Comfort and incidence of abnormal serum sodium, Bun, creatinine and osmolality in dehydration of terminal illness

Abstract

This prospective clinical study was undertaken to evaluate the effect of spontaneous food/fluid intake on serum sodium and comfort levels in a population of terminal patients (n = 31) receiving clysis or intravenous hydration. The median and mode of serum sodium were within normal limits and 56 percent of the patients were eunatremic. There was no statistically significant difference in comfort scores between predehydration and dehydration phases, and 85 percent had an optimal comfort score. A statistically significant difference was found (p < 0.5) between mean daily comfort scores of those with normal sodium versus those with abnormal sodium; those with hypernatremia were lower but still in the top third comfort levels. Because the sodium was tested using a Chem7, we also were able to calculate the BUN, creatinine, and osmolality. These are presented and compared to other study results. The findings of this study reinforce the belief that fluid depletion in dying patients results in relatively benign symptoms, that serum sodium levels are not always altered with limited intake and that comfort levels can be maintained when the serum sodium is abnormal.

Delirium and dehydration: some fluid for thought?

“…This polarization probably has its origins in the historic schism between the relatively aggressive approach of the hospital or biomedical model of management and the more conservative approach of traditional hospice care [33]. From the traditional hospice perspective, provision of intravenous or subcutaneous fluids to patients with advanced disease largely entails an unnecessary intervention and consequent burden for the patient [3,32,67,106].…”

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

“…Dehydration, as indicated by an increased BUN/Cr ratio or USG (Aronson et al., 2008; Vullo‐Navich et al., 1998; Weinberg et al., 1994), is known to be relatively common among patients who have experienced stroke (Rowat, Graham, & Dennis, 2012). Some studies have reported the possible relationship of dehydration with poor neurological function outcome of acute ischemic stroke patients.…”

“…Some studies have reported the possible relationship of dehydration with poor neurological function outcome of acute ischemic stroke patients. For example, BUN/Cr ratio as a marker of dehydration status was an independent predictor of early neurological deterioration among patients who had suffered acute ischemic stroke (Aronson et al., 2008; Lin et al., 2011; Vullo‐Navich et al., 1998; Weinberg et al., 1994). A correlation between BUN/Cr ratio ≥15 and worse outcome was also found in stroke patients (Schrock et al., 2012).…”

“…However, multivariate logistic regression analysis showed that BUN/Cr ratio ≥15 combined with USG > 1.010, but not either of them was independently associated with the poor outcome. The results are different from the previous results that BUN/Cr ratio ≥15 or USG > 1.010 was an independent risk of early neurological deterioration in patients with acute ischemic stroke (Aronson et al., 2008; Lin et al., 2011, 2011; Vullo‐Navich et al., 1998; Weinberg et al., 1994). The reason may be: (1) the effect of dehydration on long‐term prognosis was determined in the present study, while the effect on short‐term prognosis in other studies; (2) thrombolysed patients with acute cerebral infarction are subjects in the present study, who are different from patients with acute cerebral infarction in other studies; (3) BUN/Cr ≥ 15 combined with USG > 1.010 was used as a marker of dehydration status in our study, while either of them as a marker in other studies; (4) mRS 0–2 was used as a good outcome in the present study, while mRS ≤ 1 was defined as a good outcome in other studies (Cappellari et al., 2013; Song et al., 2017; Tsivgoulis et al., 2016).…”

“…Among these parameters, BUN/Cr and USG are widely used to assess dehydration status, especially in patients with normal renal function. Several studies have shown that BUN/Cr ratio as a marker of dehydration status was an independent predictor of early neurological deterioration (END) and poor outcomes 30 days post stroke among patients who had suffered acute ischemic stroke (Aronson et al., 2008; Lin et al., 2011; Vullo‐Navich et al., 1998; Weinberg et al., 1994). Some findings suggest that USG as a marker of dehydration status may be associated with stroke in evolution in patients with acute ischemic stroke (Lin et al., 2011; Schrock et al., 2012).…”