Step 3 Is a medical workup appropriate? An appropriate workup may help to identify or characterize a current dehydration or fluid/electrolyte imbalance or to define the risks for developing these problems. A physical examination and laboratory tests help to confirm the diagnosis and guide patient management (see Criteria for Clinical Diagnosis of Dehydration below). Criteria for Clinical Diagnosis of Dehydration For a clinical diagnosis of dehydration to be made, the following minimal criteria must be present: • Suspicion of increased output and/or decreased intake • At least two physiological or functional signs or symptoms suggesting dehydration (e.g., dizziness, dry mucous membrane, functional decline) • A BUN/creatinine ratio of >25:1 OR orthostasis (defined as a drop in systolic blood pressure >20 mmHg on a change in position) OR a pulse of >100 beats/minute OR a pulse change of 10-20 beats/minute above baseline with a change in position Patients should be categorized according to their level of risk for dehydration or fluid/electrolyte imbalance and given a workup appropriate to their risk level. It is not necessary to complete a workup on every patient, and not all of those who would benefit from a workup require comprehensive testing. It is important to define the level of workup that is appropriate for each patient and to consider non-interventional approaches. If a patient has a living will or other advance directive specifying that no artificial hydration or nutrition be administered, clinicians should discuss with the patient and others involved in the patients welfare whether a workup should proceed. If a medical workup is not performed, the reasons for this decision should be clearly documented in the patients medical record.
Posted on: Sun, 16 Mar 2014 07:37:03 +0000
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