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Hydration status examination

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?

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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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What is ‘third spacing’ of fluid?

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