Physical and Diagnostic Evaluation

• Physical findings:

• Skin Turgor/Mucous Membranes

• Hypotension/Decreased Pulse Pressure

• Tachycardia

• Orthostatic Changes: Orthostasis >20 mmHg decrease in systolic or > 10 mmHg diastolic within 2 minutes of supine to 60˚*

• Stool Guaiac

• * Volume Depletion: Orthostatic Increase in HR > 20; Autonomic Insufficinecy: Failure to Increase HR

• Diagnosis:

• Monitor Urinary Output to Fluid Challenge

• BMP*: BUN/creatinine > 20, Hyponatremia

• *Pattern Recognition: ↓ Na ↑ K Adrenal Insufficiency; ↓ K ↓ HCO3 Diarrhea, ↓ K ↑ HCO3 Vomiting

• Obtain Urinary electrolytes/creatinine (> 6 hrs off Lasix/ 24 hrs off Thiazide)