Summary
Definição
História e exame físico
Principais fatores diagnósticos
- postural dizziness
- weight loss
- orthostatic hypotension
- postural tachycardia
- signs of shock
Outros fatores diagnósticos
- decreased urine output
- diarrhea
- vomiting
- melena
- hematochezia
- high-volume gastrointestinal drainage
- polyuria
- poor oral intake
- severe sweating
- burns
- intestinal obstruction
- severe pancreatitis
- crush injuries
- intra-abdominal bleeding
- fatigue
- thirst
- dry mucous membranes
- muscle cramps
- abdominal pain
- chest pain
- confusion
- decreased skin turgor
Fatores de risco
- diuretic therapy
- chronic kidney disease
- older adult
- altered mental status
- high ambient temperature
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- CBC
- serum electrolytes
- blood glucose
- BUN
- serum creatinine
- lactate
- procalcitonin
- urinalysis
- random urine sodium
- fractional excretion of sodium (FENa)
- random urine chloride
- random urine creatinine
- random urine osmolality
- rectal exam and fecal occult blood test
Investigações a serem consideradas
- urine urea/fractional excretion of urea (FE urea)
- arterial blood gas (ABG) or venous blood gas (VBG)
- nasogastric lavage
- stool cultures
- abdominal ultrasound
- abdominal CT scan
- upper gastrointestinal endoscopy
- colonoscopy
Novos exames
- saliva osmolality
- point-of-care ultrasound (POCUS)
Algoritmo de tratamento
hemorrhagic losses
gastrointestinal nonhemorrhagic losses: vomiting and/or diarrhea
excessive diuresis
skin losses
third-space sequestration
pulmonary losses: bronchorrhea or draining pleural effusion
sustained inadequate oral intake
Colaboradores
Autores
Daniel Batlle, MD
Professor
Division of Nephrology and Hypertension
Department of Internal Medicine
Northwestern Memorial Hospital
Chicago
IL
Declarações
DB is an author of a reference cited in this topic.
Pabitra Adhikari,
MD
Nephrology Fellow
Division of Nephrology and Hypertension
Northwestern University
Chicago
IL
Declarações
PA declares that she has no competing interests.
Agradecimentos
Dr Daniel Batlle would like to gratefully acknowledge Dr Maria Aurora Posadas Salas, Dr Jason Eckel, Dr Arthur Greenberg, Dr Syed Haque, and Dr Alonso Marquez previous contributors to this topic.
Declarações
MPS, JE, and AG declare that they have no competing interests.
Revisores
Nitin Kolhe, MD
Renal Consultant
Infection Control Lead for Medical Directorate
Derby City Hospital
Derby
UK
Declarações
NK declares that he has no competing interests.
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
Declarações
IM declares that he has no competing interests.
Manish Suneja, MD
Assistant Professor
Department of Internal Medicine
Division of Nephrology
University of Iowa Hospital and Clinics
Iowa City
IA
Declarações
MS declares that he has no competing interests.
Judith H. Veis, MD
Associate Director
Nephrology
Washington Hospital Center
Washington
DC
Declarações
JHV declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-247.Texto completo Resumo
Cartotto R, Johnson LS, Savetamal A, et al. American burn association clinical practice guidelines on burn shock resuscitation. J Burn Care Res. 2024 May 6;45(3):565-89.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Dehydration
- Heart failure
- Hepatorenal syndrome
Mais Diagnósticos diferenciaisDiretrizes
- Surviving sepsis campaign: international guidelines for management of sepsis and septic shock
- Fluid therapy in neurointensive care patients
Mais DiretrizesFolhetos informativos para os pacientes
Burns (minor)
Diarrhea in adults
Mais Folhetos informativos para os pacientesConectar-se ou assinar para acessar todo o BMJ Best Practice
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