People with Alzheimer disease often drink too little because they forget, lose thirst or need help to drink. Dehydration can then trigger delirium, a sudden change in attention and thinking that is a medical emergency, not just worse dementia.
Key symptoms
- Sudden confusion, agitation or unusual sleepiness
- Changes that come and go during the day
- Poor intake of food and fluids
- Dark urine or less urine
- Falls or new weakness
What you find on exam
- Delirium screen with the Confusion Assessment Method (CAM)
- Vital signs, including orthostatic changes if safe
- Dry mouth, poor skin turgor and weight change
- Look for causes: infection, pain, urinary retention, constipation
- Review of medicines, especially sedatives and anticholinergics
Tests
- Sodium, electrolytes, kidney function and glucose
- Blood count and urinalysis if signs of infection
- Chest X-ray or other tests based on the likely cause
- Intake and output chart
Treatment basics
- Treat the cause and replace fluids, by mouth if possible or IV if needed
- Correct high sodium slowly, about 10 mEq/L or less per day
- Calm room, glasses and hearing aids on, familiar people, good sleep
- Avoid restraints and stop harmful medicines; low-dose haloperidol only for severe distress
- Plan help with drinking and regular fluid offers at home
Red flags
- Sodium very high or very low with seizures or coma
- Low blood pressure, fever or signs of sepsis
- Not eating or drinking at all, or unable to wake
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Related guides
Sources: Open RN, Nursing Fundamentals 2e; NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.