result is acute water intoxication similar to the condition seen in marathon runners [17]. Our findings suggest that re-admittance after colonoscopy due to dehydration/hyponatremia is a rare (0.8‰), but potentially fatal AE as some individuals with pre-existing diseases have poor tolerability to electrolyte imbalances and/or dehydration. The bowel preparation regime in the North Denmark Region is a polyethylene glycol electrolyte solution for screening colonoscopies and a sodium picosulfate solution for diagnostic colonoscopies. Sodium picosulfate has been reported to have an increased risk of hyponatraemia compared to polyethylene glycol which corresponds well to our finding that the risk of dehydration/hyponatraemia is higher among diagnostic colonoscopies (Table 6) [18]. However, a definite conclusion cannot be reached as the screening and diagnostic group might not be directly comparable.