fluid and elctrolyte balance1

7/25/2019 Fluid and Elctrolyte Balance1

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FLUID AND ELECTROLYTEBALANCES

Ms. K. Hema anandhy


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Water is found everywhere on earthincluding human body

In an adult 60% of the weight is water

Two third of the bodys water is found in thecell

INTRODUCTION


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Body fuids ar dis!ri"u!d i# !$odis!i#%! %o'ar!#!s(

1.Etracellular !uids"E#$ Which includesinterstitial !iud & intravascular !uid

'.Intracellular !uids"I#$

DISTRIBUTION OF BODYFLUIDS


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The !uids circulating throughout the body inetracellular and intracellular !uid s(acescontain

1.Electrolytes'.)inerals

*.#ells

COMPOSITION OF BODYFLUIDS


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+i,usion -smosis $iltration

ctive trans(ort

MO)EMENT OF BODYFLUIDS


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$luid inta/e $luid out(ut ormonal in!uence

ym(hatic in!uences 2eurologic in!uences 3enal in!uences

RE*ULATION OF BODYFLUIDS


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#hemical regulation 4iologic regulation 5hysiological regulation

1.ungs '.idneys

ACID+BASE BALANCE


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T- ./ !y's o0 fuid i"a1a#%s !-a!ay o%%ur ar(

Etracellular !uid imbalances7E8$8+9

Etracellular !uid volume ecess7E#$8E9 Etracellular !uid volume shift Intracellular !uid vloume ecess7I#$8E9 Intrcellular !uid volume de:cit7I#$8+9

FLIUD IMBALANCES


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n E#$8+; commonly called asdehydration ; is a decrease in intravascularand interstitial !uids

n E#$8+ can result in cellular !uid loss if itis sudden or severe

E2TRACELULLAR FLUID)OLUME DEFICIT


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y(erosmolar !uid volume de:cit< waterloss is greater than the electrolyte loss

Isosmolar !uid volume de:cit = e>ual(ro(ortion of !uid and electrolyte loss

y(otonic !uid volume de:cit = electrolyteloss is greater than !uid loss

THREE TYPES OF ECF)D


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?evere vomiting +ia(horesisTraumatic in@uriesThird s(ace !uid shifts

"(ercardial; (leural;(ertonial and @ointcavities

$ever Aatrointestinal suction Ileostomy $istulas 4urns

y(erventilation +ecresed +

secretions +iabetes insi(idus ddisons disease or

adrenal crisis +iuretic (hase of

acute renal failure Bse of diuretics

ETIOLO*Y AND RISKFACTORS


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+ecreased thirst res(onse +ecreased renal concentration of urine ltered + res(onse

Increased drug = drug interaction )ulti(le chronic diseases +ecreased access to !uids due to :nancial

or trans(ortation barriers

+ebilitation #hemical or (hysical restraint #hanges in mental status

ELDERLY ARE HI*H RISKOF ECF)D DUE TO


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In )ild E#$8+; 1to ' of water or '% of thebody weight is lost

In )oderate E#$8+; * to C of water loss orC%weight loss

I2 ?evere E#$8+ ; C to 10 of water loss orD% of weight loss

CLINICAL MANIFESTATION


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Thirst )uscle wea/ness +ry mucus

membranedrycrac/ed li(s orfurrowed tongue

Eyeballs soft andsun/en 7severe

de:cit9 ((rehension ;

restlessness;headache ;confusion; coma in

severe de:cit

5ostural systolic 45falls F'Cmm gand diastolic fall F'0 mm g ; with

(ulse increases F *0 2arrowed (ulse

(ressure; decreased#85&5#W5

$lattened nec/ veinsin su(ine (osition

Weight loss -liguria7G *0 ml(er

hour9

+ecreased numberand moisture instools



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Increased osmolality7F 'HC m-sm /g9 Increased or normal serum sodium level 7F

1JCmE> 9

Increase 4B2 7F'C mg 9 y(erglycemia 7 F1'0 mg dl 9 Elevated hematocrit 7F CC%9 Increased s(eci:c gravity 7 F 1.0*09

LABORATORY FINDIN*S


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Mild fuid volume loss can be corrected withoral fuid replacement


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dministration of hy(otonic I8 solution ;such as C% detrose in 0.' %saline

If the de:cit has eisted for more than 'Jhours;avoid ra(id correction of !uid "sodiumsolution to be infused at the rate of 0.C to0.1m E> hr

Ma#a3#! o0Hy'roso1ar fuid /o1u

d.%i!


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5ac/ed red cells followed by hy(otonic I8!uids is administered

In situations where the blood loss is less

than 1 normal saline or ringer lactatemay be used clients with severe E#$8+ accom(anied

by severe heart ; liver; or /idney disease

cannot tolerate large volumes of !uid andsodium

I0 -aorr-a3 is !-%aus 0or ECF)D


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E#$8E is increased !uid retention in theintravasular and interstitial s(aces

E2TRACELLULAR FLUID)OLUME E2CESS


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eart failure 3enal disorders #irrhosis of liver

Increased ingestion of high sodiumfoods

Ecessive amount of I8 !uids containingsodium

Electrolyte free I8 !uids ?I+;?e(sis decreased colloid osmotic (ressure lym(hatic and venous obstruction #ushings syndrome & glucocorticoids

FACTORS


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#onstant irritating cough +ys(nea & crac/les in lungs #yanosis; (leural ,fusion 2ec/ vein obstruction 4ounding (ulse &elevated 45 ?* gallo(

5itting & sacral edema Weight gain Increased #85& 5#W5 #hange in level of consiousness



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serum osmolality G'KCm-sm /g ow ; normal or high sodium +ecreased hematocrit " G JC%

?(eci:c gravity below 1.010 +ecreased 4B2 "G Dmg dl

LAB IN)ESTI*ATION


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+iuretics "combination of (otassium s(aringand (otassium de(leting diuretics

In (eo(le with #$; #E inhibitors and lowdose of beta bloc/ers are used

low sodium diet

MANA*EMENT

E2TRACELLULAR FLUID


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$luid that shifts into the interstitial s(acesand remain there is called as third s(ace!uid

#ommon sites are abdomen ; (leural cavity;(eritoneal cavity and (ericardial sac

E2TRACELLULAR FLUID)OLUME SHIFT( THIRD

SPACIN*


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#rushing in@uries; ma@or tissue trauma )a@or surgery Etensive burns cid =base imbalances and se(sis 5erforated (e(tic ulcers Intestinal obstruction ym(hatic obstruction

utoimmune disorders y(oalbunemia AI tract malabsor(tion

RISK FACTORS


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s/in (allor #old etremities Wea/ and ra(id (ulse y(otension -liguria

+ecreased levels of consiousness

4 I28E?TIATI-2

Elevated hematocrit & 4B2 level



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Treat the cause

1. $or burns and tissue in@uries largevolume of isosmolar I8 !uid is

administered'. lbumin is administered for (rotein

de:cit

*. I8 !uid inta/e is maintained after ma@or

surgery to maintain /idney (erfusionJ. 5ericardiocentesis if (ericarditis is the

result

C. 5aracentesis for ascitis

MANA*EMENT

INTRACELLULAR FLUID


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I#$8E is increase in amount of water insidethe cells

INTRACELLULAR FLUID)OULME E2CESS(WATER

INTO2ICATION


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dministration of ecessive amount ofhy(osmolar I8 !uids"0.JC%saline orC%detrose in water

#onsum(tion of ecessive amount of ta(

water without ade>uate nutritional inta/e ?I+ ?chiLo(hrenia"com(ulsive water

consum(tion

ETIOLO*Y


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eadaches 4ehavioral changes ((rehension Irritability; disorientation and confusion Increased I#5 = (u(illary changes and

decreased motor and sensory function 4radycardia; elevated 45; widened (ulse

(ressure & altered res(iratory (atterns;4abins/is res(onse !accidity; (ro@ectilevomiting; 5a(illedema; delirium;convulsions &coma

CLINICAL MANIFESTATIONS


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igh serum sodium level< 1'C mE> decreased hamatocrit

LABORATORY FINDIN*S


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Early administration of I8 !uids containingsodium chloride cam (revent ?I+

oral !uids such as @uices or soft drin/s canbe given orally every hour

5erform neurologic chec/s every hour tosee if cranial changes are (resent

)onitor !uid inta/e ; I8 !uids and !uidout(ut hourly and weight daily

dminister antiemetics for food and !uidretention

MANA*EMENT


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?evere hy(ernatremia and dehydration cancause I#$8+

3elatively rare in healthy adults common in elderly (eo(le and in those

conditions that result in acute water loss ?ym(toms include confusion; coma; and

cerebral hemorrhage

INTRACELLULAR FLUID)OLUME DEFICIT

Sodium Definiti Risk factors/ etiology Clinical Laboratory management


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imbalances on manifestation findings

Hyponatr

-aemia

It isdefined

as a

plasma

sodium

level

below

!"

m#$/ L

%idney diseases

&drenalinsufficiency

'astrointestinal

losses

(se of diuretics

)especially wit*

along wit* lowsodium diet+

,etabolic acidosis

eak rapid

pulse

Hypotension Di..iness &ppre*ension

and aniety &bdominal

cramps 0ausea and

vomiting

Diarr*ea Coma and

convulsion Cold clammy

skin 1inger print

impression on

t*e sternumafter palpation

2ersonality

c*ange

Serum

sodium less

t*an !"m#$/L

serum

osmolality

less t*an

345m6sm/kg

urine specificgravity less

t*an 755

Identify t*e

cause and treat

8&dministration of

sodium orally9 by

0' tube or

parenterally

81or patients w*o

are able to eat :

drink9 sodium iseasily accomplis*ed

t*roug* normal diet

81or t*ose unable

to eat9Ringer;s

lactate solution or

isotonic saline0acl?is given

81or very low

sodium 57!>0acl

may be indicated

8water restriction in

case of

*ypervolaemia


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Sodium

imbalan

-ce

Definit

ion

causes Clinical

manifestation

Lab findings management

Hypernat

-remia

It is

definedas

plasma

sodium

level

greater

t*an

@"m#

$/L

8Ingestion of

large amountof

concentrated

salts

8Iatrogenic

administration

of *ypertonic

saline IA

8#cess

alderosterone

secretion

Low grade

fever 2ostural

*ypertension

Dry tongue

: mucous

membrane

&gitation

Convulsions

Restlessness

#citability

6liguria or

anuria

B*irst

Dry

:flus*ed skin

8*ig* serum

sodium!"m#$/L

8*ig* serum

osmolality3="m

6 sm/kg

8*ig* urine

specificity 75!5

8&dministration of

*ypotonic sodium solution


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Definition Causes Clinical

manifestation

Lab findings ,anagement

Hyperkal

emia

It isdefined as

t*e

elevation

of

potassium

level

above

"75m#$/L

Renal failure 9

Hypertonic

de*ydration9

Gurns: trauma

Large amount of

IA administrationof potassium9

&drenal

insufficiency

(se of potassium

retaining diuretics

:

rapid infusion of

stored blood

Irregular slowpulse9

*ypotension9

aniety9

irritability9

parest*esia9

weakness

8Hig* serumpotassium

"7!m#$/L

results in

peaked B wave

HR F5 to 5

8serum

potassium ofEm#$/L results

in low broad 2-

wave

8serum

potassium

levels of

4m#$/L results

in no arterial

activity


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Calcium

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Definition Causes Clinical

if i



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imbalance manifestation

Hypercalc

emia

It is

calciumplasma

level over

"7" m#$/l

or mg/dl

Hypert*yro

idism9 ,etastatic

bone tumors9

paget;s

disease9

osteoporosis

9

prolonged

immobalisati

on

Decreased

muscle tone9

anoreia9

nausea9

vomiting9

weakness 9

let*argy9

low back

pain from

kidney

stones9

decreasedlevel of

consciousnes

s : cardiac

arrest

Hig* serum

calciumlevel

"7"m#$/L9

- ray

s*owing

generali.ed

osteoporosis9

widened

bone

cavitation9

urinary

stones9

elevated

G(0

3"mg/55ml

9

elevated

creatinine7"

mg/55ml

7IA normal saline9 given

rapidly wit* Lasipromotes urinary ecretion

of calcium

372licamycin an antitumor

antibiotics decrease t*e

plasma calcium level

!7Calcitonin decreases

serum calcium level

@7Corticosteroid drugs

compete wit* vitamin D

and decreases intestinal

absorption of calcium

"7 If cause is ecessive use

of calcium or vitamin D

supplements reduce or

avoid t*e same

&cid-Gase

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Definition Causes Clinicalmanifestation



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imbalance manifestation

Respiratory

acidosis

Hypoventilation

: ecessive

C63 production

It is a

clinical

disorder inw*ic* t*e

pH is less

t*an E7!"

and t*e

paC63 is

greater

t*an

@3mmHg

C62D9

neuromuscular

disorder9 'uillian-Garre syndrome9

,ysst*enia gravis9

Respiratory center

depression9 Drugs9

late &RDS9

Dyspnea 9disorientation9

coma

2H lesser t*an

E7!"9

2aco3 greatert*an @"mmHg9

Hyperkalemia9

Hypoemia

7Breat underlying

cause

37Support ventilation

!7Correct electrolyte

imbalance

@7Intravenous

0aHC6!

Respiratory

Alkalosis

Hyperventilation

It is a

clinical

condition

in w*ic*

t*e arterial

2* is

greater

t*anE7@"

and t*e

paC63 is

less t*an!4mmHg

Hypoemia9

impaired lung

epansion9

t*ickened alveolar

capillary

membrane9

C*emical

stimulation of

respiratory center9

traumatic

stimulation ofrespiratory center

Bac*ypnea9

giddiness9

di..iness9

syncope9

convulsions9

coma9

weakness9

parest*esia9

tetany

2H greater t*an

E7!"

2aC63 lesser

t*an !" mmHg9

Hypokalemia9

Hypocalcemia

Increase C63

retention

t*roug* C63

rebreat*ing :

sedation and

mec*anical

*ypoventilation

Definition causes Clinical

if t ti



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manifestation

,etabolic

&cidosis

It is a

clinicalcondition in

w*ic* t*e

HC6! : pH

is decreased

Renal failure9

Diabeticketoacidosis9

Lactic acidosis9

ingested toins9

renal tubular

acidosis

Hyperventilation

confusion9drowsiness9

coma9 *eadac*e

2H E7!"9

HC6!33m#$/L

7Breat t*e underlying

cause

37Intravenous

0aHC6!

!7correct electrolyte

imbalance

,etabolic

&lkalosis

It is a

clinical

condition in

w*ic* 2H israised

Hypokalemia9

gatric fluid loss9

massive

correction ofw*ole blood9

6vercorrection of

acidosis wit*

0aC6!

Hypoventilation

Dysryt*mias

2H E7@"

Hypokalemia

Hypocalcemia

2aC63 normalor increased

7Breat t*e underlying

cause

37&dminister %CL

!7intravenous

acidifying

salts


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CONCLUSION

hank you

fluid and elctrolyte balance1

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