Current Technique of Fluid Status Assessment

Abstract

Congest Heart Fail. 2010;16(4)(suppl 1):S45–S51. ©2010 Wiley Periodicals, Inc.Early in the management of acute illness, it is critically important that volume status is accurately estimated. If inappropriate therapy is given because of errors in volume assessment, acute mortality rates are increased. Unfortunately, as the gold standard of radioisotopic volume measurement is costly and time‐consuming, in the acute care environment clinicians are forced to rely on less accurate measures. In this manuscript, the authors review the currently available techniques of volume assessment for patients presenting with acute illness. In addition to discussing the accuracy of the history, physical examination, and radiography, acoustic cardiography and bedside ultrasonography are presented.

Role of Volume Redistribution in the Congestion of Heart Failure

“…The complexity in studying volume shifts explains the lack of attention to the contribution of the splanchnic compartment and intercompartmental fluid shifts to the pathophysiology of HF. Biomarkers such as natriuretic peptides and routine physical exam evaluation using vascular congestion (jugular venous distension), extravascular volume (lower extremity edema and ascites), and change in body weight correlate poorly with total body volume state and provide little information on the distribution of intravascular volume between the central and splanchnic vascular compartment. Potentially useful diagnostic tools to measure intercompartmental fluid shifts include radionuclide plethysmography, which allows measurements of the splanchnic blood pool over time .…”

The clinical management of hyponatraemia

“…Signs of hypovolaemia include dry mucous membranes, tachycardia and hypotension. Patients with hypervolaemia present with raised jugular venous pressure, peripheral and pulmonary oedema 9. Euvolaemia is determined primarily through the absence of other signs.…”

Volume Control by Using the Body Composition Monitor in a Puerperal Patient on Hemodialysis

“…Conventional evaluation of the dry weight, such as according to patients' symptoms and physical examination, is neither accurate nor reliable3). Recently, new devices including a body composition monitor, can provide a rapid, accurate estimation of the volume status4). Several recent studies have been conducted for volume management of hemodialysis patients based on using a body composition monitor (BCM, Fresenius Medical Care, Germany)5, 6).…”