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Lee Hooper - One of the best experts on this subject based on the ideXlab platform.
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which frail older people are dehydrated the uk drie study
Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2016Co-Authors: Lee Hooper, Alice Downing, Florence Jimoh, Joyce Groves, Carol Free, Vicky Cowap, Diane Bunn, Paul R Hunter, John F. Potter, Lee ShepstoneAbstract:Background: Water-loss dehydration in older people is associated with increased mortality and disability. We aimed to assess the prevalence of dehydration in older people living in UK long-term care, and associated cognitive, functional and health characteristics. Methods: The Dehydration Recognition In our Elders (DRIE) cohort study included people ≥65 years living in long-term care without heart or renal failure. In a cross-sectional baseline analysis we assessed Serum Osmolality, previously suggested dehydration risk factors, general health, markers of continence, cognitive and functional health, nutrition status and medications. Univariate linear regression was used to assess relationships between participant characteristics and Serum Osmolality, then associated characteristics entered into stepwise backwards multivariate linear regression. Results: DRIE included 188 residents (mean age 86 years, 66% women) of whom 20% were dehydrated (Serum Osmolality >300mOsm/kg). Linear and logistic regression suggested that renal, cognitive and diabetic status were consistently associated with Serum Osmolality and odds of dehydration, while potassium-sparing diuretics, sex, number of recent health contacts, and bladder incontinence were sometimes associated. Thirst was not associated with hydration status. Conclusions: DRIE found high prevalence of dehydration in older people living in UK long-term care, reinforcing the proposed association between cognitive and renal function and hydration. Dehydration is associated with increased mortality and disability in older people, but trials to assess effects of interventions to support healthy fluid intakes in older people living in residential care are needed to enable us to formally assess causal direction and any health benefits of increasing fluid intakes.
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accuracy of prediction equations for Serum osmolarity in frail older people with and without diabetes
The American Journal of Clinical Nutrition, 2014Co-Authors: Mario Siervo, Diane Bunn, Carla M Prado, Lee HooperAbstract:Background: Serum Osmolality is an accurate indicator of hydration status in older adults. Glucose, urea, and electrolyte concentrations are used to calculate Serum osmolarity, which is an indirect estimate of Serum Osmolality, but which Serum osmolarity equations best predict Serum Osmolality in the elderly is unclear. Objective: We assessed the agreement of measured Serum Osmolality with calculated Serum osmolarity equations in older people. Design: Serum Osmolality was measured by using freezing point depression in a cross-sectional study. Plasma glucose, urea, and electrolytes were analyzed and entered into 38 Serum osmolarity-prediction equations. The Bland-Altman method was used to evaluate the agreement and differential bias between measured Osmolality and calculated osmolarity. The sensitivity and specificity of the most-promising equations were examined against Serum Osmolality (reference standard). Results: A total of 186 people living in UK residential care took part in the Dehydration Recognition In our Elders study (66% women; mean ± SD age: 85.8 ± 7.9 y; with a range of cognitive and physical impairments) and were included in analyses. Forty-six percent of participants had impending or current dehydration (Serum Osmolality ≥295 mmol/kg). Participants with diabetes (n = 33; 18%) had higher glucose (P 80% of participants, regardless of diabetes or hydration status. The equation's sensitivity (79%) and specificity (89%) for impending dehydration (≥295 mmol/kg) and current dehydration (>300 mmol/kg) (69% and 93%, respectively) were reasonable. Conclusions: The assessment of a panel of equations for the prediction of Serum osmolarity led to identification of one formula with a greater diagnostic performance. This equation may be used to predict hydration status in frail older people (as a first-stage screening) or to estimate hydration status in population studies. This trial was registered at the Research Register for Social Care (http://www.researchregister.org.uk) as 122273.
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accuracy of prediction equations for Serum osmolarity in frail older people with and without diabetes
The American Journal of Clinical Nutrition, 2014Co-Authors: Mario Siervo, Diane Bunn, Carla M Prado, Lee HooperAbstract:Background: Serum Osmolality is an accurate indicator of hydration status in older adults. Glucose, urea, and electrolyte concentrations are used to calculate Serum osmolarity, which is an indirect estimate of Serum Osmolality, but which Serum osmolarity equations best predict Serum Osmolality in the elderly is unclear. Objective: We assessed the agreement of measured Serum Osmolality with calculated Serum osmolarity equations in older people. Design: Serum Osmolality was measured by using freezing point depression in a cross-sectional study. Plasma glucose, urea, and electrolytes were analyzed and entered into 38 Serum osmolarity-prediction equations. The Bland-Altman method was used to evaluate the agreement and differential bias between measured Osmolality and calculated osmolarity. The sensitivity and specificity of the most-promising equations were examined against Serum Osmolality (reference standard). Results: A total of 186 people living in UK residential care took part in the Dehydration Recognition In our Elders study (66% women; mean 6 SD age: 85.8 6 7.9 y; with a range of cognitive and physical impairments) and were included in analyses. Forty-six percent of participants had impending or current dehydration (Serum Osmolality $295 mmol/kg). Participants with diabetes (n = 33; 18%) had higher glucose (P , 0.001) and Serum Osmolality (P , 0.01). Of 38 predictive equations used to calculate osmolarity, 4 equations showed reasonable agreement with measured Osmolality. One [calculated osmolarity = 1.86 3 (Na + +K + ) + 1.15 3 glucose + urea +14; all in mmol/L] was characterized by narrower limits of agreement and the capacity to predict Serum Osmolality within 2% in .80% of participants, regardless of diabetes or hydration status. The equation’s sensitivity (79%) and specificity (89%) for impending dehydration ($295 mmol/kg) and current dehydration (.300 mmol/kg) (69% and 93%, respectively) were reasonable. Conclusions: The assessment of a panel of equations for the prediction of Serum osmolarity led to identification of one formula with a greater diagnostic performance. This equation may be used to predict hydration status in frail older people (as a first-stage screening) or to estimate hydration status in population studies. This trial was registered at the Research Register for Social Care (http://www.researchregister.org.uk) as 122273. Am J Clin Nutr doi: 10.3945/ajcn.114.086769.
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o4 25 assessment of dehydration in older people agreement of measured Serum Osmolality with calculated Serum osmolarity equations
European Geriatric Medicine, 2014Co-Authors: Lee Hooper, K Bunn, M Prado, Mario SiervoAbstract:Introduction: Serum Osmolality is the best indicator of hydration status in older adults. Serum glucose, urea and electrolytes are commonly analysed in health care situations, and are used to calculate Serum osmolarity, an estimate of Serum Osmolality, but it is unclear which equations best predict Serum Osmolality. We assessed agreement of measured Serum Osmolality with calculated Serum osmolarity equations in older people. Methods: Serum Osmolality (by freezing point depression) was measured at baseline in the Dehydration Recognition in our Elders, DRIE, cohort (http://driestudy.appspot.com/). Serum glucose, urea and electrolytes were entered into 38 Serum osmolarity prediction equations. We evaluated agreement (Bland-Altman) and differential bias between measured Osmolality and calculated osmolarity. Sensitivity and specificity of the most promising equations were examined against Serum Osmolality (reference standard). Results: 186 people living in UK residential care took part in DRIE (66% women, mean age 85.8±7.9 years, with a range of cognitive and physical impairments) and were included in analyses. 19% had current dehydration (Serum Osmolality >300mmol/kg). Of 38 osmolarity equations, four showed reasonable agreement and one (calculated osmolarity= 1.86×(Na++K+)+1.15×glucose+urea+14, all in mmol/L)1 better predicted Serum Osmolality (>80% of participants within 2%, regardless of diabetes or hydration status). Using a cut-off of >296mmol/L for calculated osmolarity gave good sensitivity (97%) and specificity (76%) for current dehydration (>300mmol/kg) (table). Conclusions: One formula had clearly better diagnostic performance and could predict dehydration as a first stage screening in frail older people or estimate hydration status in population studies. 1. Khajuria & Krahn. Clin Biochem 2005;38:514-519.
M J Bedel - One of the best experts on this subject based on the ideXlab platform.
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the effect of intravenous lactated ringer s solution versus 0 9 sodium chloride solution on Serum Osmolality in human volunteers
Anesthesia & Analgesia, 1999Co-Authors: E L Williams, K L Hildebrand, S A Mccormick, M J BedelAbstract:UNLABELLED: Animal studies have shown that large volumes of IV lactated Ringer's solution (LR) decrease Serum Osmolality, thereby increasing cerebral water. These studies have led to recommendations to limit LR to avoid cerebral edema in neurosurgical patients. Eighteen healthy human volunteers aged 20-48 yr received 50 mL/kg LR over 1 h on one occasion and 0.9% sodium chloride (NS) on another. Venous samples were taken at baseline (T1), at infusion end (T2), and 1 h after T2 (T3). Time until first urination was noted. With LR, Serum Osmolality decreased by 4+/-3 mOsm/kg from T1 to T2 and increased insignificantly with NS. At T3, Osmolality returned almost to baseline in the LR group. Blood pH increased from T1 to T2 with LR by 0.04+/-0.04 and decreased with NS by 0.04+/-0.04. These pH changes persisted at T3. Subjective mental changes occurred only with NS. Abdominal discomfort was more common with NS. Time until first urination was longer with NS (106+/-11 min) than with LR (75+/-10 min) (P < 0.001). In healthy humans, an infusion of large volumes of LR, but not NS, transiently decreased Serum Osmolality, whereas acidosis associated with NS persisted and urinary output was slower with NS. IMPLICATIONS: Large volumes of lactated Ringer's solution administered to healthy humans produced small transient changes in Serum Osmolality. Large volumes of sodium chloride did not change Osmolality but resulted in lower pH.
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the effect of intravenous lactated ringer s solution versus 0 9 sodium chloride solution on Serum Osmolality in human volunteers
Anesthesia & Analgesia, 1999Co-Authors: E L Williams, K L Hildebrand, S A Mccormick, M J BedelAbstract:Animal studies have shown that large volumes of IV lactated Ringer's solution (LR) decrease Serum Osmolality, thereby increasing cerebral water.These studies have led to recommendations to limit LR to avoid cerebral edema in neurosurgical patients. Eighteen healthy human volunteers aged 20-48 yr rec
E L Williams - One of the best experts on this subject based on the ideXlab platform.
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the effect of intravenous lactated ringer s solution versus 0 9 sodium chloride solution on Serum Osmolality in human volunteers
Anesthesia & Analgesia, 1999Co-Authors: E L Williams, K L Hildebrand, S A Mccormick, M J BedelAbstract:UNLABELLED: Animal studies have shown that large volumes of IV lactated Ringer's solution (LR) decrease Serum Osmolality, thereby increasing cerebral water. These studies have led to recommendations to limit LR to avoid cerebral edema in neurosurgical patients. Eighteen healthy human volunteers aged 20-48 yr received 50 mL/kg LR over 1 h on one occasion and 0.9% sodium chloride (NS) on another. Venous samples were taken at baseline (T1), at infusion end (T2), and 1 h after T2 (T3). Time until first urination was noted. With LR, Serum Osmolality decreased by 4+/-3 mOsm/kg from T1 to T2 and increased insignificantly with NS. At T3, Osmolality returned almost to baseline in the LR group. Blood pH increased from T1 to T2 with LR by 0.04+/-0.04 and decreased with NS by 0.04+/-0.04. These pH changes persisted at T3. Subjective mental changes occurred only with NS. Abdominal discomfort was more common with NS. Time until first urination was longer with NS (106+/-11 min) than with LR (75+/-10 min) (P < 0.001). In healthy humans, an infusion of large volumes of LR, but not NS, transiently decreased Serum Osmolality, whereas acidosis associated with NS persisted and urinary output was slower with NS. IMPLICATIONS: Large volumes of lactated Ringer's solution administered to healthy humans produced small transient changes in Serum Osmolality. Large volumes of sodium chloride did not change Osmolality but resulted in lower pH.
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the effect of intravenous lactated ringer s solution versus 0 9 sodium chloride solution on Serum Osmolality in human volunteers
Anesthesia & Analgesia, 1999Co-Authors: E L Williams, K L Hildebrand, S A Mccormick, M J BedelAbstract:Animal studies have shown that large volumes of IV lactated Ringer's solution (LR) decrease Serum Osmolality, thereby increasing cerebral water.These studies have led to recommendations to limit LR to avoid cerebral edema in neurosurgical patients. Eighteen healthy human volunteers aged 20-48 yr rec
Tin Aung - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of Choroidal Thickness, Intraocular Pressure, and Serum Osmolality After the Water Drinking Test in Eyes With Primary Angle Closure
2020Co-Authors: Monisha E Nongpiur, Valencia Hui Xian Foo, Mani Baskaran, Tin A Tun, Rahat Husain, Shamira A Perera, John Mark De Leon, Tin AungAbstract:PURPOSE. We evaluated changes in choroidal thickness (ChT), IOP, ocular biometry, and Serum Osmolality after the water drinking test (WDT) in subjects with previous acute primary angle closure (APAC) and primary angle closure glaucoma (PACG). METHODS. We evaluated 38 subjects, including 21 with APAC and 17 with PACG. Each subject underwent IOP measurement, A-scan biometry, spectral domain-optical coherence tomography (SDOCT), anterior segment-optical coherence tomography (ASOCT), and Osmolality measurements at baseline, 30, and 60 minutes after consuming at least 10 mL/kg of water. The ChT at the macula was measured from SDOCT images using the 7-line scan protocol. The fellow-eyes of APAC (FE-APAC) were compared to eyes with PACG. RESULTS. The mean age 6 SD of the study subjects was 62.8 6 8.6 years and 21 (55.3%) were females. At baseline, Serum Osmolality was significantly lower (P < 0.001) in the FE-APAC group, whereas ChT was similar in both groups (P ¼ 0.56). At 30 minutes after WDT, both groups demonstrated a significant increase in IOP (FE-APAC, 3.0 [95% confidence interval {CI}, 1.52, 4.48] mm Hg; PACG, 5.06 [95% CI, 3.68, CONCLUSIONS. The increase in IOP after WDT was higher in PACG eyes compared to FE-APAC; however, the latter had lower Serum Osmolality at baseline. Change in mean ChT following WDT was associated with a lower baseline Serum Osmolality
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evaluation of choroidal thickness intraocular pressure and Serum Osmolality after the water drinking test in eyes with primary angle closure
Investigative Ophthalmology & Visual Science, 2015Co-Authors: Monisha E Nongpiur, Valencia Hui Xian Foo, John Mark S De Leon, Mani Baskaran, Tin A Tun, Rahat Husain, Shamira A Perera, Tin AungAbstract:PURPOSE We evaluated changes in choroidal thickness (ChT), IOP, ocular biometry, and Serum Osmolality after the water drinking test (WDT) in subjects with previous acute primary angle closure (APAC) and primary angle closure glaucoma (PACG). METHODS We evaluated 38 subjects, including 21 with APAC and 17 with PACG. Each subject underwent IOP measurement, A-scan biometry, spectral domain-optical coherence tomography (SDOCT), anterior segment-optical coherence tomography (ASOCT), and Osmolality measurements at baseline, 30, and 60 minutes after consuming at least 10 mL/kg of water. The ChT at the macula was measured from SDOCT images using the 7-line scan protocol. The fellow-eyes of APAC (FE-APAC) were compared to eyes with PACG. RESULTS The mean age ± SD of the study subjects was 62.8 ± 8.6 years and 21 (55.3%) were females. At baseline, Serum Osmolality was significantly lower (P < 0.001) in the FE-APAC group, whereas ChT was similar in both groups (P = 0.56). At 30 minutes after WDT, both groups demonstrated a significant increase in IOP (FE-APAC, 3.0 [95% confidence interval {CI}, 1.52, 4.48] mm Hg; PACG, 5.06 [95% CI, 3.68, 6.26] mm Hg; P < 0.001 for both) and decrease in Serum Osmolality (P < 0.001 for both), but no significant change in ChT. The magnitude of change in IOP was significantly greater in PACG eyes (P = 0.04). After multivariate analysis, a lower mean baseline Serum Osmolality (β = -0.44, P = 0.003) was associated with a greater change in ChT at 30 minutes after WDT. CONCLUSIONS The increase in IOP after WDT was higher in PACG eyes compared to FE-APAC; however, the latter had lower Serum Osmolality at baseline. Change in mean ChT following WDT was associated with a lower baseline Serum Osmolality.
Diane Bunn - One of the best experts on this subject based on the ideXlab platform.
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which frail older people are dehydrated the uk drie study
Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2016Co-Authors: Lee Hooper, Alice Downing, Florence Jimoh, Joyce Groves, Carol Free, Vicky Cowap, Diane Bunn, Paul R Hunter, John F. Potter, Lee ShepstoneAbstract:Background: Water-loss dehydration in older people is associated with increased mortality and disability. We aimed to assess the prevalence of dehydration in older people living in UK long-term care, and associated cognitive, functional and health characteristics. Methods: The Dehydration Recognition In our Elders (DRIE) cohort study included people ≥65 years living in long-term care without heart or renal failure. In a cross-sectional baseline analysis we assessed Serum Osmolality, previously suggested dehydration risk factors, general health, markers of continence, cognitive and functional health, nutrition status and medications. Univariate linear regression was used to assess relationships between participant characteristics and Serum Osmolality, then associated characteristics entered into stepwise backwards multivariate linear regression. Results: DRIE included 188 residents (mean age 86 years, 66% women) of whom 20% were dehydrated (Serum Osmolality >300mOsm/kg). Linear and logistic regression suggested that renal, cognitive and diabetic status were consistently associated with Serum Osmolality and odds of dehydration, while potassium-sparing diuretics, sex, number of recent health contacts, and bladder incontinence were sometimes associated. Thirst was not associated with hydration status. Conclusions: DRIE found high prevalence of dehydration in older people living in UK long-term care, reinforcing the proposed association between cognitive and renal function and hydration. Dehydration is associated with increased mortality and disability in older people, but trials to assess effects of interventions to support healthy fluid intakes in older people living in residential care are needed to enable us to formally assess causal direction and any health benefits of increasing fluid intakes.
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accuracy of prediction equations for Serum osmolarity in frail older people with and without diabetes
The American Journal of Clinical Nutrition, 2014Co-Authors: Mario Siervo, Diane Bunn, Carla M Prado, Lee HooperAbstract:Background: Serum Osmolality is an accurate indicator of hydration status in older adults. Glucose, urea, and electrolyte concentrations are used to calculate Serum osmolarity, which is an indirect estimate of Serum Osmolality, but which Serum osmolarity equations best predict Serum Osmolality in the elderly is unclear. Objective: We assessed the agreement of measured Serum Osmolality with calculated Serum osmolarity equations in older people. Design: Serum Osmolality was measured by using freezing point depression in a cross-sectional study. Plasma glucose, urea, and electrolytes were analyzed and entered into 38 Serum osmolarity-prediction equations. The Bland-Altman method was used to evaluate the agreement and differential bias between measured Osmolality and calculated osmolarity. The sensitivity and specificity of the most-promising equations were examined against Serum Osmolality (reference standard). Results: A total of 186 people living in UK residential care took part in the Dehydration Recognition In our Elders study (66% women; mean ± SD age: 85.8 ± 7.9 y; with a range of cognitive and physical impairments) and were included in analyses. Forty-six percent of participants had impending or current dehydration (Serum Osmolality ≥295 mmol/kg). Participants with diabetes (n = 33; 18%) had higher glucose (P 80% of participants, regardless of diabetes or hydration status. The equation's sensitivity (79%) and specificity (89%) for impending dehydration (≥295 mmol/kg) and current dehydration (>300 mmol/kg) (69% and 93%, respectively) were reasonable. Conclusions: The assessment of a panel of equations for the prediction of Serum osmolarity led to identification of one formula with a greater diagnostic performance. This equation may be used to predict hydration status in frail older people (as a first-stage screening) or to estimate hydration status in population studies. This trial was registered at the Research Register for Social Care (http://www.researchregister.org.uk) as 122273.
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accuracy of prediction equations for Serum osmolarity in frail older people with and without diabetes
The American Journal of Clinical Nutrition, 2014Co-Authors: Mario Siervo, Diane Bunn, Carla M Prado, Lee HooperAbstract:Background: Serum Osmolality is an accurate indicator of hydration status in older adults. Glucose, urea, and electrolyte concentrations are used to calculate Serum osmolarity, which is an indirect estimate of Serum Osmolality, but which Serum osmolarity equations best predict Serum Osmolality in the elderly is unclear. Objective: We assessed the agreement of measured Serum Osmolality with calculated Serum osmolarity equations in older people. Design: Serum Osmolality was measured by using freezing point depression in a cross-sectional study. Plasma glucose, urea, and electrolytes were analyzed and entered into 38 Serum osmolarity-prediction equations. The Bland-Altman method was used to evaluate the agreement and differential bias between measured Osmolality and calculated osmolarity. The sensitivity and specificity of the most-promising equations were examined against Serum Osmolality (reference standard). Results: A total of 186 people living in UK residential care took part in the Dehydration Recognition In our Elders study (66% women; mean 6 SD age: 85.8 6 7.9 y; with a range of cognitive and physical impairments) and were included in analyses. Forty-six percent of participants had impending or current dehydration (Serum Osmolality $295 mmol/kg). Participants with diabetes (n = 33; 18%) had higher glucose (P , 0.001) and Serum Osmolality (P , 0.01). Of 38 predictive equations used to calculate osmolarity, 4 equations showed reasonable agreement with measured Osmolality. One [calculated osmolarity = 1.86 3 (Na + +K + ) + 1.15 3 glucose + urea +14; all in mmol/L] was characterized by narrower limits of agreement and the capacity to predict Serum Osmolality within 2% in .80% of participants, regardless of diabetes or hydration status. The equation’s sensitivity (79%) and specificity (89%) for impending dehydration ($295 mmol/kg) and current dehydration (.300 mmol/kg) (69% and 93%, respectively) were reasonable. Conclusions: The assessment of a panel of equations for the prediction of Serum osmolarity led to identification of one formula with a greater diagnostic performance. This equation may be used to predict hydration status in frail older people (as a first-stage screening) or to estimate hydration status in population studies. This trial was registered at the Research Register for Social Care (http://www.researchregister.org.uk) as 122273. Am J Clin Nutr doi: 10.3945/ajcn.114.086769.
