GetTheDiagnosis.org

Welcome, guest.
Login or Sign up to edit.

Add an entry

Search:
 

Tools

Add a finding for this diagnosis

Add prevalence for this diagnosis

Switch to calculator mode to see positive predictive value

Switch to sensitivity and specificity

Sort findings by Tag

Sort findings by Differential Diagnosis

Jump To

Good Positive and Negative Likelihood Ratios

Good Positive Likelihood Ratio

Negative Findings

Poorly Diagnostic Findings

Findings With Unspecified Accuracy

Hypovolemia: Likelihood Ratios

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.

[Edit Diagnosis] [Merge dx] [Add prevalence]

Tags: None. Tag this Diagnosis.

Differential Diagnoses include: Syndrome of Inappropriate ADH Secretion

The likelihood ratios of findings for Hypovolemia are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding +LR-LR Comments, Study
Respiratory Variation in IVC Diameter Edit 90.1

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

Dry mucous membranes Edit 20.3

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 20.3

(longitudinal). For non-blood volume loss

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

Sunken eyes Edit 3.40.5

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 3.10.5

for non-blood volume loss

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

Good Positive Likelihood Ratio

Finding +LR-LR Comments, Study
Orthostatic Tachycardia
Duplicate Edit
110.8

>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

Capillary refill time Edit 6.80.7

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

Hypotension Edit 4.30.9

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

Dry Axilla Edit 2.80.6

for non-blood volume loss

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

Weakness Edit 2.40.7

"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

Dry tongue Edit 2.20.6

for non-blood volume loss

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

Confusion Edit 2.10.6

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 +LR-LR Comments, Study
Tachycardia Edit 0.31

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 +LR-LR Comments, Study
Orthostatic Hypotension
Duplicate Edit
1.51

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

Orthostatic Hypotension
Duplicate Edit
1.50.9

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
1.70.8

>30bpm. 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 +LR-LR 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