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Seminar On Fluid and Electrolyte Imbalance
Aneez. KIst Year MSc. Nursing
EMCH CON
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Terminologies Homeostatic Hydrostatic Pressure Osmolarity Osmolality Isotonic Hypotonic Solution Hypertonic Solution Anabolism Catabolism
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Total Body Water (TBW) Intracellular Fluid (ICF) Volume Extracellular Fluid (ECF) Volume Interstitial Fluid Volume Intravascular Fluid Volume Salt Electrolyte Solution Crystalloid Colloid Balanced Crystalloid
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Anion Gap Maintenance Replacement Resuscitation
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Normal Anatomy and Physiology
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Why women have less water than men if they are the same weight?The water content of adipose (fat)
tissue is less than that of muscle, while women have more adipose tissue at the effect of feminine hormone.
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Body fluids are distributed in two distinct area: intracellular fluid (ICF) 40% body weight Extracellular fluid (ECF) 20% body weight
Interstitial fluid -15% body weight
Plasma -5% body weight
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Fluid and Electrolyte Balance between Body and Environment
Intake of fluid and electrolytes X output
Insensible loss
KidneysGastrointestinal tractSkinLungs
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Intake
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Output
Lungs and Skin 0.5 – 1 l/day GI 100-150 ml/day Kidney
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Regulation of Fluid and Electrolyte Passive transport mechanism Active transport mechanism
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Passive transport mechanism
Simple Diffusion through Lipid Layer Simple Diffusion through Protein Layer Facilitated or Carrier Mediated
Diffusion
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Simple Diffusion through Lipid Layer
Water transport
Simple diffusion?
Intracellular fluid Interstitial fluid
Lipid
cell
Water
Water channel
bilayer
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Simple Diffusion through Protein Layer
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Facilitated or Carrier Mediated Diffusion
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Special Types of Passive Transport1. Bulk Flow
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2. Filtration
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3. Osmosis
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Active Transport
Primary Active Transport Secondary Active Transport
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Primary Active Transport
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Secondary Active Transport
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Hormonal Regulation of Fluid Balance Aldosterone Antidiuretic hormone Natriuretic peptide (NP)
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Aldosterone Hormone secreted from
the zona glomerulosa cells of adrenal cortex
Stimulates kidneysRetain sodiumRetain waterSecrete potassium
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Antidiuretic hormone Also called arginine vasopressin
(AVP). ADH is produced in neuron cell
bodies in supraoptic and paraventricular nuclei of the Hypothalamus, and stored in posterior pituitary.
Physiological functionPromote the reabsorption of
water in the collecting duct.
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The natriuretic peptide family Four peptides of this family have been identified, including:
Atrial natriuretic peptide (ANP)Brain natriuretic peptide (BNP)C-type natriuretic peptide (CNP)Urodilatin
Function:Diuretic and natriuretic actions
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Atrial Natriuretic Peptide: Function
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The sensation of thirst Conscious desire for water Major factor that determines fluid intake Initiated by the osmoreceptors in hypothalamus that
are stimulated by increase in osmotic pressure of body fluids
Also stimulated by a decrease in the blood pressue through the receptor of baroreceptor
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Osmoreceptors stimulate AVP secretion and thirst
These cells project to the paraventricular nuclei (PVN) and supraoptic nuclei (SON) to produce AVP secretion
The vascular organ of the lamina terminalis (OVLT) contains osmoreceptive neurons – also the subfornical organ (SFO) and the median preoptic n. (MnPO)
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The regulation of thirsty reaction The stimulus sensed by osmoreceptor:• Not a change in the extracellular fluid osmolality• But a change in osmoreceptor neuron size or in the some intracellular substance.
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Abnormalities in the Regulation of Body Fluid.
Extra Cellular Fluid Volume Deficit (ECFVD)
Extra Cellular Fluid Volume Excess Extra Cellular Fluid Volume Shift
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Extra Cellular Fluid Volume Deficit (ECFVD)
A decrease in intravascular and interstitial fluids.
It is a common and serious fluid imbalance that results in vascular fluid volume loss (hypovolemia).
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Risk Factors
Diabetic ketoacidosis Hemorrhage Difficulty to swallowing Aged Severe mentally ill patient
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Laboratory findings
Increased Osmolality Increased or normal serum sodium level BUN (> 25 mg/d1) Hyperglycaemia (> 120 mg / dl) Increased specific gravity of urine Elevated hematocrit (>55%), Increased
Specific gravity
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Management of Dehydration
Pharmacologic Management Dietary management Nursing Management Nursing Diagnoses and Collaborative
Problems Nursing Intervention
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Falls Precautions: Assess for orthostatic hypotension Assess muscle strength in legs Orient the patient to the environment Remind the patient to call for help before
getting out of bed or a chair Help the patient get out of bed or a chair Provide, or remind the patient to use, a walker
or cane for ambulating
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Help the incontinent patient toilet every 1 to 2 hours Clean up spills immediately Provide adequate lighting at all times, especially at night Keep the call light within reach, and ensure that the
patient can use it Place the bed in the lowest position with the brakes
locked Place objects that the patient needs within reach Ensure that adequate handrails are present in the
patient's room, bathroom, and hall Encourage family members or significant other to stay
with the patient
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Extra Cellular Fluid Volume Excess ECFVE is increased fluid retention in the
intravascular & interstitial spaces
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Extra Cellular Fluid Volume Shift
Fluid volume shift is basically a change in the location of extra cellular fluid between the intravascular and the interstitial spaces.
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Electrolyte Balance and Imbalance Sodium
HyponatremiaHypernatremia
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Hyponatremia
• Definition:– Commonly defined as a serum sodium
concentration <135 meq/L– Hyponatremia represents a relative excess
of water in relation to sodium.
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Hyponatremia is the most common electrolyte disorder
Acute hyponatremia (developing over 48 h or less) are subject to more severe degrees of cerebral edema
sodium level is less than 105 mEq/L, the mortality is over 50%
Chronic hyponatremia (developing over more than 48 h) experience milder degrees of cerebral edema
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Types
Hypovolemic hyponatremiaEuvolemic hyponatremiaHypervolemic hyponatremiaRedistributive hyponatremiaPseudohyponatremia
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Hypovolemic hyponatremia
Develops as sodium and free water are lost and/or replaced by inappropriately hypotonic fluids
Sodium can be lost through renal or non-renal routes
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Nonrenal lossGI losses
Vomiting, Diarrhea, fistulas, pancreatitisExcessive sweatingThird spacing of fluids
ascites, peritonitis, pancreatitis, and burns Cerebral salt-wasting syndrome
traumatic brain injury, aneurysmal subarachnoid hemorrhage, and intracranial surgery
Must distinguish from SIADH
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Renal LossAcute or chronic renal insufficiencyDiuretics
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Euvolemic hyponatremia
Normal sodium stores and a total body excess of free waterPsychogenic polydipsia, often in psychiatric
patients Administration of hypotonic intravenous (5% DW)
or irrigation fluids ( sorbitol, glycerin) in the immediate postoperative period
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administration of hypotonic maintenance intravenous fluids
Infants who may have been given inappropriate amounts of free water
bowel preparation before colonoscopy or colorectal surgery
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Hypervolemic hyponatremia
Total body sodium increases, and TBW increases to a greater extent.
Can be renal or non-renalacute or chronic renal failure
dysfunctional kidneys are unable to excrete the ingested sodium load
cirrhosis, congestive heart failure, or nephrotic syndrome
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Hypervolemic hyponatremia
Total body sodium increases, and TBW increases to a greater extent.
Can be renal or non-renalacute or chronic renal failure
dysfunctional kidneys are unable to excrete the ingested sodium load
cirrhosis, congestive heart failure, or nephrotic syndrome
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Redistributive hyponatremia
Water shifts from the intracellular to the extracellular compartment, with a resultant dilution of sodium. The TBW and total body sodium are unchanged. This condition occurs with hyperglycemiaAdministration of mannitol
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Hypernatremia
Hypernatremia is usually due to water deficit Excess water loss :eg- heat exposure diabetes insipidus Impaired thirst:eg-primary hypodypsia, comatose Excessive Na retension
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Clinical feature
Excessive thirst,polyuria,nausea Muscular weakness, neuromuscular
irritability Altered mental status,focal neurological
deficit occasionally coma or seizures
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Treatment correct water deficit water deficit = (plasma Na-140)/140*0.6*body wt in kg Rate of correction : -Acute hypernatremia- 1mEq/L/hr -Chronic hypernatremia-1mEq/L/hr or 10mEq/L over
24hr -rapid correction may lead to cerebral oedema
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Potassium
Hypokalemia Hyperkalemia
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Calcium
Hypocalcemia Hypercalcemia
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Phosphorus
Hypophosphatemia Hyperphosphatemia
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Magnesium
Hypomagnesemia Hypermagnesemia
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Bibliography Priscilla Lemone, Karen Burke. “Medical surgical nursing,
critical thinking in client care”. 4th edition (2008). Page no. 185-198
Ignatavicius Workman. “Medical surgical nursing, Patient centred collaborative care”. 6th edition (2010). Elsevier publication. Page no. 1022-1024
Brunner and Suddharth. “Text book of medical surgical nursing”. Page no. 249-255
Guyyton and Hall. “Text book of medical physiology”. 11th edition (2006). Elsevier publications. Page no. 642-650
Gerard.J.Tortora. “Principles of anatomy and physiology”. 11th edition (2006). Wiley publication. Page no. 1122-1130
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K. Sembulingam, Prema Sembulingam. “Essentials of medical physiology”. 5thedition (2010). Jaypee publications. Page no. 302-309
Journal of Sports medicine Volume 31, Issue 10, August 2001 ISSN: 0112-1642 (Print) 1179-2035 (Online)
Journal of Reproduction and Fertility. Supplement [1998, 53:1-14]
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THANK YOU…………