Hypervolemia, or fluid overload, means the body holds too much salt and water in the blood vessels and tissues. It usually comes from heart failure, kidney disease, liver cirrhosis or too much IV fluid, and severe cases flood the lungs.
Key symptoms
- Swelling of the legs, ankles or abdomen
- Rapid weight gain over a few days
- Shortness of breath, worse when lying flat
- Waking up at night short of breath
- Fatigue and less exercise tolerance
What you find on exam
- Pitting edema and weight above baseline
- Raised jugular venous pressure
- Crackles at the lung bases
- High blood pressure, S3 gallop or ascites
Tests
- Daily weights and an intake and output chart
- Electrolytes, creatinine and BUN
- BNP and chest X-ray: vascular congestion, pleural effusions
- Echocardiogram or bedside ultrasound of the IVC and lungs
Treatment basics
- A loop diuretic such as IV furosemide
- Limit sodium and, when needed, fluid intake
- Stop or slow IV fluids
- Treat the cause: heart failure, kidney or liver disease
- Dialysis or ultrafiltration when diuretics fail
Red flags
- Low oxygen or breathlessness at rest (pulmonary edema)
- Very low urine output despite diuretics
- Confusion or low blood pressure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; Open RN, Nursing Fundamentals 2e. Written by Making Synapses. Making Synapses is not affiliated with these organizations.