Reflections on Factors That Led to a Dehydration Hospitalization: Lived Experience to Inform Systems Change for Nursing Home Residents

This personal narrative describes a family's journey through a preventable dehydration crisis during the COVID-19 pandemic. When a 93-year-old nursing home resident tested positive for COVID-19, her family prepared for the worst. Instead, she nearly died from severe dehydration, not the virus, and was hospitalized for hypovolemic shock, only to be discharged four and a half days later, still COVID-positive, having recovered with rehydration alone. Medical documentation reveals deterioration from inadequate oral intake (300 mL per day) to pre-shock hypotension to frank shock (72/56 mmHg at 17:20), while oxygen saturation remained normal throughout. The admission diagnosis hierarchy (Acute Kidney Injury, Hyperkalemia, COVID-19) confirms dehydration complications were primary. This case demonstrates that providing 2.4 L per day of fluid (37 mL/kg per day), as supported by Institute of Medicine intake recommendations and century-old physiological measurements, would have prevented hospitalization. This experience identifies actionable system changes and raises critical questions about how many pandemic-era deaths attributed to COVID-19 were actually preventable dehydration deaths.