Volume depletion in adults

The level of monitoring required depends on the cause of volume depletion and its severity. Acute hemorrhage, whether from trauma or gastrointestinal bleeding, often requires treatment in the intensive care unit (ICU) until the patient has been adequately resuscitated and the bleeding source identified and treated. Hemodynamic shock from any cause also requires ICU treatment.

The management of less severe volume depletion is based on provider assessment. Some patients may require intravenous fluid resuscitation that necessitates an extended emergency department stay or hospital admission. Individuals in whom oral replacement fluids are adequate do not typically require hospitalization.

Adequate monitoring of hemodynamic parameters (blood pressure and heart rate) and urine output is key in titrating fluid therapy. Invasive hemodynamic monitoring (central venous pressure, mixed venous oxygenation) may be appropriate for critically ill patients and those with labile volume status.

One cohort study suggests that the shock index (heart rate divided by systolic blood pressure) could be a useful tool for monitoring prognostic deterioration in patients at risk of circulatory collapse.[50]Kristensen AK, Holler JG, Hallas J, et al. Is shock index a valid predictor of mortality in emergency department patients with hypertension, diabetes, high age, or receipt of β- or calcium channel blockers? Ann Emerg Med. 2016 Jan;67(1):106-13. http://www.ncbi.nlm.nih.gov/pubmed/26144893?tool=bestpractice.com The shock index was independently associated with 30-day mortality in a broad population of emergency room patients. Old age, hypertension, and beta- or calcium-channel blockers weakened this association. However, a shock index greater than or equal to 1 suggested substantial 30-day mortality risk in all emergency room patients.