Mnemonic

Fluid Status Assessment

A memory aid for assessing whether a patient is dry or overloaded.

Expansion

History, observations, examination and charts together

Expansion

Signs of hypovolaemia

  • Thirst, dry mucous membranes, reduced skin turgor
  • Tachycardia, postural drop in blood pressure, narrow pulse pressure
  • Low JVP, cool peripheries, prolonged capillary refill
  • Reduced urine output (under 0.5 ml/kg/h), concentrated urine
  • Rising urea disproportionate to creatinine, rising lactate
  • Weight loss

Signs of fluid overload

  • Raised JVP, peripheral and sacral oedema
  • Bibasal crackles, orthopnoea, third heart sound
  • Weight gain, ascites
  • Positive fluid balance

Sources of information often neglected

  • The fluid balance chart and the daily weight, which is the single most reliable measure of change
  • Insensible losses: fever, sweating, tachypnoea, burns, stoma and drain output

Cautions: skin turgor is unreliable in the elderly; oedema indicates interstitial excess and can coexist with intravascular depletion, as in sepsis, hypoalbuminaemia and liver disease; and a patient can be simultaneously fluid overloaded and intravascularly dry, which is why oedema alone should never prevent fluid resuscitation in shock.

A passive leg raise or fluid challenge with reassessment is the most reliable bedside test of fluid responsiveness.