Early intervention in acute renal failure: Assessing fluid status is important

doi:10.1136/bmj.333.7567.551

BMJ 2006;333:551 (9 September), doi:10.1136/bmj.333.7567.551

Letter

Early intervention in acute renal failure

Assessing fluid status is important

The first 150 words of the full text of this article appear below.

EDITOR—Bennett-Jones suggests that doctors take a pragmaticand prompt approach to intravenous fluid replacement, basedon the patient's blood pressure, capillary refill time, andvenous filling.¹ Assessment of fluid status needs to be muchbroader and incorporate a full history of any fluid gains andlosses from the patient, relatives, nurses, fluid balance charts,prescription charts, anaesthetic records, and daily weights.The patient should be assessed for symptoms of hypovolaemia,which can include postural dizziness, thirst, dry mouth, reducedurine output, feeling cold, shivering, shortness of breath,and altered mental state.

Furthermore, in examining the patient, of central importanceare blood pressure, a postural fall in blood pressure, tachycardia(or rarely bradycardia with severe hypovolaemia) and posturalchanges in pulse rate, whereas capillary refill time is notof proved diagnostic value in adults.² Other signs that shouldbe sought are jugular venous pressure, pallor, peripheral perfusion,the dryness . . . [Full text of this article]

Jonathan M Gleadle, university lecturer in nephrology

Oxford Kidney Unit, Oxford OX3 7LJ jgleadle@well.ox.ac.uk