老年人失水性脱水的诊断与治疗

Diagnosis and treatment of hypertonic dehydration in the elderly

失水性脱水(water-loss dehydration)在老年人群中很常见,它增加了老年人不良事件的发生风险,降低其生活质量,并增加住院率与死亡率。目前常用的诊断脱水的方法如依据体征或通过检测尿液、尿素氮/肌酐、生物电阻抗以及唾液等均不适合用于老年人脱水的判断。关于老年人失水性脱水的诊断尚无金标准,欧洲临床营养与代谢学会(ESPEN)推荐采用直接测量血浆/血清渗透压或渗透压公式[渗透压(mmol/L)=1.86×(血钠值+血钾值)+1.15×血糖值+尿素值+14]来诊断失水性脱水。

Hypertonic dehydration is prevalent in the elderly,increases the risk of adverse events,reduces quality of life,and increases hospitalization and mortality.Current methods of diagnosing dehydration,such as physical signs,urine tests,urea nitrogen/creatinine,bioelectrical impedance and saliva,are not suitable for the diagnosis of dehydration in the elderly.There is no gold standard for the diagnosis of hypertonic dehydration in the elderly.The European Society for Clinical Nutrition and Metabolism(ESPEN)recommends the direct measurement of plasma/serum osmotic pressure or using an osmotic pressure formula[osmolarity(mmol/L)=1.86×(Na^(+)+K^(+))+1.15×glucose+urea+14](all measured in mmol/L)for the diagnosis of hypertonic dehydration.