The pathophysiology of fluid and electrolyte balance in the older adult surgical patient

被引:101
作者
El-Sharkawy, Ahmed M. [1 ]
Sahota, Opinder [2 ]
Maughan, Ron J. [3 ]
Lobo, Dileep N. [1 ]
机构
[1] Univ Nottingham Hosp, Queens Med Ctr, Div Gastrointestinal Surg,Biomed Res Unit, Nottingham Digest Dis Ctr,Natl Inst Hlth Res, Nottingham NG7 2UH, England
[2] Univ Nottingham Hosp, Queens Med Ctr, Dept Elderly Med, Nottingham NG7 2UH, England
[3] Univ Loughborough, Sch Sport Exercise & Hlth Sci, Loughborough, Leics, England
关键词
Fluid and electrolytes; Older adults; Dehydration; Fluid overload; Pathophysiology; Clinical outcome; ATRIAL-NATRIURETIC-PEPTIDE; ADVERSE DRUG EVENTS; RANDOMIZED CONTROLLED TRIAL; PLASMA-RENIN ACTIVITY; 2003; HEAT-WAVE; HOSPITAL STAY; 0.9-PERCENT SALINE; ABDOMINAL-SURGERY; ACID-BASE; POSTOPERATIVE COMPLICATIONS;
D O I
10.1016/j.clnu.2013.11.010
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
Background & aims: Age-related physiological changes predispose even the healthy older adult to fluid and electrolyte abnormalities which can cause morbidity and mortality. The aim of this narrative review is to highlight key aspects of age-related pathophysiological changes that affect fluid and electrolyte balance in older adults and underpin their importance in the perioperative period. Methods: The Web of Science, MEDLINE, PubMed and Google Scholar databases were searched using key terms for relevant studies published in English on fluid balance in older adults during the 15 years preceding June 2013. Randomised controlled trials and large cohort studies were sought; other studies were used when these were not available. The bibliographies of extracted papers were also searched for relevant articles. Results: Older adults are susceptible to dehydration and electrolyte abnormalities, with causes ranging from physical disability restricting access to fluid intake to iatrogenic causes including polypharmacy and unmonitored diuretic usage. Renal senescence, as well as physical and mental decline, increase this susceptibility. Older adults are also predisposed to water retention and related electrolyte abnormalities, exacerbated at times of physiological stress. Positive fluid balance has been shown to be an independent risk factor for morbidity and mortality in critically ill patients with acute kidney injury. Conclusions: Age-related pathophysiological changes in the handling of fluid and electrolytes make older adults undergoing surgery a high-risk group and an understanding of these changes will enable better management of fluid and electrolyte therapy in the older adult. (C) 2013 The Authors. Published by Elsevier Ltd and European Society for Clinical Nutrition and. Metabolism. All rights reserved.
引用
收藏
页码:6 / 13
页数:8
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