Table of Contents Introduction General inspection Hands and arms Head and neck Chest AbdomenLegsTo complete Test your knowledge A hydration status examination is useful when assessing unwell patients and also when prescribing intravenous fluids. Introduction Wash hands Introduce self Ask Patient’s name, DOB and what they like to be called Explain examination and obtain consent General inspection Patient: well/unwell, alert, breathless, fever, portals of infection/wounds/drains Around 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) 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 Ascites Legs Pedal oedema (overload) 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 What are the major types of shock? Oops! This section is restricted to members. 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? Oops! This section is restricted to members. What is ‘third spacing’ of fluid? Oops! This section is restricted to members.