title: Decreased hydration status of emergency department physicians and nurses by the end of their shift.
abstract: BACKGROUND
  Typical emergency department (ED) shifts are physically demanding. The aim of this study was to assess the hydration status of ED physicians and nurses by the end of their shifts.
  
  
  METHODS
  A prospective cross-sectional clinical study of ED physicians and nurses assessing fluid intake, activities, vital signs, weight, urine specific gravity and ketones at the end of the shift. Forty-three participants were tested over 172 shifts distributed over 48% in the morning, 20% in the evening and 32% at night. Fifty-eight percent were females, and 51% were physicians.
  
  
  RESULTS
  Overall, participants lost 0.3% of their body weight by the end of the shift. While physicians lost a mean of 0.57 kg (± SD 0.28; P < 0.0001, 95% CI 0.16-0.28), nurses lost 0.12 kg (± SD 0.25; P < 0.0001, 95% CI 0.07-1.7). While nurses drank more fluid (P < 0.0001), physicians had a higher specific gravity of 1.025 (P < 0.01), visited the washroom less often (P < 0.0001) and reported less workload and stress (P = 0.01 and 0.008, respectively). There were no major changes in vital signs or urinary ketones (OR.0.41, 95% CI 0.1-2.1). In a multivariate analysis, being male (OR 13.5, 95% CI 1.6-112.5), being of younger age (OR 4.1, 95% CI 1.7-10.2), being Middle Eastern (OR 5.3, 95% CI 1.1-26.2), working the morning shift (OR 2.7, 95% CI 0.7-10.5) and having less fluid intake (OR 5.7, 95% CI 1.2-26.6) were significant predictors of decreased hydration.
  
  
  CONCLUSIONS
  The majority of physicians and to a lesser extent nurses working in a tertiary care emergency department have decreased hydration status at the end of the shift. Therefore, awareness of the hydration status by emergency department staff is needed. A further study in a similar setting with more subjects and a better balance among the variables is recommended.
authors.affiliation: Emergency Department, King Faisal Specialist Hospital and Research Centre, Altakhassusi, Riyadh 11211, Saudi Arabia. momar@kfshrc.edu.sa.
authors.forename: Mohammed Z
authors.initials: MZ
authors.lastname: Alomar
authors.forename: Abdullah
authors.initials: A
authors.lastname: Akkam
authors.forename: Samer
authors.initials: S
authors.lastname: Alashqar
authors.forename: Abdelmoneim
authors.initials: A
authors.lastname: Eldali