H.13 Volume Stats: Simple Tool for Round-the-Clock, Accurate Volume Status Exams
Volume status exams—physical exams whereby physicians assess the amount of excess fluid in a human’s body—are performed by physicians multiple times a day, for multiple patients, in multiple specialties. These exams are a difficult part of a physician’s daily routine that drives many of the decisions they make day in and day out. The exams are sometimes characterized as an art. We look at a patient’s neck veins, their abdomen, their feet, and their fingers. We listen to their hearts, their lungs, and their stories to try to determine just how much fluid they are retaining so that we can appropriately diuresis them and yet, we have no gold standard for assessing fluid status accurately and quickly. In order to reduce diagnostic inaccuracy and save time, a round-the-clock tool to assess a patient’s volume status by viewing the inferior vena cava and internal jugular vein should be considered.
Lab markers like BUN, serum osmolarity, creatinine, sodium, and others have been useful alongside imaging tools like Point-of-care ultrasound of the inferior vena cava. And other physical exam maneuvers have proven to be more helpful than others while being notoriously difficult (ie. jugular venous distension is the most sensitive and specific physical exam maneuver to perform but also one of the most difficult). All of these together though, can make for a tedious and confusing task. This is not to mention the practical difficulties of finding an ultrasound machine. If we had a tool that could tell us all of this information at once, volume status exams would become an easy daily task.
The largest impact to note here would be that of diagnostic accuracy. Diuretics are often given to patients who may not need them based on inaccurate fluid status exams which increases the risk for dehydration and acute kidney injury. A quick and accurate assessment of volume would allow physicians to perfectly titrate the amount of diuresis a patient requires to reach a state of euvolemia. Ultimately, this would save the healthcare system, patients, and physicians time and resources.