Decreased Skin Turgor

Cornelia de Vries Feyens, M.D., and Cornelis P.C. de Jager, M.D.
N Engl J Med 2011; 364:e6 January 27, 2011

A 61-year-old man with a vasoactive intestinal polypeptide-secreting neuroendocrine tumor (VIPoma) and diarrheal fluid losses exceeding 10 liters per day was transferred to the intensive care unit with severe volume depletion. On physical examination, the blood pressure was 54/30 mm Hg, and there was sinus tachycardia of 156 beats per minute. His total enteric fluid loss was 17 liters in the first 2 days after admission. The patient was also noted to have severely decreased skin turgor. Skin that was pinched over his anterior leg (Panel A) continued to be tented even after 10 minutes (Panel B). In patients with a normal fluid volume, the skin would be expected to return to its usual contour almost immediately. Skin elasticity is known to decrease with age, and there is no widely accepted threshold value distinguishing normal from abnormal skin turgor. Nevertheless, the skin turgor in this patient was dramatically decreased, clearly illustrating the loss of normal skin elasticity that can occur with severe volume depletion. The tenting resolved with volume resuscitation. After the intravenous administration of octreotide, the secretory diarrhea ceased within 12 hours. A pancreatic tumor measuring 44 by 30 mm was subsequently identified on computed tomography and was resected. The patient had a full recovery.

Cornelia de Vries Feyens, M.D.
Cornelis P.C. de Jager, M.D.
Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
p.de.jager@jbz.nl