Fluid Volume Deficit vs Fluid Volume Excess: Assessment Comparison
Both FVD and FVE can cause tachycardia, so heart rate alone won't save you on the NCLEX. Picking the wrong volume state flips your intervention — you'd fluid-bolus an already drowning patient or restrict fluids in someone who's dry and hypotensive.
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Comparison
- Net fluid loss exceeds intake
- Vomiting, diarrhea, hemorrhage, burns
- Older adults, NPO, diabetes insipidus
- Fluid + sodium retained or overloaded
- Heart failure, renal failure, SIADH
- Excess IV fluids, cirrhosis, steroids
- ★Flat neck veins, even supine
- Acute weight loss
- orthostatic drop ≥20 mmHg
- Poor turgor (tenting), dry mucosa
- thready pulse
- ★Distended neck veins (JVD at 45°)
- Acute weight gain
- bounding pulse, HTN
- Crackles
- pitting edema
- taut skin
- ↑ BUN, ↑ Hct (hemoconcentration)
- ↑ serum osmolality
- SG > 1.030
- ↓ BUN, ↓ Hct (hemodilution)
- ↓ serum osmolality
- SG < 1.010
- Strict I&O
- daily weights
- Oral rehydration if tolerated
- Monitor for hypovolemic shock
- Strict I&O
- daily weights
- Restrict fluids and sodium
- Elevate HOB to ease breathing
- Isotonic IV fluids (0.9% NS or LR)
- Loop diuretics (furosemide) as ordered
- Increase fluids
- recognize thirst, dizziness
- Replace losses with vomiting/diarrhea
- Limit fluids and dietary sodium
- Weigh daily
- report rapid weight gain
- Oliguria < 0.5 mL/kg/hr
- dark urine
- Hypotension, ↓ level of consciousness then shock
- Worsening crackles, dyspnea, ↓ SpO₂
- ★Pink frothy sputum then pulmonary edema
- Hypovolemic shock
- renal hypoperfusion
- Pulmonary edema
- heart failure
Fluid Volume Deficit
- Net fluid loss exceeds intake
- Vomiting, diarrhea, hemorrhage, burns
- Older adults, NPO, diabetes insipidus
Fluid Volume Excess
- Fluid + sodium retained or overloaded
- Heart failure, renal failure, SIADH
- Excess IV fluids, cirrhosis, steroids
Fluid Volume Deficit
- ★Flat neck veins, even supine
- Acute weight loss
- orthostatic drop ≥20 mmHg
- Poor turgor (tenting), dry mucosa
- thready pulse
Fluid Volume Excess
- ★Distended neck veins (JVD at 45°)
- Acute weight gain
- bounding pulse, HTN
- Crackles
- pitting edema
- taut skin
Fluid Volume Deficit
- ↑ BUN, ↑ Hct (hemoconcentration)
- ↑ serum osmolality
- SG > 1.030
Fluid Volume Excess
- ↓ BUN, ↓ Hct (hemodilution)
- ↓ serum osmolality
- SG < 1.010
Fluid Volume Deficit
- Strict I&O
- daily weights
- Oral rehydration if tolerated
- Monitor for hypovolemic shock
Fluid Volume Excess
- Strict I&O
- daily weights
- Restrict fluids and sodium
- Elevate HOB to ease breathing
Fluid Volume Deficit
- Isotonic IV fluids (0.9% NS or LR)
Fluid Volume Excess
- Loop diuretics (furosemide) as ordered
Fluid Volume Deficit
- Increase fluids
- recognize thirst, dizziness
- Replace losses with vomiting/diarrhea
Fluid Volume Excess
- Limit fluids and dietary sodium
- Weigh daily
- report rapid weight gain
Fluid Volume Deficit
- Oliguria < 0.5 mL/kg/hr
- dark urine
- Hypotension, ↓ level of consciousness then shock
Fluid Volume Excess
- Worsening crackles, dyspnea, ↓ SpO₂
- ★Pink frothy sputum then pulmonary edema
Fluid Volume Deficit
- Hypovolemic shock
- renal hypoperfusion
Fluid Volume Excess
- Pulmonary edema
- heart failure
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Flat veins + tenting + concentrated urine = dry; JVD + crackles + edema = wet.
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