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The pathophysiology of fluid and electrolyte balance in the older adult surgical patient

El-Sharkawy, Ahmed M.; Sahota, Opinder; Maughan, Ron J.; Lobo, Dileep N.


Ahmed M. El-Sharkawy

Opinder Sahota

Ron J. Maughan

Dileep N. Lobo


Background & aims:

Age-related physiological changes predispose even the healthy older adult to fluid and electrolyte abnormalities which can cause morbidity and mortality. The aim of this narrative review is to highlight key aspects of age-related pathophysiological changes that affect fluid and electrolyte
balance in older adults and underpin their importance in the perioperative period.


The Web of Science, MEDLINE, PubMed and Google Scholar databases were searched using key terms for relevant studies published in English on fluid balance in older adults during the 15 years preceding June 2013. Randomised controlled trials and large cohort studies were sought; other studieswere used when these were not available. The bibliographies of extracted papers were also searched for relevant articles.


Older adults are susceptible to dehydration and electrolyte abnormalities, with causes ranging from physical disability restricting access to fluid intake to iatrogenic causes including polypharmacy and unmonitored diuretic usage. Renal senescence, as well as physical and mental decline, increase this susceptibility. Older adults are also predisposed to water retention and related electrolyte abnormalities, exacerbated at times of physiological stress. Positive fluid balance has been shown to be an independent risk factor for morbidity and mortality in critically ill patients with acute kidney injury.
Conclusions: Age-related pathophysiological changes in the handling of fluid and electrolytes make older adults undergoing surgery a high-risk group and an understanding of these changes will enable better management of fluid and electrolyte therapy in the older adult.


El-Sharkawy, A. M., Sahota, O., Maughan, R. J., & Lobo, D. N. (2013). The pathophysiology of fluid and electrolyte balance in the older adult surgical patient. Clinical Nutrition, 33(1),

Journal Article Type Article
Publication Date Nov 25, 2013
Deposit Date Mar 31, 2014
Publicly Available Date Mar 31, 2014
Journal Clinical Nutrition
Print ISSN 0261-5614
Electronic ISSN 0261-5614
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 33
Issue 1
Keywords Fluid and electrolytes, Older adults, Dehydration, Fluid overload, Pathophysiology, Clinical outcome
Public URL
Publisher URL


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