Dysphagia pp 601-610 | Cite as

Dehydration in Dysphagia

  • Zeno Stanga
  • Samuel Hannes Baldinger
  • Pere Clavé
Part of the Medical Radiology book series (MEDRAD)


Dehydration--increased depletion of bodily fluids--is a major problem in the elderly. In patients with dysphagia, this imbalance of body fluids is often accelerated due to restricted fluid intake, leading to increased mortality in hospitalized older adults. As a result, the hydration status of patients with a swallowing disorder must be closely monitored and rapidly corrected. In the following, dehydration and fluid balance, as well as their pathophysiology and disorders, will be discussed in detail. Furthermore, risk factors for and signs and symptoms of dehydration in the elderly in general and in dysphagic patients in particular will be outlined. In addition, management of dehydration with oral, enteral and parenteral replacement of fluids will be explained. Parenteral hypodermoclysis, for example, has been shown to be as safe and effective as intravenous replacement, with a similar or better adverse event profile in a number of systematic reviews.


Blood Urea Nitrogen Total Body Weight Plasma Osmolality Volume Depletion Serum Sodium Concentration 


  1. Allison SP, Lobo DN (2004) Fluid and electrolytes in the elderly. Curr Opin Clin Nutr Metab Care 7(1):27–33PubMedCrossRefGoogle Scholar
  2. Bennett JA, Thomas V, Riegel B (2004) Unrecognized chronic dehydration in older adults: examining prevalence rate and risk factors. J Gerontol Nurs 30(11):22–28PubMedGoogle Scholar
  3. Chidester JC, Spangler AA (1997) Fluid intake in the institutionalized elderly. J Am Diet Assoc 97(1):23–28PubMedCrossRefGoogle Scholar
  4. Dasgupta M, Binns MA, Rochon PA (2000) Subcutaneous fluid infusion in a long-term care setting. J Am Geriatr Soc 48(7):795–799PubMedGoogle Scholar
  5. Heilig CW, Stromski ME, Blumenfeld JD, Lee JP, Gullans SR (1989) Characterization of the major brain osmolytes that accumulate in salt-loaded rats. Am J Physiol 257(6):F1108–F1116PubMedGoogle Scholar
  6. Jain S, Mansfield B, Wilcox MH (1999) Subcutaneous fluid administration–better than the intravenous approach? J Hosp Infect 41(4):269–272PubMedCrossRefGoogle Scholar
  7. Kayser-Jones J, Schell ES, Porter C, Barbaccia JC, Shaw H (1999) Factors contributing to dehydration in nursing homes: inadequate staffing and lack of professional supervision. J Am Geriatr Soc 47(10):1187–1194PubMedGoogle Scholar
  8. Lavizzo-Mourey R, Johnson J, Stolley P (1988) Risk factors for dehydration among elderly nursing home residents. J Am Geriatr Soc 36(3):213–218PubMedGoogle Scholar
  9. Lieberman HR (2007) Hydration and cognition: a critical review and recommendations for future research. J Am Coll Nutr 26(5):555S–561SPubMedGoogle Scholar
  10. Lien YH, Shapiro JI, Chan L (1990) Effects of hypernatremia on organic brain osmoles. J Clin Invest 85(5):1427–1435PubMedCrossRefGoogle Scholar
  11. Lipschitz S, Campbell AJ, Roberts MS, Wanwimolruk S, McQueen EG, McQueen M, Firth LA (1991) Subcutaneous fluid administration in elderly subjects: validation of an under-used technique. J Am Geriatr Soc 39:6–9PubMedGoogle Scholar
  12. Luckey AE, Parsa CJ (2003) Fluid and electrolytes in the aged. Arch Surg 138(10):1055–1060PubMedCrossRefGoogle Scholar
  13. Martin JH, Larsen PD (1994) Dehydration in the elderly surgical patient. Assoc Operat Rm Nurs J 60(4):666–671Google Scholar
  14. Mentes JC (2006) Oral hydration in older adults: greater awareness is needed in preventing, recognizing, and treating dehydration. Am J Nurs 106(6):40–49PubMedCrossRefGoogle Scholar
  15. Mentes JC, Wakefield B, Culp K (2006) Use of a urine color chart to monitor hydration status in nursing home residents. Biol Res Nurs 7(3):197–203PubMedCrossRefGoogle Scholar
  16. O’Keefe ST, Lavan JN (1996) Subcutaneous fluids in elderly hospital patients with cognitive impairment. Gerontology 42(1):36–39CrossRefGoogle Scholar
  17. Phillips PA, Johnston CI, Gray L (1993) Disturbed fluid and electrolyte homoeostasis following dehydration in elderly people. Age Ageing 22(1):S26–S33PubMedGoogle Scholar
  18. Remington R, Hultman T (2007) Hypodermoclysis to treat dehydration: a review of the evidence. J Am Geriatr Soc 55(12):2051–2055Google Scholar
  19. Robertson GL (1987) Physiology of ADH secretion. Kidney Int 21:S20–S26Google Scholar
  20. Robertson GL, Aycinena P, Zerbe RL (1982) Neurogenic disorders of osmoregulation. Am J Med 72:339–353PubMedCrossRefGoogle Scholar
  21. Sasson M, Shvartzman P (2001) Hypodermoclysis: an alternative infusion technique. Am Fam Physician 64(9):1575–1578PubMedGoogle Scholar
  22. Slesak G, Schnürle JW, Kinzel E, Jakob J, Dietz PK (2003) Comparison of subcutaneous and intravenous rehydration in geriatric patients: a randomized trial. J Am Geriatr Soc 51(2):155–160PubMedCrossRefGoogle Scholar
  23. Stookey JD, Pieper CF, Cohen HJ (2005) Is the prevalence of dehydration among community-dwelling older adults really low? Informing current debate over the fluid recommendation for adults aged 70+ years. Public Health Nutr 8(8):1275–1285PubMedCrossRefGoogle Scholar
  24. Thomas DR, Cote TR, Lawhome L, Levenson SA, Rubenstein LZ, Smith DA, Stefanacci RG, Tangalos EG, Morley JE, Council Dehydration (2008) Understanding clinical dehydration and its treatment. J Am Med Dir Assoc 9:292–301PubMedCrossRefGoogle Scholar
  25. Vivanti AP, Campbell KL, Suter MS, Hannan-Jones MT, Hulcombe JA (2009) Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia. J Hum Nutr Diet 22(2):148–155PubMedCrossRefGoogle Scholar
  26. Walsh G (2005) Hypodermoclysis: an alternate method for rehydration in long-term care. J Infus Nurs 28(2):123–129PubMedCrossRefGoogle Scholar
  27. Warren JL, Bacon WE, Harris T, McBean AM, Foley DJ, Phillips C (1994) The burden, outcomes associated with dehydration among US elderly, 1991. Am J Public Health 84(8):1265–1269PubMedCrossRefGoogle Scholar
  28. Weinberg AD, Minaker KL (1995) Dehydration. Evaluation and management in older adults. Council on Scientific Affairs, American Medical Association. JAMA 15 274(19):1552–1556CrossRefGoogle Scholar
  29. Whelan K (2001) Inadequate fluid intakes in dysphagic acute stroke. Clin Nutr 20(5):423–428PubMedCrossRefGoogle Scholar
  30. Xiao H, Barber J, Campbell ES (2004) Economic burden of dehydration among hospitalized elderly patients. Am J Health Syst Pharm 61(23):2534–2540PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2011

Authors and Affiliations

  • Zeno Stanga
    • 1
  • Samuel Hannes Baldinger
    • 1
  • Pere Clavé
    • 2
  1. 1.University Polyclinic for Endocrinology, Diabetes and Clinical Nutrition, University Clinic for General Medicine, University HospitalBernSwitzerland
  2. 2.Universitat Autònoma de Barcelona, Hospital de MataróBarcelonaSpain

Personalised recommendations