DehydrationMANAGEMENT

ENDOCRINE AND METABOLIC PRESENTATIONS · 12 SECTIONS

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665 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

Acute Porphyria Adrenal crisis Adrenal Insufficiency (Addisonian Crisis)Dehydration Diabetes Insipidus Diabetic Ketoacidosis (DKA)Galactosemia Homocystinuria Hypercalcemia Hyperkalemia Hypermagnesemia Hypernatremia Hyperosmolar Hyperglycemic State (HHS)Hypertensive emergency Hypertensive urgency Hypocalcemia Hypoglycemia Hypogonadism (Acute Presentation)Hypokalemia Hypomagnesemia Hyponatremia Hypoparathyroidism (Tetany)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 Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

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

›Functional status

High risk features

›Red flags for alternate diagnosis

›Fever or rigors

›Sepsis concern

›Chest pain or dyspnea

›MI or PE concern

›Severe headache or confusion

›CNS process

›Severe abdominal pain

›Surgical abdomen

›GI bleeding symptoms

›Melena

›Hematemesis

›Medication contributors

›Diuretics

›Recent dose increase

›SGLT2 inhibitors

›Volume loss risk

›Euglycemic ketoacidosis risk

›ACE inhibitor or ARB

›AKI risk during volume depletion

›NSAIDs

›AKI risk during hypoperfusion

›Laxatives

›Chronic diarrhea

›Comorbid risk

›Chronic kidney disease

›Limited renal reserve

›Heart failure

›Fluid intolerance risk

›Cirrhosis

›Effective arterial hypovolemia

›Diabetes mellitus

›Osmotic diuresis

›DKA and HHS risk

›Adrenal insufficiency

›Salt wasting and shock risk

›Population specific risk

›Older adult

›Delirium risk

›Reduced thirst drive

›Infant or young child

›Rapid decompensation

›Caregiver report reliability

›Pregnancy

›Hyperemesis gravidarum

Baseline status

›Usual weight and recent change

›Acute weight loss

›Dry weight in dialysis patient

›Baseline vitals and BP range

›Chronic hypertension

›Autonomic dysfunction

›Baseline urine output

›Oliguria baseline in CKD

›Diuretic baseline in heart failure

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

›Sunken eyes in child

›JVP and lung exam

›Flat neck veins

›Clear lungs

›Crackles suggesting overload or alternate diagnosis

›Abdomen and third spacing

›Diffuse tenderness

›Peritonitis

›Ascites

›Distension

›Bleeding assessment

›Melena on exam if indicated

›Hematemesis evidence

›Vaginal bleeding

›Ecchymoses

PITFALLS

›Exam limitations

›Poor correlation of skin turgor in older adults

›Dry mucosa from mouth breathing

›Orthostatics unreliable in severe illness

›Missed mixed physiology

›Sepsis with vasodilation

›Cardiogenic shock with poor forward flow

›Obstructive shock

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

›Toxicologic

›Ethanol related gastritis and vomiting

›Stimulant induced hyperthermia

›Cardiorespiratory

›Pulmonary embolism ICD-10 I26.99

›Acute coronary syndrome ICD-10 I24.9

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

Targeted labs by phenotype

›Suspected DKA or HHS

›Serum ketones or beta hydroxybutyrate

›Ketosis quantification

›Serum osmolality

›HHS severity

›Phosphate

›Repletion planning

›Suspected adrenal crisis

›Random cortisol

›Interpretation limited in acute illness

›TSH and free T4 if thyroid disease suspected

›Coexisting endocrine disease screen

›Suspected infection

›Blood cultures before antibiotics when feasible

›Shock or high fever

›Urinalysis

›Pyuria or bacteriuria

›Suspected GI bleed

›Type and screen

›Transfusion planning

›INR if anticoagulant use

›Reversal planning

Interpretation pitfalls

›Lab caveats

›Hemoconcentration

›Elevated hematocrit without true polycythemia

›Early creatinine lag

›AKI present despite near baseline creatinine

›Normal sodium with major intravascular loss

›Isotonic loss pattern

›Low bicarbonate differential

›Diarrhea

›DKA

›Lactic acidosis

›Renal failure

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

›Posterior pituitary and hypothalamic evaluation

›Limitations

›Time and transport instability

›Monitoring constraints

›CT indications when dehydration is not the full story

›Severe abdominal pain

›Obstruction

›Perforation

›Ischemia

›Concern for GI bleeding source complications

›Perforated ulcer

›Colitis

›Head CT indications

›Head trauma from syncope

›Focal neurologic deficit

›Contrast considerations

›Prerenal AKI and contrast risk context

›Life threatening diagnosis priority over contrast avoidance

Ultrasound

›POCUS for shock and volume status

›Cardiac views

›Hyperdynamic small LV pattern

›Pericardial effusion exclusion

›IVC assessment

›Small collapsible IVC supporting low right atrial pressure

›Interpretation limited in ventilation and right heart disease

›Lung ultrasound

›B lines suggesting fluid intolerance or alternate diagnosis

›Pleural effusion recognition

›FAST when trauma concern

›Free fluid screening

›Hydronephrosis screening

›Post renal obstruction mimic

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

›Normal perfusion markers

›Oral tolerance

›Successful PO challenge

›Safe follow up

›Primary care or urgent reassessment

›Return precautions understood

Observation pathways

›ED observation candidates

›Mild to moderate dehydration

›IV fluids and antiemetics

›Repeat vitals and labs if indicated

›Syncope or near syncope with suspected volume depletion

›ECG reassuring

›No high risk features after evaluation

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

Pediatrics

›Pediatric specific considerations

›Rapid progression risk

›Short symptom duration with severe findings

›Assessment features

›Tear production

›Fontanelle fullness in infants

›Capillary refill

›Oral rehydration priority

›Mild to moderate dehydration first line

›Weight based dosing and fluids

›Bolus 20 mL/kg isotonic crystalloid

›Maintenance calculation per institutional standard

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

›Water loss exceeding sodium loss

›Hyponatremic dehydration

›Sodium loss exceeding water loss

›Isonatremic dehydration

›Proportional sodium and water loss

Therapeutic Considerations

›Fluid therapy principles

›Restore perfusion first

›Isotonic crystalloids preferred

›Replace deficits and ongoing losses

›Transition to oral early

›Avoid overly rapid correction

›Sodium disorder correction limits

›Balanced crystalloids vs saline tradeoffs

›Lower chloride load with balanced fluids

›Saline familiarity and availability

›Oral rehydration rationale

›Sodium glucose cotransport mechanism

›Effective absorption despite diarrhea

›Reduced need for IV therapy

›Lower complication risk

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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Comprehensive Clinical Review

Structured, evidence-informed, long-form analysis for deeper understanding.

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.