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Volume depletion in adults

Última revisão: 23 Sep 2025
Última atualização: 06 Aug 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • postural dizziness
  • weight loss
  • orthostatic hypotension
  • postural tachycardia
  • signs of shock
Detalhes completos

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
Detalhes completos

Fatores de risco

  • diuretic therapy
  • chronic kidney disease
  • older adult
  • altered mental status
  • high ambient temperature
Detalhes completos

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
Detalhes completos

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
Detalhes completos

Novos exames

  • saliva osmolality
  • point-of-care ultrasound (POCUS)

Algoritmo de tratamento

AGUDA

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.

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Referencias

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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.
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