Management of Decreased Elastic Skin Turgor
Assessment of Decreased Skin Turgor
- Decreased skin turgor is one of several key clinical signs of dehydration, along with dry mucous membranes, thirst, tachycardia, orthostasis, decreased urination, and lethargy 1
- When evaluating skin turgor, assess the skin's ability to return to normal position after being pinched or tented 3
First-Line Management: Oral Rehydration
- Administer oral rehydration solution containing appropriate electrolyte balance (Na 90 mM, K 20 mM, Cl 80 mM, HCO3 30 mM, and glucose 111 mM) 1
- Oral rehydration therapy is safer, less painful, less costly, and superior to IV fluids for persons able to take oral fluids 1
- The patient's thirst naturally decreases as rehydration occurs, helping protect against overhydration 1
- Stool output can be further reduced with food-based oral rehydration therapy in cases of dehydration due to diarrhea 1
Intravenous Fluid Management
- In patients unable to take oral fluids, intravenous rehydration should be initiated 2
- Monitor for signs of fluid overload during rehydration, especially in elderly or cardiac patients 2
Special Considerations for Different Populations
- Apply moisturizers with high lipid content to maintain skin barrier function in elderly patients with decreased skin turgor 4
- Consider gabapentin for persistent pruritus in elderly skin with decreased turgor 5
- Avoid sedative antihistamines in elderly patients except in short-term or palliative settings 5
- Consider intermittent pneumatic compression rather than compression stockings for immobile patients with decreased skin turgor to prevent DVT 6
Monitoring and Follow-up
- Reassess skin turgor regularly during rehydration therapy to monitor improvement 1, 2
- Monitor other signs of volume status including vital signs, urine output, and mental status 2
- For patients with infectious causes of dehydration, address the underlying infection while managing fluid status 1