Etiology, clinical manifestations, and diagnosis of volume depletion in adults
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor of Medicine
- University of Rochester School of Medicine and Dentistry
In a variety of clinical disorders, fluid losses reduce extracellular fluid volume, potentially compromising tissue perfusion. Early diagnosis and prompt treatment to restore euvolemia can be lifesaving.
True volume depletion may occur when sodium-containing fluids are lost in the urine, from the gastrointestinal tract or skin, or by acute sequestration into an internal "third-space" that results in a diminished intravascular volume.
When these fluid losses occur, two factors serve to protect against the development of hypovolemia:
●Dietary sodium and water intake are generally far above basal needs. As a result, relatively large losses must occur unless intake is concomitantly reduced (as with anorexia or vomiting).
●The kidney minimizes urinary losses by enhancing sodium and water reabsorption.
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- Gastrointestinal losses
- Skin losses
- Sequestration into a third-space
- CLINICAL MANIFESTATIONS
- - Symptoms related to volume depletion
- - Symptoms related to the cause of fluid loss
- - Symptoms related to electrolyte abnormalities
- Physical examination
- - Skin and mucous membranes
- - Arterial blood pressure
- - Jugular venous pressure
- Laboratory abnormalities
- - Low urine volume
- - Elevation of the BUN and serum creatinine concentration
- - Hypernatremia and hyponatremia
- - Hypokalemia and hyperkalemia
- - Metabolic alkalosis and acidosis
- - Hematocrit and serum albumin concentration
- Manifestations of shock
- Manifestations in the elderly
- Urine sodium concentration
- Less specific laboratory tests
- - Fractional excretion of sodium
- - Urine osmolality
- - Urinalysis
- Central venous pressure
- Diagnosis in certain clinical settings
- - Heart failure
- - Cirrhosis
- - Renal disease
- - Elderly
- - Shock
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