The Hypovolemic Patient

The Hypovolemic Patient is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Volume depletion generally results from a deficit in total body Na+ content. 
This may result from renal or extrarenal losses of Na+ from the ECF. Free water loss can also cause volume depletion, but the quantity required to do so is large as water is lost mainly from the ICF and not the ECF, where volume contraction can be assessed.
  • Renal losses may be secondary to enhanced diuresis, salt-wasting nephropathies, mineralocorticoid deficiency, or resolution of obstructive renal disease.
  • Extrarenal losses include fluid loss from the GI tract (vomiting, nasogastric suction, fistula drainage, diarrhea), respiratory losses, skin losses (especially with burns), hemorrhage, and severe third spacing of fluid in critically ill patients.

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