Resumo
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
Divulgaciones
NK declares that he has no competing interests.
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
Divulgaciones
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
Divulgaciones
MS declares that he has no competing interests.
Judith H. Veis, MD
Associate Director
Nephrology
Washington Hospital Center
Washington
DC
Divulgaciones
JHV declares that she has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
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 Resumen
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 Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Dehydration
- Heart failure
- Hepatorenal syndrome
Más DiferencialesGuías de práctica clínica
- Surviving sepsis campaign: international guidelines for management of sepsis and septic shock
- Fluid therapy in neurointensive care patients
Más Guías de práctica clínicaFolletos para el paciente
Burns (minor)
Diarrhea in adults
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