THE HYDRATION GAP
The Science Behind Micronutrient and Hydration Therapy
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.
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The Effects of Dehydration
Dehydration is linked to and worsens:
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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
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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.
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
Improved Risk Factors:
IV Hydration:
Progression-Preventive Intervention for Impending or Subacute Dehydration
Bolus “rebalances”
ICF/ECF equilibrium
Reduces risk, attenuates cognitive, other sequelae
Resets baseline for sustained oral hydration
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.
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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
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Micronutrient replacement adjunctive, supports plans of care for:
• Cognitive function • Immune function • Skin health • Malnutrition • Wound healing • Co-Morbidities (CV/DM)
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Clinical policies to address micronutrient deficiencies supports quality of care, compare with the effort/cost of treating diseases arising from malnutrition.
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Why Intravenous Micronutrient Administration?
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Nutrients are present in cells at much higher concentrations than in serum
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Intravenous micronutrient replacement is designed to overcome limitations of oral or intramuscular absorption.
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Both aging and disease states have adverse effects on cellular capacity to maintain normal concentration gradients
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Myocardial magnesium concentrations are 65% lower in patients with cardiomyopathy than in controls.
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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.
Micronutrients
General
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.
Micronutrients
Cardiac
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.
Micronutrients
Cognitive
Micronutrients
Immune Function
Micronutrients
Wound Healing
Chronic Dehydration
in Nursing Home Residents
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.
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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.