Reduced Survival with Increasing Plasma Osmolality in Elderly Continuing-care Patients

O'Neill, PA; Faragher, E. B.; Davies, Ioan; Wears, Robert L.; McLean, K.; Fairweather, D.S.

doi:10.1093/ageing/19.1.68

Cited by 43 publications

(14 citation statements)

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“…25 A significant relationship between raised plasma osmolality and mortality has been shown in long-stay community patients and acutely ill patients, which suggests that dehydration may have influenced survival. 17,18 Studies involving stroke patients are limited. Joynt et al 5 demonstrated no significant difference in plasma osmolality on admission between stroke patients and control subjects.…”

Section: Discussionmentioning

confidence: 99%

Influence of Raised Plasma Osmolality on Clinical Outcome After Acute Stroke

Bhalla

Sankaralingam

Dundas

et al. 2000

Stroke

189

135

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Background and Purpose-Abnormal physiological parameters after acute stroke may induce early neurological deterioration. Studies of the effect of dehydration on stroke outcome are limited. We examined the association of raised plasma osmolality on stroke outcome at 3 months and the change of plasma osmolality with hydration during the first week after stroke. Methods-Acute stroke patients had their plasma osmolality measured at admission and at days 1, 3, and 7. Maximum plasma osmolality and the area under curve (AUC) were also calculated during the first week. Patients were stratified according to how they were hydrated: orally, intravenously, or both. Outcome included survival at 3 months after stroke. Logistic regression was performed to examine the association between raised plasma osmolality (Ͼ296 mOsm/kg) and survival, adjusting for stroke severity. Linear regression was performed to examine the pattern of plasma osmolality across hydration groups. Results-One hundred sixty-seven patients were included. Mean admission (300 mOsm/kg, SD 11.4), maximum (308.1 mOsm/kg, SD 17.1), and AUC (298.3 mOsm/kg, SD 11.7) plasma osmolality were significantly higher in those who died compared with survivors (293.1 mOsm/kg [SD 8.2], 297.7 mOsm/kg [SD 8.7], and 291.7 mOsm/kg [SD 8.1], respectively; PϽ0.0001). Admission plasma osmolality Ͼ296 mOsm/kg was significantly associated with mortality (OR 2.4, 95% CI 1.0 to 5.9). In patients hydrated intravenously, there was no significant fall in plasma osmolality compared with patients hydrated orally (Pϭ0.68). Conclusions-Raised plasma osmolality on admission is associated with stroke mortality, after correcting for case mix.Correction of dehydration after stroke requires a more systematic approach. Trials are required to determine whether correcting dehydration after stroke improves outcome.

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Section: Discussionmentioning

confidence: 99%

Influence of Raised Plasma Osmolality on Clinical Outcome After Acute Stroke

Bhalla

Sankaralingam

Dundas

et al. 2000

Stroke

189

135

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“…It has been reported that 11% of acutely ill elderly patients were found to have hyponatraemia, and approximately 22% of those elderly in long-term institutional care also had significantly low sodium levels [1,2]. There is also a significantly increased incidence of hyperosmolar states which are associated with increased mortality [3].…”

Section: Clinical Assessment Of Hydration Status In the Older Patientmentioning

confidence: 99%

“…McLean et al [8] describe a higher range for plasma osmolality in a study of community-dwelling elderly (mean 302 mosm/ kg, SD 14 mosm/kg) when compared with younger counterparts (mean 291.2, SD 1.2 mosm/kg). In a further study these workers describe a mean osmolality of 304 mosm/kg in elderly patients in a continuing-care facility, with the higher osmolality readings associated with increased mortality [3]. However, other workers have described osmolality readings in healthy elderly as unchanged from published normal ranges for the general population [9].…”

Section: Clinical Assessment Of Hydration Status In the Older Patientmentioning

confidence: 99%

A Review of Water Balance in Ageing in Health and Disease

1999

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The elderly are at increased risk of changes in body water and sodium, often accompanying comorbid disease states, which are associated with increased mortality. The clinical assessment of the hydration status of an elderly patient is difficult and the elderly care physician relies on both the clinical picture and laboratory investigation. Although still contentious, research suggests that the elderly may appreciate thirst less readily. However, healthy elderly may be able to produce an enhanced vasopressin response to osmotic stimulation compared to their younger counterparts, possibly in response to reduced renal function. The changes in these systems, when combined with coincident disease, place elderly patients at risk of water imbalance and electrolyte disturbance.

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“…The association between hyperosmolality and mortality in both institutionalized elderly patients 86 and medical emergencies 88 may not be directly due to breakdown in water homeostasis, but may reflect the presence of severe or multiple pathology.…”

Section: The Kidneymentioning

confidence: 99%

Aging homeostasis

O'Neill

1997

Rev. Clin. Gerontol.

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Homeostasis is the ability of a living organism to control its internal environment despite fluctuations in the external environment. Claude Bernard proposed the concept of 'milieu interieur'. The hypothesis rests on the belief that cells need a precisely defined local environment in which to function optimally. The maintenance of the micro-environment is dependent on integration of the systems of the organism (body), including behaviour, to protect the cell(s) from external stressors. When the environment changes, the body needs to sense the alteration, then set in motion mechanisms which mitigate the change and restore the previous balance. If it fails to do this, the organism will ultimately die as systems fail.

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Reduced Survival with Increasing Plasma Osmolality in Elderly Continuing-care Patients

Cited by 43 publications

References 0 publications

Influence of Raised Plasma Osmolality on Clinical Outcome After Acute Stroke

Influence of Raised Plasma Osmolality on Clinical Outcome After Acute Stroke

A Review of Water Balance in Ageing in Health and Disease

Aging homeostasis

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