Does This Patient Have Volume Overload?: The Rational Clinical Examination - PubMed
9 hours ago
- #clinical examination
- #BNP
- #volume overload
- Accurate assessment of intravascular volume is crucial for managing fluid in patients with volume overload.
- Key physical examination findings for volume overload include jugular venous distention >3 cm above the sternal angle (specificity 92%), lower extremity edema (specificity 80%), and crackles on auscultation (specificity 81%).
- Vascular congestion on chest radiography strongly suggests volume overload (specificity 91%).
- Point-of-care ultrasonography findings like bilateral pulmonary B-lines (specificity 77%) and inferior vena cava collapsibility index <50% (specificity 79%) indicate volume overload.
- A plasma BNP level ≥100 ng/mL is the single best test for identifying volume overload (specificity 87%), while levels <100 ng/mL make it unlikely (sensitivity 87%).
- Absence of pulmonary B-lines or BNP levels <100 ng/mL are useful to exclude volume overload.