Hydration status and signs of dehydration Flashcards

1
Q

What are the cases of dehydration?

A

Decreases input: increased risk with age, decreased oral intake

Increased output: diabetes, diarrhoea and vomiting, fever, drugs

Insufficient replacement fluid

Major haemorrhage

Sepsis

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2
Q

What are the causes of fluid overload?

A

Iatrogenic – excess fluid prescribed

Cardiac failure

Renal failure

↑ADH secretion

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3
Q

How do you review hydration status? (without assessing patient)

A

• Fluid balance (Large positive /negative balance)

Observation chart (tachycardia, BP, Temperature, O2 saturations)

Medications (diuretics, heart medication, nephrotoxic drug)

Bloods (↑↑Urea, ↑Creatinine, ↑albumin, ↑Haematocrit)

Chest X-ray (pulmonary oedema, heart failure)

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4
Q

How do you manage dehydration?

A

Fluid challenge (250-500ml Hartmann’s or 0.9% NaCl)

Assess why they are dehydrated

Increase oral intake (if possible

Maintenance fluids

Consider altering medications

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5
Q

How do you manage overload?

A

Nitrates

Diuretics

CPAP (if severe enough)

Assess why they are overloaded?

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6
Q

How should you assess a patients hydration status) (HINT: exam)

A
1. Introduction 
• Introduce self and Identify patient
• Gain Consent and acquire a chaperone
• Wash hands
• Ask about pain
• Position patient and ensure adequate exposure
2. General inspection
• Body habitus (obese/cachexic)
• Oedema
• Breathless (suggesting fluid overload)
• IV lines, Nasogastric tubes
• ‘Nil by mouth’ signs/ Food/drink around bed
• Catheter (how much? What colour?)
• Vomit bowels
• Surgical Drains
• Stomas
  1. Examine the hands
    • Assess warmth
    • Capillary refill time
    • Assess skin turgor
  2. Examine the Arms
    • Pulse (weak, ↑in dehydration and overload)
    • Lying/standing BP (a difference of >20mmHg is significant)
  3. Examine the neck
    • Carotid pulse (character- weak/thready?)
    • JVP (>4cm ↑ is significant – Overload?)
  4. Examine the head
    • Temperature (fever – dehydration?)
    • Sunken eyes (dehydration)
    • Dry mouth (dehydration)
  5. Examine the chest
    • Parasternal heaves (right heart dilatation)
    • Displace apex beat (left heart dilatation)
    • 3rd heart sound (Heart failure, fluid overload)
  6. Examine the back and legs
    • Lung bases (crackles = LVF)
    • Sacral oedema (RVF)
    •Ankle oedema (RVF)
9. Conclude
• Thank patient 
• Review charts and blood
• Daily weights
• Repeat blood (U&Es, LFTs, FBCs)
• CXR (pulmonary oedema)
• Specific gravity of urine
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