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Water, water everywhere but not a drop to drink...

Especially it seems for the people in our hospitals and even worse our older people at home. I have worried for some time that we are not hydrating people properly in hospital and not making the connection between recurring Urinary Tract Infections (UTI’s) and hydration.

The very sad news of Mr Gorny, a young gentleman driven to dialling 999 to gain hydration that never appeared demonstrated it’s not just age related. There was a time this was properly monitored. I remember being in labour with my beautiful daughter Felicity and being refused a drink all day (8am – 8pm) then suddenly in the thrust (excuse the word) of her being born being forced to drink a glass of water while regaining my breath between pushes because they realised I was so dehydrated.

It’s a basic need and should be as properly monitored as medicine rounds; and choices should be available not just water; tea or coffee. Encourage relatives to bring squash or other favourites in again and give the drinks in decent containers – not paper cups. Labelling and numbering cups and bottles would help instead of blindly ticking fluid charts. Remember especially for people’s whose visual perception of the world has become a great challenge through neurological impairment (Dementia) – clear fluid in a clear plastic cup or jug cannot be seen.

Let friends and relatives bring in a favourite cup or mug if it helps. My Mum only ever liked proper china cups; and when in hospital on one occasion during her last few months and being offered a plastic beaker she felt degraded. The lovely young girl serving the drinks told her she couldn’t do this to her and went and found at least a proper cup. 

We need to work on prevention of dehydration the nursing and care homes and with vulnerable elderly living alone as these are the biggest customers who get rushed in and stay much longer in hospital from Acute Kidney Injury. 

There needs to be a big campaign to deal with “staying well during infections” that deals with the elderly vulnerable population on a dangerous drug cocktail… and how the community (including friends/family/volunteers) can play a role in driving better hydration, withholding toxic drugs temporarily (medicine’s management)… treatment with antibiotics.

These are challenges for Donal O’Donaghue the National Clinical Director for Kidney Care and his colleagues in implementing a community Acute Kidney Injury prevention strategy. Acute Kidney Injury is a common illness affecting 20% of hospitalised patients and can be community acquired so patients are admitted with it. 

AKI happens as a complication of severe infection (sepsis), poor blood flow to the kidneys (seen in dehydration, haemorrhage, cardiac or liver failure), toxicity (from nephrotoxic drugs and radiological contrast), and obstruction of the urinary tract (as in malignancy or bladder disease) and due to specific kidney diseases such as nephritis. More information regarding causes of AKI (STOP AKI) can be found at the London Acute Kidney Injury Network.

Good hydration plays a huge part in preventing urinary tract infections and Acute Kidney Injury and is a very basic need. Let’s work together and start today to ensure vulnerable people – young and old have this basic need met. Maybe there needs to be a QIPP (Quality; Innovation; Productive; Prevention) programme for this linked to Clinical Commissioning Group commissioning plans. The investment in prevention of dehydration has to be worth it in terms of better outcomes for people and reducing avoidable costs of not preventing.

Published 1st November 2018