Volume depletion in adults

No unified strategy for the primary prevention of volume depletion exists, because this disorder occurs as a manifestation of a wide range of acute illnesses that cannot always be anticipated. However, physicians should always consider the need for adequate salt and fluid administration when a patient's intake is diminished by lack of access to or inability to ingest oral fluids, or when losses of electrolytes and fluid occur due to vomiting, diarrhea, or osmotic diuresis.[13]Brienza N, Giglio MT, Marucci M, et al. Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study. Crit Care Med. 2009 Jun;37(6):2079-90. http://www.ncbi.nlm.nih.gov/pubmed/19384211?tool=bestpractice.com

Gastrointestinal hemorrhage is unpredictable, but certain drugs such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and alcohol predispose to this form of bleeding. Therefore, patients can be counseled to avoid these potential precipitants.

Nursing-home residents, patients with impaired sensorium, and infants and children may be unable to complain of thirst and/or may have limited access to fluid. These patients are at high risk for developing volume depletion and should be monitored closely for signs and symptoms (tachycardia, listlessness, fatigue, and confusion) and given suitable access and assistance to maintain adequate fluid and solute intake. In situations in which vital signs are monitored, early clues such as postural tachycardia or hypotension help to alert the clinician to volume depletion.

Closely monitoring intake and output in hospitalized patients allows early detection of developing volume deficits and the ability to intervene with fluids sooner. Being aware of the voiding frequency is helpful in those patients who cannot communicate their symptoms.

Diuretics are extremely challenging to manage in many patients. There is often a fine balance between prescribing enough to avoid edema and prescribing so much that excess urinary losses of fluid and volume depletion ensue. Awareness of weight changes, symptoms, and vital signs can help determine the appropriate diuretic dose. Setting a goal that allows for a tolerable amount of edema without signs or symptoms of volume depletion may provide additional assurance that appropriate volume status will be maintained.