Images in Clinical Medicine
Poor Skin Turgor
N Engl J Med 1998; 338:25January 1, 1998
- Article
Figure 1 A 74-year-old man was found unconscious at home and brought to the emergency department. He was obtunded and moved only with painful stimuli. His blood pressure was 95/55 mm Hg, with a heart rate of 115 beats per minute and a temperature of 35.8°C. His mucous membranes were dry, and his skin turgor was markedly decreased. Volume status was evaluated by squeezing the skin of the patient's abdomen (Panel A) and assessing the response 15 seconds (Panel B) and 40 seconds (Panel C) after the pressure was released. The following values were recorded on admission: serum sodium, 186 mmol per liter; serum chloride, 150 mmol per liter; blood urea nitrogen, 155 mg per deciliter (55 mmol per liter); serum creatinine, 6.6 mg per deciliter (583 μmol per liter); hematocrit, 53 percent; and white-cell count, 32,600 per cubic millimeter. The patient was treated with normal saline and broad-spectrum antibiotics and admitted to the intensive care unit. After the administration of 3 liters of normal saline, the patient began to receive half-normal saline and, later, quarter-normal saline, for a total of approximately 10 liters of fluid in the first 24 hours. After 50 hours, the patient's serum sodium concentration was 142 mmol per liter, the serum creatinine concentration was 1.9 mg per deciliter (168 μmol per liter), his mental status had improved so that he could follow simple commands, and he was transferred to an intermediate care unit.
Oscar M. Aguilar, M.D.
Mariano Albertal, M.D.
University of Kansas Medical Center, Kansas City, KS 66103- Citing Articles (2)
Citing Articles
1
Ronni Wolf, Danny Wolf, Donald Rudikoff, Lawrence Charles Parish. (2010) Nutrition and water: drinking eight glasses of water a day ensures proper skin hydration—myth or reality?. Clinics in Dermatology 28:4, 380-383
CrossRef2
Carol Dealey. (2009) Skin Care and Pressure Ulcers. Advances in Skin & Wound Care 22:9, 421-428
CrossRef
