DehydrationMANAGEMENT

ENDOCRINE AND METABOLIC PRESENTATIONS · 12 SECTIONS

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665 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

Acute Porphyria Adrenal crisis Adrenal Insufficiency (Addisonian Crisis)Dehydration Diabetes Insipidus Diabetic Ketoacidosis (DKA)Euglycemic DKA (SGLT2 inhibitor)Galactosemia GLP-1 receptor agonist complications (retained gastric contents, aspiration risk)Homocystinuria Hypercalcemia Hyperkalemia Hypermagnesemia Hypernatremia Hyperosmolar Hyperglycemic State (HHS)Hypertensive emergency Hypertensive urgency Hypocalcemia Hypoglycemia Hypogonadism (Acute Presentation)Hypokalemia Hypomagnesemia Hyponatremia Hypoparathyroidism (Tetany)Insulin pump failure Maple Syrup Urine Disease (Crisis)Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCAD)Metabolic Acidosis Metabolic Alkalosis Myasthenia gravis crisis Myxedema coma Pellagra Pheochromocytoma (Crisis)Pituitary Apoplexy Pompe Disease (GSD II)Respiratory Acidosis Respiratory Alkalosis Scurvy SIADH Starvation Ketosis Tarui Disease (GSD VII)Thyroid storm Tyrosinemia Vitamin D Deficiency (Severe-Rickets)Von Gierke Disease (GSD I)

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp111

Immediate priorities

›Stabilization priorities

›Airway compromise risk

›Depressed mental status

›Active emesis with aspiration risk

›Breathing threats

›Respiratory distress from metabolic acidosis compensation

›Pulmonary edema after fluid loading

›Circulation threats

›Hypotension with altered mentation

›Shock index greater than 0.9

›Oliguria or anuria

›Mottling or cool extremities

›Immediate reversible causes

›Active hemorrhage

›Sepsis

›Anaphylaxis

›Adrenal crisis

›Diabetic ketoacidosis

›Hyperosmolar hyperglycemic state

›Resuscitation bay triggers

›SBP less than 90 mmHg or MAP less than 65 mmHg

›Persistent after initial crystalloid challenge

›Suspected occult bleeding

›Lactate 4 mmol/L or greater

›Persistent despite fluids

›Concerning for shock physiology beyond simple volume loss

›Severe electrolyte derangement

›Sodium 160 mmol/L or greater

›Sodium 120 mmol/L or less with symptoms

›Potassium 6.0 mmol/L or greater

›Monitoring and access

›Large bore IV access

›Two peripheral 18 gauge or larger if feasible

›Intraosseous access if IV delayed in shock

›Continuous monitoring

›ECG

›Pulse oximetry

›Automated BP cycling every 2 to 5 minutes in shock

›Output tracking

›Foley for critical illness

›Strict intake and output

›Hemodynamic targets

›MAP 65 mmHg or greater

›Higher target if chronic hypertension and poor perfusion signs

›Urine output 0.5 mL/kg/hour or greater in adults

›1 mL/kg/hour or greater in children

›Mentation at baseline

›Delirium improvement after resuscitation

›Capillary refill less than 2 seconds in children

›Skin perfusion normalization

Key concepts

›Definitions and framing

›Dehydration as total body water deficit

›Hypertonic water loss with hypernatremia

›Isotonic loss with normal sodium

›Hypotonic loss with hyponatremia

›Volume depletion as extracellular fluid and intravascular deficit

›Orthostasis

›Prerenal azotemia

›Shock in severe cases

›Hypovolemic shock as inadequate preload and perfusion

›Hemorrhagic causes

›Non hemorrhagic fluid loss

›Common etiologic buckets

›GI losses

›Vomiting

›Diarrhea

›Ostomy output

›Renal losses

›Diuretics

›Osmotic diuresis from hyperglycemia

›Diabetes insipidus

›Third spacing

›Pancreatitis

›Bowel obstruction

›Burns

›Reduced intake

›Poor access to fluids

›Dysphagia

›Delirium

›Insensible losses

›Fever

›Tachypnea

›Heat exposure

Phenotype based approach

›Pattern recognition

›Uncomplicated dehydration

›Normal BP

›Mild tachycardia

›Dry mucosa

›Clinically significant volume depletion

›Orthostatic symptoms

›Tachycardia

›Decreased urine output

›Hypovolemic shock

›Hypotension

›Altered mental status

›Cool clammy skin

›Weak pulses

›Mixed shock

›Sepsis with relative hypovolemia

›Cardiogenic component with fluid intolerance

›Obstructive physiology

›Early pitfalls

›Normal BP in compensated shock

›Tachycardia as early sign

›Narrow pulse pressure

›Elderly on beta blockers

›Blunted tachycardia

›Reliance on mentation and perfusion signs

›Over attribution

›Abdominal catastrophe masquerading as dehydration

›Sepsis masquerading as gastroenteritis

02History/hx82

Presenting pattern and timeline

›Symptom onset and tempo

›Hours to days

›Gastroenteritis pattern

›Diuretic change

›Weeks

›Endocrine causes

›Malignancy related poor intake

›Fluid loss sources

›Vomiting

›Frequency

›Inability to tolerate oral intake

›Diarrhea

›Frequency

›Bloody stool

›Polyuria

›Nocturia

›Polydipsia

›Excess sweating or heat exposure

›Exertion

›Environmental temperature

›Intake and access

›Reduced oral intake

›Nausea

›Dysphagia

›Food insecurity

›Ability to obtain fluids

›Living situation

03Physical Exam/exam49

Vital signs and perfusion

›Hemodynamic profile

›Tachycardia

›Shock index calculation

›Hypotension

›MAP estimation

›Orthostatic change

›Symptom reproduction

›Heart rate increase

›Fever

›Increased insensible losses

›Perfusion markers

›Capillary refill

›Delayed refill

›Skin temperature

›Cool extremities

›Peripheral pulses

›Thready pulses

›Mental status

›Lethargy

›Delirium

›Urine output estimate

›Recent voiding history

Volume status exam

›Mucous membranes and skin

›Dry oral mucosa

›Reduced tears in child

›Skin turgor reduction

04Differential Diagnosis/ddx32

Life threats to exclude

›Shock syndromes

›Hemorrhagic shock

›GI bleed ICD-10 K92.2

›Ectopic pregnancy ICD-10 O00

›Trauma related hemorrhage ICD-10 T79.4

›Septic shock ICD-10 R65.21

›Pneumonia ICD-10 J18.9

›Pyelonephritis ICD-10 N10

›Anaphylaxis ICD-10 T78.2

›Adrenal crisis ICD-10 E27.2

›Cardiogenic shock ICD-10 R57.0

›Metabolic emergencies

›Diabetic ketoacidosis ICD-10 E10.10 or E11.10

›Hyperosmolar hyperglycemic state ICD-10 E11.00

›Severe hyponatremia ICD-10 E87.1

›Severe hypernatremia ICD-10 E87.0

›Surgical and ischemic abdomen

›Mesenteric ischemia ICD-10 K55.9

›Bowel obstruction ICD-10 K56.609

›Pancreatitis ICD-10 K85.9

Mimics and contributors

›Orthostatic syndromes without true hypovolemia

›POTS SNOMED CT concept

›Medication induced vasodilation

›Renal and endocrine polyuria

›Diabetes insipidus ICD-10 E23.2

›Hypercalcemia ICD-10 E83.52

05Laboratory Tests/lt61

Core panel

›Initial labs for most patients

›Basic metabolic panel

›Sodium pattern for dehydration type

›Potassium for arrhythmia risk

›Bicarbonate for metabolic acidosis

›Creatinine for AKI severity

›Glucose

›Hyperglycemia suggesting osmotic diuresis

›Hypoglycemia in poor intake or adrenal crisis

›CBC

›Anemia suggesting bleeding

›Leukocytosis suggesting infection

›Magnesium

›Arrhythmia risk

›Repletion planning

›Renal perfusion markers

›BUN

›Elevated with prerenal azotemia

›BUN to creatinine ratio

›Suggestive pattern for prerenal physiology

›Acid base and perfusion

›Venous blood gas

›pH and bicarbonate trend

›CO2 for compensation adequacy

›Lactate

›Hypoperfusion marker

›Sepsis screening support

06Diagnostic Tests/dt58

Scoring Systems

›Bedside indices

›Shock index

›Heart rate divided by systolic BP

›Greater than 0.9 concerning for occult shock

›qSOFA in infection concern

›Altered mentation

›Respiratory rate 22 or greater

›SBP 100 mmHg or less

›Pediatric dehydration clinical scales

›General appearance

›Eyes and tears

›Mucous membranes

›Capillary refill

›Skin turgor

›Orthostatic assessment

›Symptomatic orthostasis

›Lightheadedness or syncope

›Weakness on standing

›Objective patterns

›Heart rate increase 30 or greater on standing

›Systolic BP drop 20 mmHg or greater

MRI

›MRI use cases in volume depletion workup

›Persistent altered mental status without clear cause

›Stroke evaluation

›Encephalitis consideration

›Suspected pituitary pathology with diabetes insipidus

07Disposition/dispo40

Level of care decisions

›ICU indications

›Shock requiring vasopressors

›Persistent hypotension after adequate fluids

›Severe electrolyte derangement

›Sodium 160 mmol/L or greater

›Sodium 120 mmol/L or less with symptoms

›Potassium 6.0 mmol/L or greater

›Severe AKI

›Oliguria or anuria

›Refractory acidosis

›Uremic complications

›DKA or HHS requiring insulin infusion

›Altered mental status

›Severe acidosis

›Inpatient ward indications

›Ongoing IV fluid requirement

›Persistent vomiting

›Inadequate oral intake

›Moderate AKI

›Rising creatinine trend

›High risk comorbidity

›Heart failure

›CKD

›Frailty

›Discharge suitability

›Hemodynamic stability

›No orthostatic symptoms after treatment

08Treatment/t104

Fluids and route selection

›Route strategy

›Oral rehydration when feasible

›Mild to moderate dehydration

›Intact mental status

›No persistent intractable vomiting

›IV rehydration when needed

›Shock or poor perfusion

›Inability to tolerate PO

›Severe electrolyte derangement

›Fluid type selection

›Isotonic crystalloids as first line for volume depletion

›Balanced crystalloid option

›0.9% saline option

›Dextrose containing fluids

›Hypoglycemia risk

›Hypernatremia correction planning

›Blood products when hemorrhage

›Massive transfusion protocol activation when indicated

Adult IV crystalloid protocols

›Initial bolus for hypoperfusion

›Balanced crystalloid 500 mL to 1 L

›Reassessment after each bolus

›Repeat bolus if persistent hypoperfusion and no overload signs

›0.9% saline 500 mL to 1 L

›Consider hyperchloremic acidosis risk with large volumes

›Sepsis with hypoperfusion pattern

›30 mL/kg crystalloid within 3 hours

›Early reassessment of fluid responsiveness

›Early vasopressor if hypotension persists

›Maintenance and deficit replacement

›Goal directed replacement

›Ongoing losses matching

›Transition to oral as soon as possible

›Slow correction strategy for chronic deficits

›Comorbidity adjusted rate

Pediatric rehydration protocols

›IV bolus for shock

›Isotonic crystalloid 20 mL/kg

›Repeat up to 60 mL/kg with reassessment

›Earlier escalation if persistent shock

›Moderate dehydration without shock

›Oral rehydration solution

›Small frequent volumes

›5 to 10 mL every 1 to 2 minutes as tolerated

›NG rehydration option

›When oral intake limited but gut usable

›Maintenance fluid principles

›Isotonic maintenance preferred in many hospitalized children

›Hyponatremia prevention strategy

Electrolyte and acid base management

›Sodium disorders

›Hypernatremia management

›Initial intravascular resuscitation with isotonic fluid if unstable

›Free water deficit correction after stabilization

›Correction rate target no more than 10 to 12 mmol/L per 24 hours

›Hyponatremia management

›Isotonic crystalloids for hypovolemic hyponatremia

›Severe symptomatic hyponatremia hypertonic saline pathway as indicated

›Potassium disorders

›Hypokalemia repletion planning

›Oral preferred if mild and tolerating PO

›IV replacement with ECG monitoring when severe

›Hyperkalemia recognition

›Immediate protocol if ECG changes or severe elevation

›Metabolic acidosis

›Diarrhea related non anion gap acidosis

›Volume replacement

›Potassium monitoring

›Lactic acidosis from hypoperfusion

›Perfusion restoration

›Sepsis source control if applicable

Medications and adjuncts

›Antiemetics to enable oral rehydration

›Ondansetron PO 4 mg

›Repeat once if vomiting persists

›QT prolongation risk context

›Ondansetron IV 4 mg

›Alternative when PO not feasible

›Vasopressors when fluids insufficient

›Norepinephrine infusion for persistent hypotension after fluids

›MAP target 65 mmHg or greater

›Early initiation in septic shock pattern

›Stop or hold contributors when appropriate

›Diuretics

›Temporary hold during acute volume depletion

›ACE inhibitor or ARB

›Temporary hold during AKI from hypovolemia

›NSAIDs

›Avoid during AKI risk state

Reassessment and endpoints

›Response tracking

›Repeat vitals after each intervention

›Heart rate trend

›BP trend

›Perfusion markers

›Mentation

›Capillary refill

›Skin temperature

›Urine output trend

›Foley output in critical illness

›Repeat labs when indicated

›Creatinine trend

›Sodium trajectory

›Lactate clearance in shock

›Fluid intolerance surveillance

›Rising oxygen requirement

›New crackles

›New B lines on lung ultrasound

›Increasing JVP

09Special Populations/sp38

Pregnancy

›Pregnancy specific considerations

›Hyperemesis gravidarum patterns

›Ketonuria risk

›Thiamine deficiency risk

›Fluid choice and goals

›Isotonic crystalloids for volume depletion

›Avoid hypotension compromising uteroplacental perfusion

›Antiemetic safety framing

›Ondansetron risk benefit discussion context

›Alternative agents per local guidance

›Fetal and obstetric assessment triggers

›Vaginal bleeding

›Abdominal pain

›Reduced fetal movement later gestation

Geriatric

›Older adult considerations

›Blunted tachycardia with beta blockers

›Reliance on perfusion markers

›Delirium as dehydration presentation

›Reversible contributors

›Fluid intolerance risk

›Heart failure

›CKD

›Medication review emphasis

›Diuretics

›Antihypertensives

›Sedatives increasing fall risk

10Background/b46

Epidemiology

›Frequency contexts

›Common ED presentation drivers

›Viral gastroenteritis

›Heat related illness

›Diuretic associated volume depletion

›High burden populations

›Infants and young children

›Older adults

›Patients with limited access to fluids

›Complication patterns

›AKI from prerenal hypoperfusion

›Reversible with timely rehydration

›Falls and syncope

›Orthostatic hypotension link

Pathophysiology

›Intravascular depletion cascade

›Reduced preload

›Decreased stroke volume

›Compensatory tachycardia

›Neurohormonal response

›RAAS activation

›ADH release and water retention

›Renal consequences

›Prerenal azotemia

›Acute tubular injury if prolonged

›Dehydration sodium patterns

›Hypernatremic dehydration

11Patient Discharge Instructions/pdi23

copy discharge instructions

›Home care plan

›Oral rehydration solution use

›Small frequent sips

›Increase as tolerated

›Diet progression

›Bland foods as tolerated

›Avoid alcohol until well hydrated

›Medication guidance

›Avoid NSAIDs until normal hydration and kidney function

›Follow prescriber instructions on diuretics and BP meds

›Return to ED now

›Fainting or near fainting

›Chest pain

›Shortness of breath

›Confusion or severe weakness

›No urination for 8 to 12 hours

›Persistent vomiting preventing fluids

›Bloody stool or black tarry stool

›Fever with worsening symptoms

›Severe abdominal pain

›Follow up

›Primary care within 24 to 72 hours if symptoms not fully resolved

›Repeat labs plan if AKI or electrolyte abnormality during visit

12References/r21

Clinical guidelines and consensus

›Core guidance sources

›NICE CG174 Intravenous fluid therapy in adults in hospital

›Isotonic crystalloid for resuscitation

›Ongoing reassessment to avoid overload

›Surviving Sepsis Campaign guidelines

›Initial 30 mL/kg crystalloid for sepsis induced hypoperfusion

›Early vasopressor for persistent hypotension

›AAP guidance on oral rehydration for pediatric gastroenteritis

›Oral rehydration solution as first line for mild to moderate dehydration

›Ondansetron support for vomiting to facilitate oral rehydration

Coding and terminology

›Medical coding references

›ICD-10 dehydration E86.0

›Dehydration clinical diagnosis mapping

›ICD-10 hypovolemia E86.1

›Volume depletion mapping

›ICD-10 volume depletion unspecified E86.9

›Nonspecific volume depletion mapping

›SNOMED CT dehydration concept

›Standardized terminology alignment

›SNOMED CT hypovolemia concept

›Standardized terminology alignment

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Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

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