Fluid status history and examination

Question 1

History fluids

Answer 1

Fluid intake:
Assess if the patient’s fluid intake been adequate.

Symptoms suggestive of dehydration:
Thirst
Dizziness/syncope

Fluid loss:
Vomiting (or NG tube loss)
Diarrhoea (including stoma output)
Polyuria
Fever
Hyperventilation
Increased drain output (e.g. biliary drain, pancreatic drain)

Co-morbidities:
Heart failure
Renal failure

Question 2

approach to examining for fluid status

Answer 2

ABCDE

A
B - crackles? (hyper) increased RR? (hyper) dec o2 sats (hyper)
C - heart and urine
Increased heart rate (>90 bpm) (hypo) Hypotension (systolic BP <100 mmHg) (hypo) , prolonged CRT (hypo),
oedema (hyper) Hypertension (hyper) Elevated JVP (hyper)
Urine output - catheter, fluid chart, weight chart
D - decreased gcs (hypo)
E - wounds, drains, distension, bleeding