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Hypovolemia: Sensitivity and Specificity

Introduction: Hypovolemia can come from many sources, including dehydration or volume loss, e.g. from vomiting, diarrhea, blood loss, etc.

The data here is for adults primarily.

See also Prerenal Kidney Failure, since this often results from hypovolemia and in many cases is used to diagnose low-perfusion states.

Similar to the results below, patients with specifically Ruptured Ectopic Pregnancy may not appear tachycardic or hypotensive despite hemoperitoneum.

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Tags: None. Tag this Diagnosis.

Differential Diagnoses include: Syndrome of Inappropriate ADH Secretion

The sensitivity and specificity of findings for Hypovolemia are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Finding SensitivitySpecificity Comments, Study
Respiratory Variation in IVC Diameter Edit 90%90%

calculate dIVC = (IVCmax-IVCmin)/IVCmin -> If dIVC >= 18%, will patient respond to 7ml/kg fluid challenge (measured by increase in CI)

in ventilated septic patients

Study: Intensive Care Med. 2004 Sep;30(9):1740-6. PMID 15034650

Specific Findings

Finding SensitivitySpecificity Comments, Study
Orthostatic Tachycardia
Duplicate Edit		 22%98%

>30 bpm OR severe postural dizziness. for moderate blood loss (<630ml).

For >630ml blood loss, in healthy volunteers, sensitivity = 97%.

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Hypotension Edit 13%97%

for blood loss <630ml.

for blood loss >630ml, sensitivity = 33%.

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Tachycardia Edit 1%96%

for blood loss <630ml.

for >630ml blood loss, sensitivity = 12%.

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Capillary refill time Edit 34%95%

longer than age- and sex-matched upper limit of normal. For non-blood volume loss

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Orthostatic Hypotension
Duplicate Edit		 9%94%

for blood loss >630ml.

>20mmHg decrease in SBP.

Sensitivity = 27% for patients >65, specificity = 86%.

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022

Sensitive Findings

Finding SensitivitySpecificity Comments, Study
Dry mucous membranes Edit 85%58%

for non-blood volume loss

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Tongue furrows Edit 85%58%

(longitudinal). For non-blood volume loss

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022

Negative Findings

Finding SensitivitySpecificity Comments, Study
Tachycardia Edit 1%96%

for blood loss <630ml.

for >630ml blood loss, sensitivity = 12%.

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
Sunken eyes Edit 62%82%

for non-blood volume loss

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Speech disturbance Edit 56%82%

for non-blood volume loss

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Dry Axilla Edit 50%82%

for non-blood volume loss

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Weakness Edit 43%82%

"upper or lower extremity". For non-blood volume loss

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Orthostatic Hypotension
Duplicate Edit		 29%81%

SBP decrease >20mmHg. for non-blood volume loss.

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Orthostatic Tachycardia
Duplicate Edit		 43%75%

>30bpm. for non-blood volume loss.

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Dry tongue Edit 59%73%

for non-blood volume loss

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Confusion Edit 57%73%

for non-blood volume loss

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022

Findings With Unspecified Accuracy

Finding SensitivitySpecificity Comments, Study
Skin turgor Edit No accuracy specified.

is not associated with dehydration, though sensitivity and specificity not given.

In children, skin turgor has been demonstrated to have some diagnostic accuracy ("for the detection of 5% dehydration, abnormal skin turgor carried a pooled sensitivity of 58% and specificity of 76%" - PMID 17901292).

Study: JAMA. 1999;281:1022-1029. http://jama.ama-assn.org/cgi/content/full/281/11/1022
Thirst Edit No accuracy specified.

does not correlate with dehydration severity, though sensitivity and specificity not given.

Study: J Emerg Med. 1992 May-Jun;10(3):267-74. PMID 1624737

 

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