Fluid Volume Disturbance

Fluid Volume Deficit (Hypovolemia)

 Definition:fluid volume deficit (FVD) occurs when loss of extracellular fluid volume exceeds the intake of fluid

It occurs when water and electrolyte are lost in the same proportion as they exist in normal fluids Fluid volume deficit (hypovolemia) should not be confused with the term dehydration, which refers to loss of water alone with increased serum sodium level, FVD may occur alone or in combination with other imbalances


FVD results from loss of body fluids and occurs more rapidly when coupled with decreased fluid intake

FVD can develop from inadequate intake alone if the decreased intake is prolonged

Causes of FVD include abnormal fluid losses such as resulting from vomiting, diarrhea, G.I suctioning and sweating and decreased intake as in Nausea or irritability to gain access to fluids (Beck – 2000) Additional risk factors diabetes inspidius, adrenal insufficiency, osmotic dieresis hemorrhage and coma

Clinical Manifestation 

Fluid volume deficit can develop rapidly and can be

  • Mild
  • Moderate
  • Or severe depending on the degree of fluid loss

Important characteristics of FVD include

  • Acute wt loss
  • Decreased skin turgor
  • Oliguria
  • Concentrated urine
  • Postural hypotension
  • A weak, rapid heart rate
  • Flattened neck veins
  • Increased temperature
  • Decreased central venous pressure
  • Cool
  • Clamming skin related to peripheral vasoconstriction
  • Thirst
  • Anorexia
  • Nausea
  • Muscles weakness
  • Cramps


  • BUN (blood urine nitrogen) related to serum cretinine concentration (a ratio greater than 20:1)
  • Health history
  • Physical examination
  • Serum electrolytes changes serum K, Na (hypokalemia, hyponatermia or hypernatermia, hyperkalemia)
  • Urine specific gravity increased

Medical Management 

  • Planning of correction of fluid loss for patient with fluid volume deficit (FVD)
  • The health care provider consider the usual maintenance requirements of the patient and other factors (such as fever) that can influence fluid needs
  • When deficit is not severe the oral route is preferred
  • In acute and severe losses the I/V route is required isotonic electrolyte solutions e.g lactated Ringer’s or 0.9% N/S are frequently used to treat hypotension pts with FVD
  • Maintain and assess I/O (intake and output chart)
  • Wt: , vital signs, central venous pressure, level of consciousness (LOC), breath sounds, skin color
  • The rate of fluid administration is based on severity of loss of and patient hemodynamic response

Nursing Management 

  • To assess for fluid volume deficit
  • Nurse monitors and measures fluid intake and output at least every 8 hours and sometime hourly
  • Vital signs closely monitored
  • Nurse should observe for weak pulse and postural hypotension
  • Skin and tongue turgor is monitored on regular basis
  • Preventing FVD – as diarrhea
  • Correcting FVD – if patient is unable to take fluid the orally the nurse should give fluid parental I/V