Assessment of Fluid Balance and Hydration

Clinical Assessment

  • Peripheral perfusion, capillary refill time

  • Heart rate, blood pressure, JVP and urine output

  • Biochemical markers

      • Urea and creatinine

      • Bicarbonate and base excess

  • Haematocrit

  • Fluid balance – at best a rough guide

      • Charted intake

      • Charted losses of all types

  • Insensible losses


Invasive Assessment

Predictors of increased cardiac output in response to administration of fluid

  • CVP and Pulmonary artery pressures (particularly diastolic), and pulmonary artery occlusion pressure:  useful in patients with "normal" lungs and right heart function.  In other patients a trend in pressures may be useful.

  • Cardiac output and cardiac index

  • PiCCO derived estimates of intra-thoracic blood volume and extra vascular lung water

  • Variation in arterial wave form peak with positive pressure ventilatory cycle.

This is a notoriously difficult aspect of critical care practice.  Often the decision to administer fluid is governed by a conglomeration of each of the above factors.  If you are in any doubt consult the duty intensive care specialist, but do not delay the administration of fluid in the acute resuscitation phase.

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Page last reviewed: 13 May 2014