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Acute renal failure

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Causes
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Clinical features

Volume contraction 

Look for  a

  • sunken eyes b
  • dry axillae b
  • dry nose or mouth mucous membranes b
  • longitudinal tongue furrows b

Why?

Sunken eyes, dry axillae, dry mucous membranes and tongue furrows make dehydration more likely

Patient a Target Disorder and
Reference Standard
Diagnostic Test LR+
(95% CI)
Post-test Probability LR-
(95% CI)
Post-test Probability
suspected hypovolaemia ot due to blood loss
(pre-test probability: 15%)
hypovolaemia not due to blood loss
(biochemistry)
sunken eyes 3.4
(1.0 to 12)
38% 0.5
(0.3 to 0.7)
8%
  dry axillae 2.8
(1.4 to 5.4)
33% 0.6
(0.4 to 1.0)
10%
  dry mouth and mucous membranes 2.0
(1.0 to 4.0)
26% 0.3
(0.1 to 0.6)
5%
  longitudinal furrows on tongue 2.0
(1.0 to 4.0)
26% 0.3
(0.1 to 0.6)
5%

Note:

The following are not very helpful at diagnosing dehydration b
  • postural changes in pulse or blood pressure
  • neurological signs or symptoms (including confusion and slurred speech)

Expiry date: July 2003
Levels of Evidence used in grading these guides

Authors   C   Clase , CM   Ball
Reviewer   S   Hsu
CAT Writers   C   Clase , CM   Ball