Volume Overload

• • Volume overload

Epidemiology

• • Postoperative patients

  • Heart failure

  • Liver disease

  • Renal failure

  • Hypoalbuminuria

  • Head injury (syndrome of inappropriate antidiuretic hormone [SIADH])

  • Burns (SIADH)

  • Cancer (SIADH)

Symptoms and Signs

• • Sacral edema

  • Extremity edema

  • Jugular venous distention

  • Tachypnea

  • Increased body weight

  • Elevated central pressures

  • Gallop rhythm

  • Confusion (SIADH)

  • Lethargy (SIADH)

Laboratory Findings

• • Hyponatremia (SIADH)

  • Concentrated urine (SIADH)

  • Elevated urine sodium (SIADH)

  • Low urine sodium

  • High urine potassium

• • May be concurrent with myocardial failure or ischemia

  • Evaluation should include cardiac evaluation

• • Serum electrolytes

  • UA (SIADH)

When to Refer

• • Cardiology consult if primary cardiogenic failure

• • Sodium restriction

  • Water restriction if low sodium

  • Diuretics if severe

  • Diuretics (SIADH)

  • IV isotonic saline to match urinary output (SIADH)

Medications

• • Diuretics

Treatment Monitoring

• • Serum sodium

Complications

• • Pulmonary edema

  • Congestive heart failure

  • Prerenal azotemia

Prognosis

• • Excellent

Prevention

• • Monitor daily weights

  • Judicious IV hydration

  • Monitor sodium intake

References