Salt in the desert: A comparison of clinical versus serum-calculated osmolality determination of dehydration

McCrow, Judy, Morton, Margaret, Travers, Catherine, Harvey, Keren, & Eeles, Eamonn (2016) Salt in the desert: A comparison of clinical versus serum-calculated osmolality determination of dehydration. Healthy Aging Research, 5(4).

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Background: Clinicians frequently use their own judgement to assess patient’s hydration status although there is limited evidence for the diagnostic utility of any individual clinical symptom. Hence, the aim of this study was to compare the diagnostic accuracy of clinically assessed dehydration in older hospital patients (using multiple symptoms), versus dehydration measured using serum-calculated osmolality (CO) as the reference standard.

Method: Participants were 44 hospital patients aged ≥ 60 years. Dehydration was assessed clinically and pathologically (CO) within 24 hours of admission and at study exit. Indicators of diagnostic accuracy were calculated.

Results: Clinicians identified 27% of patients as dehydrated at admission, and 19% at exit, compared to 19% and 16% using CO. Agreement between the measures was fair at admission and poor at exit. Clinical assessment showed poor sensitivity for predicting dehydration with reasonable specificity.

Conclusions: Compared to the use of CO, clinical assessment of dehydration in older patients was poor. Given that failure to identify dehydration in this population may have serious consequences, we recommend that clinicians do not rely upon their own assessments without also using the reference standard.

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ID Code: 95599
Item Type: Journal Article
Refereed: Yes
Keywords: dehydration, aged, sensitivity
ISSN: 2261-7434
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Copyright Owner: Copyright 2015 McCrow et al.
Copyright Statement: This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Deposited On: 16 May 2016 23:10
Last Modified: 17 May 2016 23:44

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