Hydration status and signs of dehydration Flashcards
What are the cases of dehydration?
Decreases input: increased risk with age, decreased oral intake
Increased output: diabetes, diarrhoea and vomiting, fever, drugs
Insufficient replacement fluid
Major haemorrhage
Sepsis
What are the causes of fluid overload?
Iatrogenic – excess fluid prescribed
Cardiac failure
Renal failure
↑ADH secretion
How do you review hydration status? (without assessing patient)
• 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)
How do you manage dehydration?
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
How do you manage overload?
Nitrates
Diuretics
CPAP (if severe enough)
Assess why they are overloaded?
How should you assess a patients hydration status) (HINT: exam)
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
- Examine the hands
• Assess warmth
• Capillary refill time
• Assess skin turgor - Examine the Arms
• Pulse (weak, ↑in dehydration and overload)
• Lying/standing BP (a difference of >20mmHg is significant) - Examine the neck
• Carotid pulse (character- weak/thready?)
• JVP (>4cm ↑ is significant – Overload?) - Examine the head
• Temperature (fever – dehydration?)
• Sunken eyes (dehydration)
• Dry mouth (dehydration) - Examine the chest
• Parasternal heaves (right heart dilatation)
• Displace apex beat (left heart dilatation)
• 3rd heart sound (Heart failure, fluid overload) - 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