ABSTRACT
Increased skin turgor (between eyebrows easiest area to evaluate); appearance of sunken eyes, dry or tacky mucous membranes, possible tachycardia due to decrease in plasma volume (hypovolemic shock); loss of body weight; small urinary bladder (large bladder in the face of severe dehydration; consider blockage or renal failure)
3. Diagnosis: Obtain a complete blood count (CBC)/chemistry/ electrolyte/blood gas panel to evaluate
a. CBC: elevated hematocrit (HCT) above 38 hemoconcentration, increased plasma protein
i. Excessive hemorrhage and blood loss; if HCT 20 or below, consider blood transfusion (see Blood transfusion)
b. Chemistry
i. Elevated BUN (blood urea nitrogen): greater than 30
ii. Hypokalemia: potassium less than 3.0; 3.0 considered normal
iii. Hyponatremia: sodium below 120 strongly consider intravenous fluids (should be approximately 135)
iv. Hypocalcemia (calcium): treat if below 0.85 or profound weakness if near this limit
v. Elevated creatinine: elevated significantly; 1.0 can be normal
vi. Metabolic acidosis
1. HCO3: 24 considered normal
2. pH: less than 7.4
c. Ultrasound: stabilize patient first; may be indicated if pregnant and dystocia a concern
d. X-ray (optional): stabilize patient first; may be required if unable to age fetus via ultrasound; age via bone calcification stage or fetal head circumference on ultrasound (best)
e. Work up other causes once patient stable; obtain samples prior to treatment (baseline CBC/plasma or serum/electrolytes/blood culture samples, etc.) that may be altered by treatment. For diarrhea, rectal cultures and stool samples can be obtained once stable if time is of the essence.
