Extrarenal loss
Renal loss
Gastrointestinal losses
Na + loss by the normal kidney
Vomiting
Diuretics
Diarrhea
Adrenal insufficiency
Nasogastric suction
Decreased renin production
Fistulas
Na + loss by the abnormal kidney
Bleeding
Chronic kidney disease
Transcellular losses
Diuretic phase of acute kidney injury
Acute pancreatitis
Postobstructive diuresis
Ileus
Renal transplantation
Peritonitis
Salt-losing nephropathy
Small bowel obstruction
Tubulointerstitial diseases
Pleural effusions
Skin losses
Excessive sweating
Burns
Inflammatory skin diseases
Cystic fibrosis
Table 10.2
Pertinent clinical and laboratory features of volume contraction
Clinical evaluation | Dehydration | Volume depletion |
|---|---|---|
History | ||
Dietary history of Na+ and water intake | Yes | Yes |
History of renal disease | Yes | Yes |
History of medications (diuretics) | Yes | Yes |
History of travel, diarrhea, vomiting, bleeding | Yes | Yes |
History of symptoms: thirst, weakness, dizziness, lethargy | Yes (more thirst) | Yes (less thirst) |
Physical examination | ||
Low blood pressure | Yes | Yes |
Orthostatic blood pressure and pulse changes | No | Yes |
Poor skin turgor | + | +++ |
Dry mucous membranes | +++ | + |
↓ Urine output | +++ | ++ |
Laboratory data | ||
Serum [Na+] | High | Normal to slightly low |
Serum osmolality | High | Normal |
Serum creatinine | + | ++ |
Serum BUN | + | ++ |
Hematocrit | + | ++ |
Urine osmolality
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