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Appendix L

Tools to Monitor Dehydration,

Malnutrition, and Kidney Function

In Chapter Seven, you learned about the importance of osmolality as an indicator of dehydration. A valuable part of the medical record you keep for your loved one will be your assessment of his or her hydration status. Using the lab values that you will find in the medical record kept by the nursing home (or by your loved one’s physician if your loved one is living independently), you can monitor this status. An important tool is the calculation of osmolality. Keep a copy of this appendix in your three-ring binder and update the osmolality chart frequently.

Calculating Osmolality:

 

 

normal

date

date

date

Sodium

135 – 148

 

 

 

Potassium

3.5 – 5.5

 

 

 

BUN

5 – 26

 

 

 

Glucose

65 – 109

 

 

 

 

 

 

 

 

Osmolality

285 – 295

 

 

 

 

An Internet calculator is found at the following site:

 www.intmed.mcw.edu/clincalc/osmol.html

You can also calculate this on paper using the following formula:

Serum Osmolality = (2 x (Na+K)) + (BUN/2.8) + (glucose/18)

Because kidney function is adversely affected by dehydration, keeping track of kidney function is important as an early warning that serious problems exist. An important indicator of kidney function is the ratio of BUN to serum creatinine. You can use the lab values in the chart below to make this calculation. Note that a ratio of 20:1 or higher indicates serious kidney malfunction. 

Tracking BUN:Serum creatinine ratio: 

 

Normal

date

date

date

A. BUN

5 – 26

 

 

 

B. Serum creatinine

65 – 109

 

 

 

 

 

 

 

 

Ratio = (A÷B)/1

< 20:1

 

 

 

            (Normal is < 20:1)

(BUN:Serum creatinine ratio equals BUN ÷ Serum creatinine:1)

Example: 40:2 equals 40 ÷ 2  to 1  (20 to 1 or 20:1)

 Another valuable indicator of kidney function measures how well the kidneys filter and eliminate toxins. This is done by measuring the level of serum creatinine left in the bloodstream after filtration. Use the chart below to record lab values and to record the calculation of estimated glomerular filtration.

 Calculating Kidney Function – Estimated Glomerular Filtration rate (GFR):

 

Normal

date

date

date

A. BUN

5 – 26

 

 

 

B. Serum creatinine

65 – 109

 

 

 

 

 

 

 

 

Est. Creatinine Clearance

85 – 125 ♀

95 – 135 ♂

 

 

 

 A calculator is found on the Internet at http://www.intmed.mcw.edu/clincalc/creatinine.html

 You can also use the following formula to calculate estimated creatinine clearance:

For men:  [[140 - age(yr)]*weight(kg)]/[72*serum Cr(mg/dL)] 
For women:  [[140 - age(yr)]*weight(kg)]/[72*serum Cr(mg/dL)] X .85

Monitoring Body Mass Index (BMI)

Use the website below to monitor BMI. For this, you will need to keep track of your loved one’s weight and height. Again, clinicians recommend that the elderly be weighed once a week at the same time of day, wearing the same or similar clothing. 

Body Mass Index:

 

Date

Date

Date

Weight

 

 

 

Height

 

 

 

 

 

 

 

Body Mass Index (BMI):

 

 

 

 Use the calculator at http://www.dr-bob.org/tips/bmi.html  

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Taking Charge: Good Medical Care for the Elderly & How to Get It. A Caregiver's Manual in How to Detect, Manage, and Prevent Six Common, Fatal Conditions in the Elderly Patient | Home |Table of Contents | Delirium | Medication Errors | Adverse Drug Reactions | Falls | Dehydration | Protein-Energy Malnutrition | How to Avoid Problems Caused by Under-Staffing in Nursing Homes | How to Handle End-of-Life Decision-Making | Appendices |   Disclaimer

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