Approach to Volume Disorders, Part 2

Assessing Volume Status

  • Track ins and outs (Is & Os) - this is not an exact science because you can't exactly measure insensible losses, but it will give you an idea of the volume status
  • Normal urine output of an adult = 1mL/kg per hr 
  • Skin turgor and mucous membranes are difficult to assess and are not always reliable
  • Daily wts are a good way to assess volume trends
  • Don't lose sight of the BIG PICTURE. What is the overall health of your patient?
    • Pts with: fever, burns, open wounds have a higher insensible loss
    • For each degree over 37 degree C, estimate an increase in loss of 100mL/ day
    • Pts with CHF may have pulmonary edema so pay close attention to their volume status
    • Pts with end stage renal dz are prone to hypervolemia
    • Pts with hypOalbuminemia tend to "3rd space" fluids out of vasculature and are therefore total body hypervolemic, but intra-vascularly depleted

Source: Step up to Medicine (Agabegi and Agabegi)

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