Hydration Reassessment Guide for Residents on Call

Overview

A thorough reassessment of hydration status is essential to evaluate fluid therapy effectiveness and guide further interventions, especially during on-call shifts when quick but accurate assessments are crucial.

Key Steps in Hydration Reassessment

1. Clinical Assessment
   • Vital Signs: Check for tachycardia, blood pressure stability, and respiratory rate, which can indicate ongoing fluid deficits.
   • Physical Signs:
     • Mucous Membranes: Inspect for moisture level (dry indicates dehydration).
     • Skin Turgor: Assess skin elasticity by gently pinching and observing skin recoil, especially on the abdomen in young children.
     • Fontanelle (infants): Sunken fontanelle suggests dehydration.
     • Capillary Refill: Delayed (>2 seconds) refill may indicate poor perfusion and dehydration.
   • Urine Output: A critical indicator of fluid balance, with decreased output suggesting a deficit. Track hourly in acute cases (goal: >1 mL/kg/hr).
2. Laboratory Evaluation
   • Electrolytes Panel (Na, K, Cl): Look for signs of electrolyte imbalances (e.g., hypernatremia, hypokalemia).
   • Blood Urea Nitrogen (BUN) and Creatinine: Elevated BUN/creatinine ratio can indicate dehydration.
   • Urine Specific Gravity: High specific gravity (>1.025) points to concentrated urine and possible dehydration.
3. Fluid Balance Review
   • Intake vs. Output: Compare administered fluids with losses (urine, stool, gastric, etc.). Calculate cumulative fluid balance since admission or last reassessment.
   • Adjust Fluid Plan: If the clinical and lab findings indicate continued dehydration or overload, adjust the maintenance or replacement fluids accordingly.
4. Daily Weight Monitoring
   • Weight changes help determine true fluid gains or losses; a consistent weight loss suggests dehydration despite therapy.
5. Documentation & Communication
   • Create a clear event note in the patient’s chart to document findings, adjustments, and plan for continued hydration assessment.

Example Template for Event Note:

• Date/Time: [e.g., Nov 5, 2024, 18:00]
• Patient ID and Location: [Name, MRN, Room]
• Hydration Assessment:
  • Vitals: HR: ___, BP: ___, RR: ___, Temp: ___
  • Physical Exam Findings: [e.g., mucous membranes dry, skin turgor delayed]
  • Lab Results: [e.g., Na 142 mEq/L, K 3.8 mEq/L, BUN 18 mg/dL]
  • Urine Output: [e.g., 0.8 mL/kg/hr since last assessment]
• Fluid Balance:
  • Intake: ___ mL (over last 24 hours)
  • Output: ___ mL (urine ___ mL, other losses ___ mL)
  • Cumulative Balance: [e.g., -200 mL]
• Weight Change: [e.g., 2 kg since admission]
• Fluid Adjustment/Interventions: [e.g., increase maintenance fluids by 10%]
• Reassessment Plan: Monitor urine output hourly, repeat labs in ___ hours.
• Resident Signature: [Your Name and Title]

Suggested Video Resources

1. Clinical Hydration Assessment in Pediatrics - A step-by-step demonstration of physical assessment.