Assessing Fluid Status | Diabetic Exam - MedSchool
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Diabetic Exam
 

Assessing Fluid Status

 
 

Dehydration

    • Look For

    • Abnormal obs - tachycardia, hypotension
    • Fluid balance chart - negative fluid balance, oliguria
    • Weight loss - an acute decrease in weight may indicate short-term change in fluid status
    • Dry mucous membranes - especially the tongue
    • Sunken eyes
    • Increased capillary refill time (>2 seconds)
    • Weak radial pulse
    • Decreased skin turgor - pinch a fold of skin on the patient’s arm and then release it. Decreased skin turgor is present if the fold takes an abnormal time to return to its normal contour.
    • Causes of Dehydration

    • Poor fluid intake
    • Fluid loss - diarrhoea, vomiting, sweating, diuresis (diabetes, diuretics)
    • Complications

    • Seizures
    • Renal failure
    • Hypovolaemic shock

Fluid Overload

    • Look For

    • Hypertension
    • Positive fluid balance in obs chart
    • Weight gain - look for a recent weight and compare to current weight
    • Bounding pulses
    • Raised JVP
    • Presence of S3 (gallop rhythm)
    • Crackles on lung field auscultation
    • Ascites - shifting dullness or fluid thrill
    • Pitting oedema to the sacrum and lower limbs, as well as elsewhere in the body in severe hypervolaemia
    • Causes of Fluid Overload

    • Excessive IV fluids
    • Heart failure
    • Renal failure
    • Hepatic cirrhosis
    • SIADH
    • Pregnancy
Last updated on November 28th, 2019
 
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