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Water balance disorders are medical conditions that occur when there is a deviation from the body's water volume or osmolarity, disrupting normal homeostasis and leading todehydration, hypotonic hydration, hyperhydration, edema, or water intoxication.
Dehydration
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Osmolality refers to the number of solute particles per kilogram of solvent in a solution. Plasma osmolality specifically indicates the total number of solute particles per kilogram of water in blood plasma. This value reflects the body's hydration status and is tightly regulated through mechanisms controlling water intake and output. While water consumption is a conscious decision, the body has intrinsic regulatory systems to maintain fluid balance. Dehydration, a state of water deficit...
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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
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DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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Hyperosmolar Dehydration in Sepsis: Implications for Initial Fluid Management.

Kyung-Eui Lee1, Jinwoo Lee2, Sang-Min Lee2,3

  • 1Department of Pulmonology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Gyeonggi-do, Republic of Korea.

Critical Care Medicine
|October 8, 2025
PubMed
Summary

Hyperosmolar dehydration in sepsis patients increases 30-day mortality. Liberal fluid management improves outcomes for these patients, highlighting the need for personalized fluid strategies in sepsis care.

Keywords:
Sepsisdehydrationfluid therapypropensity scoretreatment outcome

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Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Internal Medicine

Background:

  • Sepsis commonly leads to hypovolemia, potentially causing hyperosmolar dehydration and intracellular volume depletion.
  • Understanding the impact of hyperosmolar dehydration is crucial for effective sepsis management.

Purpose of the Study:

  • To evaluate the effect of hyperosmolar dehydration on clinical outcomes in sepsis patients.
  • To determine if hyperosmolar dehydration can indicate optimal initial fluid management.

Main Methods:

  • Nationwide propensity score-matched cohort study (September 2019 - December 2021).
  • Analysis of data from 20 tertiary/university-affiliated hospitals in South Korea.
  • Inclusion of adult patients with sepsis or septic shock admitted to the ICU.

Main Results:

  • Hyperosmolar dehydration (serum osmolarity ≥ 295 mOsm/L) was present in 58.1% of 4,487 patients.
  • 30-day mortality was higher in the hyperosmolar dehydration group (29.9% vs. 27.3%).
  • Liberal fluid management ( >30 mL/kg) improved lactate levels in hyperosmolar dehydration patients without worsening organ failure scores.

Conclusions:

  • Hyperosmolar dehydration in sepsis is linked to increased 30-day mortality.
  • Individualized fluid management, considering dehydration status, is vital for sepsis treatment.
  • Liberal fluid administration benefits hyperosmolar dehydration patients by improving lactate levels without increasing organ dysfunction.