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THE HYDRATION GAP

The Science Behind Micronutrient and Hydration Therapy

Soft Surface

Dript IV was founded by nursing home operators who struggled to maintain adequate patient hydration.

Like many operators, we became aware of the persistent problems caused by lack of adequate hydration for a certain set of patients—we call them The 30%—and the patient trauma and reactive care that follows.

We call this The Hydration Gap

Dript IV finally closes The Hydration Gap. We work hand-in-hand with veteran clinicians to develop science-backed treatments and cadences that lead to better patient outcomes, fewer hospitalizations, and more proactive care.

The Effects of Dehydration

The Effects of Dehydration

Dehydration is linked to and worsens:

Frailty • Neurocognitive Functioning • Oral Health • Prolonged Surgical Recovery • Risk Of Arrhythmia • Risk Of Transient Ischemic Attacks • Greater Length Of Hospital Stay, Either As A Principal Or Secondary Diagnosis • Mortality Rates

In a study of 30,000 patients 65+, a positive association of dehydration with falls alone; for the outcome of 'falls or death', dehydration was positively associated along with loop diuretics and antipsychotic medications. 

Lower hydration levels are associated with incidences of acute confusion, constipation, urinary tract infections (UTIs), exhaustion, falls and delayed wound healing. 

Blurry Waves

The Dehydration Cascade

Regular

Patient

Dript

Patient

Reduced Oral Intake

Even 95% of required intake

creates deficit over time

Intracellular Fluid Shift

Physiologic response to maintain homeostasis

Mood Fatigue Cognition

Initial response to ICF deficit; I&O’s & labs look normal

Reduced Participation In Care

Mood and fatigue reduce activity level and engagement

Secondary Symptoms & Sequelae

Changes in ADLs; muscle cramps; headaches; fall risk; infection risk; diabetic instability

Reduced Oral Intake

Even 95% of required intake

creates deficit over time

Intracellular Fluid Shift

Physiologic response to maintain homeostasis

DRIPT IV 

Fluid/Micronutrient Bolus "Reset" 

of ICF/ECF Equilibrium

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Improved Risk Factors:

IV Hydration:
Progression-Preventive Intervention for Impending or Subacute Dehydration

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Bolus “rebalances”

ICF/ECF equilibrium

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Reduces risk, attenuates cognitive, other sequelae

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Resets baseline for sustained oral hydration

The Dehydration Cascade
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Micronutrient Supplementation

Micronutrient Supplementation

Micronutrient Supplementation

There are numerous directional studies on the prevalence, and risks, associated with micronutrient deficits in the elderly, and a number of directional studies on the potential positive effects of micronutrient supplementation on cognitive function, immune function, nutritional status and skin health.

At the end of the day this is nutrition, not medication, so the benefit/risk ratio is very high.

Similar to mild fluid losses, micronutrient deficiencies may be relatively mild, diffuse and sub-acute and hence easily missed

Micronutrient replacement adjunctive, supports plans of care for:

• Cognitive function • Immune function • Skin health • Malnutrition • Wound healing • Co-Morbidities (CV/DM)

Clinical policies to address micronutrient deficiencies supports quality of care, compare with the effort/cost of treating diseases arising from malnutrition.

Why Intravenous Micronutrient Administration?

Nutrients are present in cells at much higher concentrations than in serum

Intravenous micronutrient replacement is designed to overcome limitations of oral or intramuscular absorption.

Both aging and disease states have adverse effects on cellular capacity to maintain normal concentration gradients

 

Myocardial magnesium concentrations are 65% lower in patients with cardiomyopathy than in controls.

Intravenous administration produces a marked, thought transient increase in serum concentration and provides a window of opportunity for cells to rebalance by ‘flooding’ the environment with nutrients.

Micronutriet Benefits

Micronutrients
General

01.

Geirsdóttir, Ó.G., Bell, J.J. (eds)

Interdisciplinary Nutritional Management and Care for Older Adults. Perspectives in Nursing Management and Care for Older Adults. Springer, Cham.

02.

Blaauw R, Osland E, Sriram K, Ali A, Allard JP, Ball P, Chan LN, Jurewitsch B, Logan Coughlin K, Manzanares W, Menéndez AM, Mutiara R, Rosenfeld R, Sioson M, Visser J, Berger MM. - JPEN J Parenter Enteral Nutr. 2019 Mar;43 Suppl 1:S5-S23. doi: 10.1002/jpen.1525

Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper.

03.

Montgomery SC, Streit SM, Beebe ML, Maxwell PJ 4th - Nutr Clin Pract. 2014 Aug;29(4):435-444. doi: 10.1177/0884533614537684.

Micronutrient Needs of the Elderly

04.

Sriram K, Lonchyna VA. - JPEN J Parenter Enteral Nutr. 2009 Sep-Oct;33(5):548-62. 
doi: 10.1177/0148607108328470

Micronutrient supplementation in adult nutrition therapy: practical considerations.

05.

Gana,W.;DeLuca,A.; Debacq, C.; Poitau, F.; Poupin, P.; Aidoud, A.; Fougère, B. - Nutrients 2021, 13, 3163.

Analysis of the Impact of Selected Vitamins Deficiencies on the Risk of Disability in Older People.

Micronutrients
Cardiac

01.

Frustaci A, Caldarulo M, Schiavoni G, Bellocci F, Manzoli U, Cittadini A. Lancet. 1987 Oct 31;2(8566):1019. doi: 10.1016/s0140-6736(87)92575-x

Myocardial magnesium content, histology, and antiarrhythmic response to magnesium infusion.

02.

Witte KK, Nikitin NP, Parker AC, von Haehling S, Volk HD, Anker SD, Clark AL, Cleland JG. Eur Heart J. 2005 Nov;26(21):2238-44. doi: 10.1093/eurheartj/ehi442.

The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure.

Micronurients General

Micronutrients
Cognitive

01.

Huskisson E, Maggini S, Ruf M. Journal of International Medical Research. January 2007:1-19.

The Influence of Micronutrients on Cognitive Function and Performance. 

02.

Suh SW, Kim HS, Han JH, Bae JB, Oh DJ, Han JW, Kim KW. Nutrients. 2020 Apr 22;12(4):1168. doi: 10.3390/nu12041168.

Efficacy of Vitamins on Cognitive Function of Non-Demented People: A Systematic Review and Meta-Analysis. 

03.

Peeri NC, Egan KM, Chai W, Tao MH. (NHANES) 2011 to 2014. Eur J Nutr. 2021 Feb;60(1):465-474. doi: 10.1007/s00394-020-02267-4

Association of magnesium intake and vitamin D status with cognitive function in older adults: an analysis of US National Health and Nutrition Examination Survey

04.

Kaplan BJ, Crawford SG, Field CJ, Simpson JS. . Psychol Bull. 2007 Sep;133(5):747-60. doi: 10.1037/0033-2909.133.5.747.

Vitamins, minerals, and mood

05.

Tardy AL, Pouteau E, Marquez D, Yilmaz C, Scholey A. 2020 Jan 16;12(1):228. doi: 10.3390/nu12010228. 

Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence. Nutrients.

06.

Denniss RJ, Barker LA and Day CJ (2019) Front. Behav. Neurosci. 13:115. doi: 10.3389/fnbeh.2019.00115

Improvement in Cognition Following Double-Blind Randomized Micronutrient Interventions in the General Population.

Micronutrients Cognitive
Micronutrients Cardiac

Micronutrients
Immune Function

01.

Chandra RK. Ageing Res Rev. 2004 Jan;3(1):91-104. doi: 10.1016/j.arr.2003.08.004

Impact of nutritional status and nutrient supplements on immune responses and incidence of infection in older individuals.

02.

Johnson MA, Porter KH. Nutr Rev. 1997 Nov;55(11 Pt 1):400-4. doi: 10.1111/j.1753-4887.1997.tb01582.x

Micronutrient supplementation and infection in institutionalized elders.

03.

Girodon F, Lombard M, Galan P, Brunet-Lecomte P, Monget AL, Arnaud J, Preziosi P, Hercberg S. Ann Nutr Metab. 1997;41(2):98-107. doi: 10.1159/000177984

Effect of micronutrient supplementation on infection in institutionalized elderly subjects: a controlled trial.

04.

Maggini S, Wintergerst ES, Beveridge S, Hornig DH. Br J Nutr. 2007 Oct;98 Suppl 1:S29-35. doi: 10.1017/S0007114507832971.

Selected vitamins and trace elements support immune function by strengthening epithelial barriers and cellular and humoral immune responses. 

05.

Wintergerst ES, Maggini S, Hornig DH. Ann Nutr Metab. 2007;51(4):301-23. doi: 10.1159/000107673. 

Contribution of selected vitamins and trace elements to immune function.

Micronutrins Immune

Micronutrients
Wound Healing

01.

Dattola A, Silvestri M, Bennardo L, Passante M, Scali E, Patruno C, Nisticò SP. Curr Nutr Rep. 2020 Sep;9(3):226-235. doi: 10.1007/s13668-020-00322-4.

Role of Vitamins in Skin Health: a Systematic Review. 

02.

Quain AM, Khardori NM. 2015 Dec;27(12):327-35. PMID: 27447105.

Nutrition in Wound Care Management: A Comprehensive Overview. Wounds.

03.

Biesalski H. Nutrition. 2010 Sep;26(9):858. doi: 10.1016/j.nut.2010.05.015.

Micronutrients, wound healing, and prevention of pressure ulcers.

04.

Grada A, Phillips TJ. . Clin Dermatol. 2022 Mar-Apr;40(2):103-113. doi: 10.1016/j.clindermatol.2021.10.002

Nutrition and cutaneous wound healing.

05.

Sinno S, Lee DS, Khachemoune A. J Wound Care. 2011 Jun;20(6):287-93. doi: 10.12968/jowc.2011.20.6.287

Vitamins and cutaneous wound healing.

06.

Molnar JA, Underdown MJ, Clark WA. Adv Wound Care (New Rochelle). 2014 Nov 1;3(11):663-681. doi: 10.1089/wound.2014.0530

Nutrition and Chronic Wounds.

06.

Stotts NA, Wipke-Tevis D.  Ostomy Wound Manage. 1996;42(2):.

Co-factors in impaired wound healing.

Micronutrients Wound

Chronic Dehydration
in Nursing Home Residents

01.

Nagae M, Umegaki H, Onishi J, Huang CH, Yamada Y, Watanabe K, Komiya H, Kuzuya M.

Chronic Dehydration in Nursing Home Residents.

02.

Naschitz JE (2019

Dehydration Prevention and Diagnosis: A Study in Long-Term Geriatric and Palliative Care.

03.

Hooper L, Abdelhamid A, Attreed NJ, Campbell WW, et al.

Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD009647.

Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people.

04.

Beck,A.M.;Seemer,J.; Knudsen, A.W.; Munk, T.

Nutrients 2021, 13, 3142.

Narrative Review of Low-Intake Dehydration in Older Adults.

05.

Paulis, Simone & Everink, Irma & Halfens, Ruud & Dr. Lohrmann, Christa & Schols, Jos M.G.A.. (2018).

Journal of the American Medical Directors Association. 19. 10.1016/j.jamda.2018.05.009.

Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review.

06.

Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, Kiesswetter E, Maggio M, Raynaud-Simon A, Sieber CC, Sobotka L, van Asselt D, Wirth R, Bischoff SC.

Clin Nutr. 2019 Feb;38(1):10-47. doi: 10.1016/j.clnu.2018.05.024

ESPEN guideline on clinical nutrition and hydration in geriatrics.

07.

Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, Kiesswetter E, Maggio M, Raynaud-Simon A, Sieber CC, Sobotka L, van Asselt D, Wirth R, Bischoff SC.

Clin Nutr. 2019 Feb;38(1):10-47. doi: 10.1016/j.clnu.2018.05.024

ESPEN guideline on clinical nutrition and hydration in geriatrics.

08.

Wilson, MM., Morley, J.

Eur J Clin Nutr 57 (Suppl 2), S24–S29 (2003).

Impaired cognitive function and mental performance in mild dehydration.

09.

Adan A. J Am Coll Nutr. 2012 Apr;31(2):71-8. doi: 10.1080/07315724.2012.10720011.

Cognitive performance and dehydration.

10

Hamrick I, Norton D, Birstler J, Chen G, Cruz L, Hanrahan L.  Mayo Clin Proc Innov Qual Outcomes. 2020 Jun 5;4(3):259-265. doi: 10.1016/j.mayocpiqo.2020.01.003.

Association Between Dehydration and Falls.

11

Edmonds, C., Foglia, E., Booth, P., Fu, C. and Gardner, M. 2021. Archives of Gerontology and Geriatrics. 95 (Art. 104380). https://doi.org/10.1016/j.archger.2021.104380

Dehydration in older people: a systematic review of the effects of dehydration on health outcomes, healthcare costs and cognitive performance.

12

Bruno,C.;Collier,A.; Holyday, M.; Lambert, K.  Nutrients 2021, 13, 3640.

Interventions to Improve Hydration in Older Adults: A Systematic Review and Meta-Analysis.

13

Begum MN, Johnson CS. E Spen Eur E J Clin Nutr Metab. 2010;5:e47–e53.

A review of the literature on dehydration in the institutionalized elderly.

14

Feinsod FM, Levenson SA, Rapp K, Rapp MP, Beechinor E, Liebmann L. Dehydration in frail, older residents in long-term care facilities. J Am Med Dir Assoc. 2004 Mar-Apr;5(2 Suppl):S35-41. doi: 10.1097/01.JAM.0000036697.72589.

Dehydration in frail, older residents in long-term care facilities.

15

Thomas DR, Cote TR, Lawhorne L, Levenson SA, Rubenstein LZ, Smith DA, Stefanacci RG, Tangalos EG, Morley JE; J Am Med Dir Assoc. 2008 Jun;9(5):292-301. doi: 10.1016/j.jamda.2008.03.006

Dehydration Council. Understanding clinical dehydration and its treatment.

Chronic Dehydration in Nursing Home Residents
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