Hydration Status Examination
Print Friendly, PDF & Email

almostadoctor app banner for android and iOS almostadoctor iPhone, iPad and android apps almostadoctor iOS app almostadoctor android app


Liquid water. The basis of all life.

Hydration status examination is the clinical skill of assessing the patient’s level of hydration.

There may be clues in the history. E.g.:


  • Look around the bed for clues. E.g. fluid restriction signs, catheter bag, nutritional supplements
  • Look at the face for sunken orbits – this is a sign of moderate to severe dehydration
  • Look inside the mouth – look at the tongue and mucous membranes for signs of moisture. Dehydration will cause these surfaces to appear dry


Check the skin turgor. Gently pinch a fold of skin on the forearm, hold it for a few seconds, then let go.

  • Normal hydration – the skin will promptly return to its original position
  • Dehydration – the skin will take longer to return to its original position
  • This sign is unreliable in elderly patients – as these people tend to have lost their natural skin elasticity anyway
  • Capillary refill – raise the patient’s hand to the level of the heart, then press down hard on the nail for 5 seconds. Note the time taken for the normal pink colour to refill. If this takes longer than 2 seconds it indicates poor peripheral blood supply – there could be many causes for this, one of which could be low blood volume
  • Pulse – there may be a compensatory tachycardia in both dehydration and fluid overload
  • Blood pressure – check both lying and standing BP. Low standing BP indicates dehydration
  • JVP – check the height of the JVP. This is one of the most sensitive ways of judging intravascular volume. JVP will be low in dehydration and high in fluid overload. Fluid overload also commonly causes basal crepitations as a result of pulmonary oedema – so if you suspect fluid overload you should listen to the lung bases.
  • Oedema – check both sacral and ankle for signs of fluid overload. Common causes of this are heart failure, hypoalbuminaemia (liver failure), pericarditis.


You may want to listen to the lung bases if you suspect fluid overload. If crepitations are present this suggests pulmonary oedema

Finishing off

Check the urine. Very simply you could look at the colour of the urine; darker urine suggesting dehydration. You may also want to catheterise to measure urine output
  • Urine specific gravity is a slightly more accurate way of measuring hydration. It basically measures the concentration of solutes in the urine. The greater the concentration, the greater the degree of dehydration.
  • Remember – when looking at urine sample, you want an MSU – always discard the first part of the stream


Read more about
our sources

Related Articles

Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

Leave a Reply