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Fluids And Electrolytes
 

Fluids And Electrolytes

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    Fluids And Electrolytes Fluids And Electrolytes Presentation Transcript

    • 10/5/2009
      0
      FLUIDS AND ELECTROLYTES
      Dr. Tanuj Paul Bhatia
      MBBS,MS
    • Fluid compartments
      10/5/2009
      1
    • 10/5/2009
      2
    • Total body water varies with…
      Age
      Gender
      Body fat (Fat contains less water)
      10/5/2009
      3
    • 10/5/2009
      4
    • Intracellular fluid
      60% of body fluid
      Rich in :
      Potassium
      Magnesium
      proteins
      10/5/2009
      5
    • Extracellular fluid
      40 % of body fluid
      Rich in :
      Sodium
      Chloride
      Bicarbonate
      Interstitial fluid : between cells, low in protein
      Intravascular fluid(Plasma) : High in protein
      Transcellular fluids – CSF, intraocular fluids, serous membranes (third space)
      10/5/2009
      6
    • Spacing
      First space: normal
      Second Space: interstitial - edema;
      Third Space: in places not normally found
      10/5/2009
      7
    • Fluid compartments are separated by membranes that are freely permeable to water.
      Movement of fluids due to:
      Hydrostatic pressure
      Osmotic pressure
      Examples:
      Capillary filtration (hydrostatic) pressure
      Capillary colloid osmotic pressure
      Interstitial hydrostatic pressure
      Tissue colloid osmotic pressure
      10/5/2009
      8
    • 10/5/2009
      9
    • Fluid balance
      10/5/2009
      10
      Total for both is 2550ml
    • 10/5/2009
      11
    • Balance
      Fluid and electrolyte homeostasis is maintained in the body
      Neutral balance: input = output
      Positive balance: input > output
      Negative balance: input < output
      10/5/2009
      12
    • Regulators: organs & hormones
      Kidneys: regulates fluid volume, electrolytes, pH, waste; influenced by ADH & aldosterone
      Lungs: remove 500 cc fluid.
      Heart & blood vessels: regulate pressure.
      10/5/2009
      13
    • Aldosterone: REGULATES SODIUM and potassium balance. INCREASED ALDOSTERONE TO RETAIN SODIUM & excrete potassium in kidneys.
      ADH - CONTROLS WATER. ADH release causes kidney tubules to retain water
      10/5/2009
      14
    • Solutes – dissolved particles
      Electrolytes – charged particles
      Cations – positively charged ions
      Na+, K+ , Ca++, H+
      Anions – negatively charged ions
      Cl-, HCO3- , PO43-
      Non-electrolytes - Uncharged
      Proteins, urea, glucose, O2, CO2
      10/5/2009
      15
    • MW (Molecular Weight) = sum of the weights of atoms in a molecule
      mEq (milliequivalents) = MW (in mg)/ valence
      mOsm (milliosmoles) = number of particles in a solution
      10/5/2009
      16
    • Solutes determine the tonicity of a solution
      10/5/2009
      17
    • tonicity
      10/5/2009
      18
    • 10/5/2009
      19
    • 20
      Cell in a hypertonic solution
    • 21
      Cell in a hypotonic solution
    • 10/5/2009
      22
    • 23
      Movement of body fluids “ Where sodium goes, water follows.”
      Diffusion – movement of particles down a concentration gradient.Osmosis – diffusion of water across a selectively permeable membraneActive transport – movement of particles up a concentration gradient ; requires energy
    • Regulation of body water
      ADH – antidiuretic hormone + thirst
      Decreased amount of water in body
      Increased amount of Na+ in the body
      Increased blood osmolality
      Decreased circulating blood volume
      Stimulate osmoreceptors in hypothalamusADH released from posterior pituitaryIncreased thirst
      24
    • 25
      Result: increased water consumption increased water conservation
      Increased water in body, increased volume and decreased Na+ concentration
    • 26
    • Different components of renal function occur along thenephron.
      A normal glomerular filtration rate of 125 mL/minwould generate 180 L/day of filtrate containing 27,000 mmolofsodium.
      10/5/2009
      27
    • Approximately two thirds of the filtered sodium is absorbed in the PCT,
      20% in the LOH,
      7% in the DCT,
      and 3%in the CD;
      the net excretion of urinary sodium per day, as a fraction of the total sodium filtered load, is less than 1%.
      10/5/2009
      28
    • Disturbances of fluid and electrolyte balance
      10/5/2009
      29
    • Volume depletion
      Pure volume deficits – RARE
      Causes :
      1. Comatosed patients with increased insensible loss (e.g. fever)
      2. Diabetes insipdus
      Reflected biochemicalyby hypernatremia.
      10/5/2009
      30
    • Clinical features
      Due to depressed nervous system
      Lethargy
      Muscle rigidity
      Seizures
      Coma
      10/5/2009
      31
    • Treatment
      Replacement of adequate water by 5% Dextrose
      10/5/2009
      32
    • Volume and electrolyte depletion
      Due to extrarenal loss of body fluid
      Causes :
      Vomiting
      Diarrohoea
      Nasogastric suction
      Intestinal fistulae
      Intestinal obstruction
      Peritonitis
      10/5/2009
      33
    • Effects
      10/5/2009
      34
    • Effects
      10/5/2009
      35
    • Clinical features
      Sunken eyes
      Tongue – Dry and Coated
      Low urinary output
      Lab:
      Normal or Slightly reduced Serum Sodium
      Low urinary sodium
      10/5/2009
      36
    • Treatment
      Replacement of sodium deficit in addition to volume deficit by infusion of
      Isotonic saline, or
      Ringer’s lactate
      Depending on the severity of hyponatremia
      10/5/2009
      37
    • Volume overload
      Conservation of sodium and water following stress like surgery
      If fluid intake is excessive in immediate post op  fluid overload may occur.
      10/5/2009
      38
    • Tendency of fluid overload increases in patients with :
      Heart disease
      Liver disease
      Kidney disease
      10/5/2009
      39
    • Clinical features
      Peripheral edema
      Jugular venous distension
      Tachypnoea ( due to pulmonary edema)
      10/5/2009
      40
    • Treatment
      Mild overload:
      Restriction of sodium and water
      Severe overload :
      Diuretics
      10/5/2009
      41
    • Specific electrolyte disorders
      10/5/2009
      42
    • Hyponatremia
      Always associated with volume depletion
      Clinical features and treatment as discussed before
      10/5/2009
      43
    • Hypernatremia
      Serum Na levels > 150Mmol/l
      Causes:
      Renal dysfunction
      Cardiac failure
      Drug induced (NSAIDS, corticosteroids)
      10/5/2009
      44
    • Types of hypernatremia
      Euvolemic (pure water loss)
      Hypovolemic (more water lost than sodium)
      Hypervolemic (both gained but more sodium gained)
      10/5/2009
      45
    • Clinical features
      Pitting edema
      Puffiness of face
      Increased urination
      Dilated jugular veins
      Features of pulmonary edema
      10/5/2009
      46
    • Treatment
      Restriction of sodium and saline.
      Treatment of pulmonary edema.
      10/5/2009
      47
    • Hypokalemia
      Serum potassium levels <3.5 mEq/L
      Causes :
      Diarrhoea
      Villous tumor of rectum
      After trauma or surgery
      Gastric outlet obstruction
      Duodenal fistula
      10/5/2009
      48
    • Clinical features
      Slurred speech
      Muscular hypotonia
      Depressed reflexes
      Paralytic ileus
      Weakness of respiratory muscles
      Cardiac arrhythmias
      ECG shows prolonged QT interval , depessed ST segment and inversion of T waves
      10/5/2009
      49
    • Treatment
      Oral potassium 2g 6th hourly
      Intravenous KCl 40 mmol/litre given in 5% dextrose of normal saline, under ECG monitoring
      Max dose per hour = 20 mmol
      10/5/2009
      50
    • Hyperkalemia
      Normal range of K = 3.5-5 mEq/L
      Hyperkalemia >6 mEq/L
      Causes
      Renal failure
      Rapid infusion of potassium
      Massive blood transfusion
      Diabetic ketoacidosis
      Potassium sparing diuretics
      10/5/2009
      51
    • Dangerous condition, can cause sudden cardiac arrest.
      High serum potassium levels
      Peaked ‘T’ waves in ECG
      10/5/2009
      52
    • Treatment
      IV admin. Of 50 ml of 50% glucose with 10 units of soluble insulin, slowly.
      Hemodialysis if life threatening.
      Correction of acidosis.
      10/5/2009
      53
    • Hypermagnesimia
      It is rare
      Occurs because of renal failure or during treatment of pre eclampsia for which magnesium sulfate is given.
      10/5/2009
      54
    • Hypomagnesimia
      Causes :
      Malnutrition
      Large GI fluid loss
      Patients on Total Parenteral Nutrition
      10/5/2009
      55
    • Clinical features
      Hyperreflexia
      Muscle spasm
      Paraesthesia
      Tetany
      It mimics hypocalcemia
      Often associated with hypokalemia and hypocalcemia
      IV/Oral magnesium is needed.
      10/5/2009
      56
    • Hypocalcemia
      Causes
      Hypoparathyroidism
      Severe pancreatitis
      Severe trauma
      Crush injuries
      10/5/2009
      57
    • Clinical features
      Circumoralparasthesia
      Hyperactive DTRs
      Carpopedal spasm
      Adbdominal cramps
      Rarely, convulsions
      ECG shows prolonged Q-T interval
      10/5/2009
      58
    • Treatment
      Treatment of alkalosis, if present
      Intravenous calcium gluconate
      Vitamin D
      Oral calcium suplements
      10/5/2009
      59
    • Hypercalcemia
      Causes :
      Hyperparathyroidism
      Cancer with bony metastasis
      Sarcoidosis
      Prolonged immobilization
      10/5/2009
      60
    • Clinical features
      Fatigue
      Muscle weakness
      Depression
      Anorexia
      Constipation
      10/5/2009
      61
    • Treatment
      Expand ECF by IV normal saline
      Also increases urinary output and thus increasing calcium excretion.
      Hemodialysis in case of renal failure.
      10/5/2009
      62
    • THANK YOU
      10/5/2009
      63