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

Abstract

The prevalence of hypertonic dehydration (HD) among community-dwelling and hospitalized populations has been evaluated. However, to our knowledge, no study had previously focused on older patients admitted to the emergency department (ED). The present study aimed to evaluate the prevalence, risk factors and short-term outcomes of HD among Thai older patients admitted to the ED.Methods: This was a prospective cross-sectional study at one urban ED in Thailand. Patients aged ≥65 years who were admitted to the ED were enrolled into the study. Data including clinical hydration status, Charlson Comorbidity Index (CCI) score, activities of daily living score, current use of medications, laboratory examination results and serum osmolarity level were collected. HD was defined as a serum osmolarity level of >300 mOsm/kg. The short-term outcomes were a 30-day ED revisit, hospital readmission and mortality rates.Results: In total, 80 (21.6%) of 370 patients presented with HD. A CCI score of ≥5 was found associated with HD among older patients (adjusted odds ratio: 1.82; 95% confidence interval: 1.03-3.21). The ED revisit rates were 18.1% in the dehydrated group and 10.9% in the non-dehydrated group. The hospital readmission rates were 8.3% in the dehydrated group and 10.6% in the non-dehydrated group. Furthermore, the 30-day mortality rates were 6.9% and 5.3% in the dehydrated and non-dehydrated groups, respectively.Conclusions: One-fifth of older patients admitted to the ED presented with HD. A CCI score of ≥5 was considered a risk factor of HD. Moreover, further studies should focus on the long-term outcomes of HD and risk reduction.

Prevalence and Risk Score for Hypertonic Dehydration among Community-Dwelling Older Adults: An Analysis of the Bangkok Falls Study

“…The model fit was tested using the Hosmer-Lemeshow goodness-of-fit , which showed a value of 0.93. The covariate potential associated with HD included age, gender, BMI [20], daily water intake, 6-CIT score (cognitive function) [10], mini nutrition assessment score [20], activities of a daily living score, CCI [9, 14], hypertension, number of medications used, the medication used [10], history of falls, and the quality of mobility by using the Stopping Elderly Accidents, Death & Injuries (STEADI) question [21]. The risk score was developed based on the final multiple logistic regression model and internal validation using the method described by Sullivan et al [22].…”

“…A systematic review among older adult nursing home residents indicated that the prevalence of HD varied between 0.8 and 38.5% using a variety of different methods [13]. One study of Thai older adults who visited the emergency department found that 21.1% presented with HD, and that a Charlson comorbidity index (CCI) score ≥5 was associated with HD [14]. Increased age, underlying diabetes mellitus (DM), and cognitive impairment had found to be a risk for impending HD in the UK hospital [10].…”

Influence of Impaired Hydration Status on Postoperative in-Hospital Death in Patients with Acute Type A Aortic Dissection

“…Buaprasert et al according to a study in patients with emergency admission 1/5 of the existence of high permeability dehydration. 6 Previous experiments have shown that in the state of hypertonic dehydration, the blood volume is relatively reduced, the blood is concentrated, and the blood viscosity is increased, which can not meet the blood supply of the corresponding organs. This is one of the important reasons leading to preoperative hypoperfusion of blood volume in patients with A AAD.…”