Which sign is most indicative of volume depletion rather than simple dehydration?

• A. Normal jugular fill
• B. Prolonged jugular refill
• C. Normal skin tent
• D. BAR/mild tachycardia

Answer: (B)

Prolonged jugular refill is most informative about volume status because it directly reflects the amount of blood available in the central venous system and how quickly it can refill the neck veins when the venous return is briefly impeded. In volume depletion, the circulating blood volume is reduced, so after a transient occlusion or early refill, the jugular veins take longer to fill again—the preload is limited and the venous system refills more slowly. This contrasts with simple dehydration where intravascular volume may be less profoundly affected and jugular refill can occur more quickly. Other signs like normal jugular fill or normal skin turgor don’t specifically point to reduced intravascular volume, and while mild tachycardia can occur in either state, it’s not as diagnostic.