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Cited by 172Hemodynamic Monitoring and TherapyElectrolyte and hormonal disordersClinical Nutrition and Gastroenterology

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

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El-Sharkawy, Ahmed M., Sahota, Opinder, Maughan, Ron J., Lobo, Dileep N.·2014·Clinical Nutrition
DOI 10.1016/j.clnu.2013.11.010
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Abstract

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.

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  • The causes of low-intake dehydration in older adults are varied and inter-related.

    “The causes of low-intake dehydration in older adults appear to be varied and inter-related and have been examined in several non-systematic reviews (7,8,242).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [242]

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Authors
El-Sharkawy, A. M., Sahota, O., Maughan, R. J., & Lobo, D. N.
Affiliations
  • National Institute for Health and Care Research (GB)
  • Queen's Medical Centre (GB)
  • Loughborough University (GB)
Corresponding author
Lobo, Dileep N.
ORCID
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2014-02
Volume
33
Issue
1
Pages
6-13
ISSN
0261-5614 (ISSN-L)
DOI
10.1016/j.clnu.2013.11.010
OpenAlex
W2097527948
Cited by
172
References
1
Citations by year
2026: 16 · 2025: 17 · 2024: 29 · 2023: 16 · 2022: 11 · 2021: 16 · 2020: 15 · 2019: 14 · 2018: 10 · 2017: 8 · 2016: 7 · 2015: 11 · 2014: 2
FWCI
1.18
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Nutrition (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords
fluid and electrolyte balance, older adults, perioperative care, dehydration, electrolyte imbalance, age-related physiological changes, renal senescence, water retention, polypharmacy, diuretics, acute kidney injury, fluid balance, surgical risk
MeSH terms
Aged, Aging, Cognition Disorders, Dehydration, Fluid Therapy, Humans, Kidney, Risk Factors, Thirst, Water-Electrolyte Balance, Critical Illness, Acute Kidney Injury, Perioperative Period

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