What Are the Signs of Dehydration In the Elderly?

The common manifestations of dehydration in the elderly are weakness, dizziness, and abnormal personality. Although obvious dryness of the oral mucosa can be seen, patients may not have obvious thirst and drinking behaviors. Severe cases are often manifested as altered consciousness (including hallucinations, slang, drowsiness, or coma), decreased urine output (increased early urine output in patients with dehydration caused by hypertonic diuresis), hypotension, increased hematocrit, but poor skin elasticity. Can be seen in normal elderly. Elevated serum urea nitrogen (BUN) and creatinine (Cr) levels often indicate a significant lack of capacity; serum sodium levels can be high, low, and normal, depending on the cause of dehydration.

Dehydration in the elderly

The loss of body fluid exceeds the intake of fluid, which is clinically manifested as a decrease in extracellular fluid volume, that is, a low-volume state with insufficient body fluid volume. Water loss is accompanied by sodium loss. The degree of loss of the two can be different. The proportion of water and sodium loss is the same. The extracellular fluid osmotic pressure is maintained within a normal range, which is called isotonic dehydration. Water loss> sodium loss, extracellular fluid penetration. Pressure> 320mmol / L, blood sodium> 150mmol / L, called hypertonic dehydration; sodium loss> water loss, extracellular fluid osmotic pressure <280mmol / L, blood sodium <130mmol / L, called hypotonic dehydration. According to the amount of body fluid lost, dehydration is divided into three degrees. Water loss of 3% to 6% of body weight is moderate dehydration, and water loss of more than 6% of body weight is severe dehydration.

Signs and symptoms of dehydration in the elderly

Dehydration medication for the elderly

1. The type of fluid replacement mainly depends on the cause of dehydration. Glucose solution (5% and 10%) is suitable for simple dehydration (such as difficult drinking water, diabetes insipidus, etc.) and supplementation of insignificant dehydration (loss of skin and respiratory tract); physiological saline or 5% glucose saline is suitable for sodium loss. When water coexists. For dehydration of hypernatremia, 0.45% NaCl can be selected. For dehydration of hyponatremia, 3% NaCl can be selected. For severe hypovolemia or concomitant hypoalbuminemia, plasma or human albumin can be selected.

2. Rehydration route When the amount of dehydration does not exceed 2% of body weight, if the patient is not associated with gastrointestinal diseases or consciousness disorders, it is best to take oral rehydration to correct it; if it is not suitable for oral rehydration or the dehydration is more serious, rapid intravenous rehydration should be immediately, To correct hypovolemia. Once orthostatic hypotension and tachycardia are corrected, the remaining dehydration can be replenished in the next 2 to 3 days to avoid heart failure.

3. Treatment monitoring Pay attention to the lack of other electrolytes and the correction of metabolic acidosis.

4. Effective judgment Skin is full and plump, urine output increases, heart rate slows, and blood pressure, BUN, and Cr levels are normal.

Dehydration diet health care for the elderly

It should be light, eat more fruits and vegetables, match the diet reasonably, and pay sufficient nutrition.

Elderly Dehydration Prevention Care

In addition to observing the patient's urine volume and blood pressure during fluid replacement, it is best to monitor central venous pressure (CVP), especially for those with suspected cardiac insufficiency.

Etiology of dehydration in the elderly

1. Insufficient intake: Elderly people have poor thirst and do not think about drinking, critically ill patients have difficulty drinking, and those with unconsciousness do not know how to drink.

2. Excessive discharge: hyperosmotic state of plasma, such as osmotic diuresis caused by hyperglycemia; diabetes insipidus, excessive drainage of kidneys due to insufficient ADH secretion or insensitive tubules to ADH; severe vomiting or diarrhea, or nasal Abnormal loss of gastric tube drainage or gastrointestinal fistula; pathological loss such as high fever and sweat, tracheotomy, chronic kidney disease, application of diuretics; in addition, special attention should be paid to insufficient adrenal function in the elderly.

Diagnosis of dehydration in the elderly

Clinically, it is necessary to distinguish between isotonic dehydration, hypertonic dehydration, hypotonic dehydration, and the relationship between dehydration and water poisoning, hypernatremia, hyponatremia, and their mutual transformation.

Dehydration test method for the elderly

Laboratory inspection:

Increased urine specific gravity, blood sodium concentration> 145mmol / L is called hypertonic dehydration, blood sodium <130mmol / L is called hypotonic dehydration, and the proportion of water and sodium is uniformly called isotonic dehydration. White blood cell count increased, hemoglobin increased, BUN, Cr increased.

Other auxiliary checks:

X-ray examination showed no abnormalities in the heart and lungs.

Dehydration complications in the elderly

Patients with severe dehydration may experience neurological symptoms such as delirium, mania or fainting, as well as unconscious coma, circulatory failure, shock, etc.

Prognosis of dehydration in the elderly

Depending on the primary disease and the timely treatment, usually dehydration alone, the prognosis is good.

Pathogenesis of dehydration in the elderly

Dehydration is a relatively simple lack of water, causing a decrease in extracellular fluid. Due to the increase in blood osmotic pressure, it can compensate for thirsty drinking water and increase renal tubular reabsorption of water. Is accompanied by sodium loss, often combined with insufficient capacity.