Dehydration Assessment

Clinical Signs

Skin tenting indicates dehydration, which can be assessed by pinching and gently lifting the skin over the shoulder blades (skin turgor test), and if the tent remains or is slow to resolve after release, the patient is dehydrated 1
The skin turgor test is a reliable indicator of hydration status, where prolonged skin tenting indicates decreased skin elasticity due to loss of interstitial fluid 2
The severity of dehydration can be estimated based on the degree of skin tenting, with mild dehydration (3-5%) showing slightly delayed return of skin, moderate dehydration (6-9%) showing obvious delay, and severe dehydration (≥10%) showing significant tenting with very slow return 3
Additional signs of dehydration to evaluate alongside skin tenting include dry mucous membranes, sunken eyes, altered mental status, and decreased urine output 2

The skin over the shoulder blades provides the most reliable assessment site for skin turgor in adults 1
The technique for assessing skin turgor involves pinching and gently lifting the skin over the shoulder blades, with a normal response being skin quickly returning to its original shape, and an abnormal response being skin remaining tented or slow to resolve 2

Elderly patients may have decreased skin elasticity due to age-related changes, potentially causing false-positive skin tenting 2
Severe malnutrition or cachexia can affect skin elasticity, and certain dermatological conditions may alter skin elasticity independent of hydration status 2

When significant skin tenting is observed, fluid resuscitation should be initiated based on the degree of dehydration, with oral rehydration for mild-moderate dehydration and intravenous fluid resuscitation for severe dehydration 2
Regular reassessment of skin turgor is necessary to evaluate response to treatment, and the underlying cause of dehydration should be identified and treated 2