A hydration status examination is useful when assessing unwell patients and also when prescribing intravenous fluids.
Introduction
W I Ask P
E
General inspection
Patient : well/unwell, alert, breathless, fever, portals of infection/wounds/drainsAround bed (if present, look at quantities of fluids going in/coming out)
In: IV fluids, NG feed, parenteral nutrition
Out: catheter, stoma, NG tube, vomit bowl
Charts: observations, fluid balance, drug chart (e.g. for diuretics, infusions etc.)
Hands and arms
Temperature (fever increases insensible losses )Pulse rate (tachycardia in dehydration )Blood pressure and postural drop (hypotension and postural drop in dehydration )
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Head and neck
Eyes (sunken in dehydration )Oral mucus membranes (dry in dehydration )JVP (raised in overload; reduced/not visible in dehydration )Carotid pulse volume and character
Chest
Sternum: capillary refill (>2 seconds in hypoperfusion) , skin turgor (reduced in dehydration )Palpation: apex beat (may be displaced in LVF )Auscultation: heart (3rd heart sound in overload ), lung bases (pulmonary oedema in overload )
Abdomen
Legs
A patient presents to ED with chest pain and this trace. What would you do?
Interpretation management
Covered in OSCE Stations
To complete
Thank patient
‘To complete my hydration status assessment, I would take a full history, look at U&Es, observations, and the fluid balance chart.’
Summarise and suggest further investigations, for example:
Serial weights
Catheterise and monitor urine output
U&Es
VBG and serum lactate
Test your knowledge
In a patient who is clinically in decompensated right heart failure (fluid overload) but with an acute kidney injury, which condition are you concerned about and how would you manage them?
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