Your SlideShare is downloading. ×
0
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Fluid & electrolytes
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Fluid & electrolytes

2,736

Published on

The underlined words are hyperlinks; please click on them to see the whole presentation. …

The underlined words are hyperlinks; please click on them to see the whole presentation.

Please tell me what you think about my slides, you can write to: mh_farjoo@yahoo.com

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,736
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
189
Comments
0
Likes
2
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Fluid & Electrolytes By M.H.Farjoo M.D. , Ph.D.Shahid Beheshti University of Medical Science
  • 2. Fluid & Electrolytes  Water  Principles of Electrolyte Therapy  Sodium  Hypernatremia  Hyponatremia  Potassium  Hyperkalemia  Hypokalemia  Calcium  Hypercalcemia  Hypocalcemia  Drug PicturesM.H.Farjoo
  • 3. Water  Total body water: 60% of body weight  Intracellular water: 40% of body weight  Extracellular water (interstitial water + plasma water): 20% of body weight  Interstitial water: 15 % of body weight  Plasma water: 5 % of body weight  Blood volume: 9 % of body weight (blood volume = plasma water + red blood cell volume)M.H.Farjoo
  • 4. Water (Cont’d)  Since water diffuses readily in all body, the osmolality (total solute concentration) in all body is the same: 290 mosm/kg water  In ECF sodium salts are main regulators of osmalality but in ICF potassium salts are major determinants.  Osmolality is controlled by:  Water intake  Water excretionM.H.Farjoo
  • 5. Cat drinking water
  • 6. Causes of Hypovolemia
  • 7. Principles of Electrolyte Therapy  Electrolytes are ionized molecules.  If concentration of electrolytes become too high (hyper-) or too low (hypo-), an electrolyte imbalance results.  Other anions:  Plasma proteins, organic acids, sulphates  Not routinely measured  Constitute the "anion gap"M.H.Farjoo
  • 8. Principles of Electrolyte Therapy (Cont’d)  Determine maintenance requirements  Calculate existing deficits of volume or composition:  The magnitude of volume deficits present.  The pathogenesis and treatment of sodium abnormality.  Assessment of potassium requirements.  Management of any coexisting acid-base imbalanceM.H.Farjoo
  • 9. Principles of Electrolyte Therapy (Cont’d)  For most problems, half of the calculated deficits should be replaced in a 24 hour period.  Reassess the patient clinical status after 24 hour and decide accordingly.  Fluid or electrolyte abnormality should take as long to correct as it took to develop.M.H.Farjoo
  • 10. Principles of Electrolyte Therapy (Cont’d)  It is difficult to recognize some electrolyte status merely according to serum values.  If a deficiency develops slowly, the organism can maintain the serum concentrations at the expense of the remaining stores.  Treatment of electrolyte disorders depends on the underlying cause of the problem.M.H.Farjoo
  • 11. Sodium  Normal sodium range: 135 - 145 meq/L  Is the major component of ECF  Sodium helps the kidneys to regulate the amount of water the body retains or excretes.  Generally, water and sodium disturbances occur simultaneously.  Sodium facilitates neuromuscular functioning.  Sodium levels indicate overall fluid balance.M.H.Farjoo
  • 12. Hypernatremia  Hypernatremia is defined as a plasma Na+ > 145 mmol/L.  Represents chiefly loss of water  Hypernatremia can be caused by inadequate water intake or excessive fluid loss.M.H.Farjoo
  • 13. Hypernatremia (Cont’d)  Severe hypernatremia has a mortality rate of 40-60%.  Death is due to cerebrovascular damage and hemorrhage resulting from dehydration and shrinkage of the brain cells.  The major symptoms of hypernatremia are neurologic.M.H.Farjoo
  • 14. Hypernatremia Manifestations  Thirst  Orthostatic hypotension  Dry mouth and mucous membranes  Dark, concentrated urine  Loss of elasticity in the skin  Irritability  Fatigue  Lethargy  Heavy, labored breathing  Muscle twitching and/or seizures  ComaM.H.Farjoo
  • 15. Approach toHypernatremia
  • 16. Hypernatremia Treatment  Rapid correction of hypernatremia is potentially dangerous.  A sudden decrease in osmolality causes a rapid shift of water into cells that have undergone osmotic adaptation.  This results in swollen brain cells and increases the risk of seizures or permanent neurologic damage.M.H.Farjoo
  • 17. Hypernatremia Treatment (Cont’d)  the water deficit should be corrected slowly over at least 48 to 72 h.  The quantity of water required to correct the deficit can be calculated from the following equation: plasma sodium concentrat ion 140water deficit total body water 140M.H.Farjoo
  • 18. Hyponatremia  A plasma Na+ concentration < 135 mmol/L.  It is one of the most common electrolyte disorders.M.H.Farjoo
  • 19. Causes ofHyponatremia
  • 20. hyponatremia
  • 21. Hyponatremia Manifestations  Nausea, abdominal cramping, and/or vomiting  Edema (swelling)  Muscle weakness and/or tremor  Paralysis  Headache  Disorientation  Slowed breathing  Seizures  ComaM.H.Farjoo
  • 22. Approach toHyponatremia
  • 23. Hyponatremia Treatment  IV fluids are used only when it is necessary and then using isotonic saline.  Only when severe hyponatremia produces mental obtundation and seizure, the patient should be treated with hypertonic solutions.  Rapid correction of hyponatremia can cause permanent brain damage due to osmotic demyelination syndrome.M.H.Farjoo
  • 24. Potassium  Potassium range is: 3.5-5.5 mEq/L  The serum Potassium concentration is determined by:  The pH of ECF  The size of intracellular Potassium pool  Any potassium excess or deficit should be assessed in the light of blood pH.M.H.Farjoo
  • 25. Potassium (Cont’d)  98% of total body potassium is located intracellularly  Plasma potassium levels may not reflect total body potassium levels!M.H.Farjoo
  • 26. Hyperkalemia  Hyperkalemia, defined as a plasma K+ concentration > 5.0 mmol/L.  Chronic hyperkalemia is virtually always associated with decreased renal K+ excretion  Hyperkalemia may be caused by any cellular damage.M.H.Farjoo
  • 27. Causes ofHyperkalemia
  • 28. Hyperkalemia (Cont’d)  ECG changes are the most helpful indicators of the severity of the problem:  In mild cases: peaking of the T wave, ST segment depression and widening of the QRS complex  In severe fatal cases (K concentration > 7.5 mmol/L): QRS widening is so severe that resembles sine wave which means: imminent cardiac arrestM.H.Farjoo
  • 29. Hyperkalemia Manifestations  Weakness  Nausea and vomiting  Colicky abdominal pain  Irregular heartbeat (arrhythmia)  Diarrhea  Muscle painM.H.Farjoo
  • 30. Approach to HyperkalemiaRTA: renal tubularacidosisTTKG: transtubular Kconcentration gradient.
  • 31. Hyperkalemia Treatment  IV injection of 100 ml of 50% dextrose solution containing 20 units of regular insulin  IV injection of NaHCO3 (if pH imbalance present)  Infusion of calcium gluconate to antagonize cardiac depressant effects of potassium without changing its serum concentration.  Administration (orally or enema) of “Kayexalate”  HemodialysisM.H.Farjoo
  • 32. Hypokalemia  Hypokalemia, defined as a plasma K+ concentration < 3.5 mmol/L  In the absence of alkalosis renal wasting is usually the cause:  Urine potassium excretion of >30 meq/24 h and serum potassium <3.5 meq/L means renal wasting.  If urine potassium excretion is <30 meq/24 h the kidneys or working properly and total body potassium is low.M.H.Farjoo
  • 33. Causes ofHypokalemia
  • 34. Hypokalemia Manifestations  Weakness (decreased muscle contractility)  Paralysis (in muscles of respiration can cause death)  Increased urination  Irregular heartbeat (arrhythmia)  Orthostatic hypotension  Muscle pain  TetanyM.H.Farjoo
  • 35. Approach to HypokalemiaTTKG: transtubularK concentrationgradientRTA: renal tubularacidosis.
  • 36. Hypokalemia Treatment  Alkalosis (if present) should be corrected.  If the patient can eat, potassium should be given orally otherwise intravenously.  In iv fluids potassium is usually given as chloride salts which helps to correct alkalosis (if present)M.H.Farjoo
  • 37. Calcium  Calcium range is: 8.8-10.4 mg/dl  Almost half of the serum calcium is bound to plasma proteins (albumin), 10% is complexed to plasma anions and 40% is free or ionized.  The ionized fraction is responsible for the biologic effects.  Acidosis increases and alkalosis decreases ionized calcium concentrationM.H.Farjoo
  • 38. Hypercalcemia Manifestations  Fatigue  Constipation  Anorexia & depression  Muscle pain  Nausea and vomiting  Polyuria (in long standing cases)  Irregular heartbeat (arrhythmia)  Coma & death (in severe cases)M.H.Farjoo
  • 39. Causes ofHypercalcemia
  • 40. Hypercalcemia Treatment  Mild hypercalcemia (< 12 mg/dl) can be managed by hydration.  Serum ca2+ concentrations > 12 mg/dl is a medical emergency!!  In severe cases (ca2+ > 14.5 mg/dl) IV isotonic saline is given to expand plasma valium and renal excretion of calcium.  Furosemide and iv sodium sulfate can also increase renal excretion of calcium.  In case of renal failure hemodialysis may be required.M.H.Farjoo
  • 41. Approach to HypercalcemiaFHH, familial hypocalciuric hypercalcemia; MEN, multiple endocrine neoplasia;PTH, parathyroid hormone; PTHrP, parathyroid hormone related peptide.
  • 42. Hypocalcemia Manifestations  Increase in DTR (deep tendon reflex)  Carpopedal spasm  Muscle & abdominal cramps  Tetany and/or convulsions  Mood changes (depression, irritability)  Dry skin & brittle nails  Prolonged QT interval  Facial twitching (chvostek sign)M.H.Farjoo
  • 43. Causes ofHypocalcemia
  • 44. Hypocalcemia Treatment  Check the whole blood pH and correct any alkalosis  For mild chronic cases: oral calcium, vitamin D, and aluminum hydroxide gels to bind dietary phosphate.  For severe cases: intravenous calcium gluconate.M.H.Farjoo
  • 45. dextrose 20%
  • 46. dextrose normal saline
  • 47. KCl tab
  • 48. NaCl serum 0.9% for irrigation
  • 49. NaCl serum 0.9% in 1000 CC normal saline
  • 50. NaCl serum 0.9% normal saline
  • 51. NaCl serum 0.45% in 1000 CC
  • 52. NaCl serum 0.45%
  • 53. ringer 500 ml
  • 54. ringer 1000 ml
  • 55. Summary In English
  • 56. Thank you Any question?

×