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Dehydration and Death During Febrile Episodes in the Nursing Home
Author(s) -
Weinberg Andrew D.,
Pals Jean K.,
Levesque Paul G.,
Beal Lorraine F.,
Cunningham Thomas J.,
Minaker Kenneth L.
Publication year - 1994
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1994.tb06589.x
Subject(s) - medicine , blood urea nitrogen , creatinine , incidence (geometry) , dehydration , prospective cohort study , cohort , pediatrics , gastroenterology , biochemistry , chemistry , physics , optics
OBJECTIVE : To determine the incidence of early hypernatremic dehydration among residents of a nursing home care unit (NHCU) presenting with significant febrile episodes (FE). DESIGN : Prospective cohort analytic study. FE were defined as temperature (T) > 100°F oral (o) or 101°F rectal (r) for ≥ 24 hours. SETTING : NHCU in a Veterans Administration hospital. PATIENTS : A total of 130 residents of the NHCU were monitored for FE during a 4‐month study period. MAIN OUTCOME MEASURES : Blood urea nitrogen (BUN)/creatinine (Cr) (abnormal ≥ 25) and serum sodium (Na)(abnormal ≥ 146 mmol/L) were drawn within 24–48 hours of the onset of all FE; documentation of impaired oral intake (OI) by staff; necessity of transfer to acute medical wards and mortality were recorded. RESULTS : There were 48 FE among 42 residents (39 M, 3 F; mean age 75 ± 11.3). Maximum recorded T during the FE ranged from 100.1°F–102.2°F o and 101.2°F‐105.3°F r. Laboratory values were available for 40/48 FE. Twenty‐three percent (9/40) had elevated BUN/Cr ratios, 25% (10/40) had elevated serum Na, and 12.5% (5/40) had both. In patients noted to have impaired OI ( n = 11) as documented by staff, increased serum Na or BUN/Cr ratio was observed in 82% (9/11). A random control group of 37 nonacutely ill, nonfebrile NHCU residents (33 M, 4 F; mean age 75 ± 10.1) having routine annual laboratory tests revealed only 1 resident (age 95) with an elevated Na of 146 and BUN/Cr ratio of 26 and 1 resident with an increased BUN/Cr ratio of 28. None of the controls had any staff documentation of impaired OI. Of the 5 deaths in the febrile group with laboratory data (total deaths = 6; 14%), 100% had either elevated serum Na and/or elevated BUN/Cr ratios, and 80% (4/5) had both. Comparing the febrile group with controls, BUN/Cr ratios were found to be significantly elevated in the febrile group ( P < 0.05). Serum sodium values were also significantly elevated in the febrile group ( P < 0.01). CONCLUSIONS : Staff documentation of impaired OI was highly associated with either elevated serum Na or increased BUN/Cr ratios. These data show that many older NHCU patients with significant fevers often have early impaired OI and laboratory evidence of dehydration. These data indicate that staff should institute appropriate monitoring for dehydration at the time of earliest detection of fever in this population.