A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications

Abstract

Background: Dehydration appears prevalent, costly and associated with adverse outcomes. We sought to generate consensus on such key issues and elucidate need for further scientific enquiry. Materials and Methods: A modified Delphi process combined expert opinion and evidence appraisal. 12 relevant experts addressed dehydration's definition, objective markers and impact on physiology and outcome. Results: Fifteen consensus statements and seven research recommendations were generated. Key findings, evidenced in detail, were that there is no universally-accepted definition for dehydration; hydration assessment is complex and requires combining physiological and laboratory variables; 'dehydration' and 'hypovolaemia' are incorrectly used interchangeably; abnormal hydration status includes relative and/or absolute abnormalities in body water and serum/plasma osmolality (pOsm); raised pOsm usually indicates dehydration; direct measurement of pOsm is the gold standard for determining dehydration; pOsm >300 and ≤280 mOsm/kg classifies a person as hyper or hypo-osmolar; outside extremes, signs of adult dehydration are subtle and unreliable; dehydration is common in hospitals and care homes and associated with poorer outcomes. Discussion: Dehydration poses risk to public health. Dehydration is under-recognised and poorly managed in hospital and community-based care. Further research is required to improve assessment and management of dehydration and the authors have made recommendations to focus academic endeavours.

Prevalence and risk factors of hypertonic dehydration among older patients admitted to the emergency department: A prospective cross‐sectional study

“…19 The prevalence of dehydration was defined as current dehydration groups. 24 The CCI is a tool used to predict the 10-year mortality of each patient. It is a summary of all comorbidities, including myocardial infarction (MI), congestive heart failure, peripheral vascular disease, cerebrovascular accident, dementia, chronic obstructive pulmonary disease, connective tissue disease, peptic ulcer disease, liver disease, diabetes mellitus, hemiplegia, moderate-to-severe chronic kidney disease, solid tumor, leukemia, lymphoma and acquired immunodeficiency syndrome.…”

Evaluation of fluid intake habit and fuid importance among middle age and elderly patients

“…Sveikatos priežiūros specialistai, taip pat artimieji ir kiti pagyvenusį žmogų prižiūrintys asmenys turėtų būti mokomi, kaip užtikrinti tinkamą mitybą ir skysčių vartojimą [6]. Dehidratacija yra nepakankamai vertinama problema, nepakankamai atpažįstama tiek ligoninėse, tiek pirminėje sveikatos priežiūroje [22]. Norint pagerinti dehidratacijos vertinimą ir valdymą, reikia atlikti daugiau tyrimų, kurti standartizuotus vertinimus bei diegti rekomendacijas klinikinėje praktikoje.…”

Factors associated with low‐intake dehydration among older inpatients: A pilot study

“…In older patients admitted to hospital, dehydration is associated with increased risk of morbidity and mortality 1,2 and is under-recognised, under-treated and poorly prevented. 3 Older adults are especially susceptible to dehydration due to age-related physiological and functional decline, impaired thirst perception and a decline in renal concentrating ability, and as such, all older persons should be considered to be at risk of low-intake dehydration. 4 Fluid intake may be further compromised due to issues around continence, multi-morbidity, the side effects of polypharmacy and diminished cognition.…”

“…4 Fluid intake may be further compromised due to issues around continence, multi-morbidity, the side effects of polypharmacy and diminished cognition. 3,5 Hospitalised patients who are dehydrated stay in hospital on average 4.7 days longer than those who are hydrated. 6 There is a lack of international consensus on the definition and diagnosis of dehydration, and many clinical and laboratory parameters have been proposed to assess dehydration in older patients.…”

“…8 Plasma osmolality is considered the most valuable and objective haematologic parameter to assess hydration status. 3 Osmolality greater than 300 mOsm/ kg is considered to be a threshold value for clinical dehydration 9 while the value of 295 mOsm/kg is often cited as a mild or impending dehydration. 10 Multiple factors may influence the fluid intake of older inpatients and contribute to dehydration.…”