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5 water & electrolyte balance
- 1. Fluid & Electrolyte Balance Prof. Faisal Ghani Siddiqui MBBS; FCPS; PGD-BIOETHICS; MCPS-HPE
- 2. Preamble • Water imbalance • Electrolyte imbalance
- 4. 30 liters
- 5. of body weight constitutes water
- 6. Distribution of Body water Totalbodywater Intracellular water 20 liters Extracellular water 10 liters Plasma 2.5 liters Interstitial fluid 7.5 liters
- 7. Daily Input of Water Food (liquids and solids) 2700 ml Oxidation of ingested food 300 ml
- 8. Daily Output of Water Urine 1500 ml Skin 1000 ml Lungs 400 ml Feces 100 ml
- 10. Hormones Causing Regulation of Body Water • Antidiuretic hormone (ADH) • Aldosterone • Renin-angiotensin mechanism
- 11. Disturbances in Body Water • Hypovolemia • Hypervolemia
- 12. Hypovolemia -Causes • Decreased Water intake • Increased water loss • Gastrointestinal tract (vomiting, diarrhea) • Skin / lungs (fever) • Lungs (tracheostomy)
- 14. Treatment of Hypovolemia IV dextroseOral water
- 15. Hypervolemia -causes • Rapid / excess infusion of IV fluids • Cardiac or renal failure (fluid retention) • Transurethral resection of prostate (excess absorption of fluid from prostatic fossa) • ADH secreting tumor e.g. oat cell tumor of lung
- 16. Hypervolemia –clinical features • Nausea and vomiting • Large volumes of dilute urine • Pedal edema • Later, drowsiness, convulsions and coma
- 17. Hypervolemia -treatment • Restrict water intake / stop infusions • IV hypertonic saline
- 20. Hypernatremia -sodium excess in body (>150mmol/l)
- 21. Hypernatremia -causes • Excess saline administration in postoperative • Excess mineralocorticoids
- 22. Hypernatremia -symptoms • Puffiness of face • Pitting edema • Weight gain • Pulmonary edema (in neglected cases)
- 23. Hypernatremia -treatment • Water administration (orally or through Ryle’s tube) • 5% Dextrose water
- 24. Hyponatremia -sodium depletion in body (<135 mmol/l)
- 25. Hyponatremia -causes • Excessive vomiting • Ryle’s tube aspiration • Severe diarrhea • Intestinal fistula • Syndrome of inappropriate antidiuretic hormone secretion (SIADH) • Excess ADH
- 26. Hyponatremia -treatment • Treat underlying cause • IV infusion of isotonic saline / Ringer’s lactate
Editor's Notes
- An adult body contains approximately 30 liters of water. This is equivalent to six 5 litrres bottles of Nestle pure water!
- 30 liters of water constitutes 60 per cent of the adult human body
- Distribution of body water Intracellular water—20 liters (2/3) Extracellular water—10 liters (1/3). Plasma (2.5 liters) Interstitial fluid (7.5 liter)
- The daily input of water is derived from two sources Exogenous in form of liquid intake and ingested solid food. The solids consumed contribute to the half of water requirement. Endogenous is released from oxidation of ingested food.
- The daily output of water is by four routes; Urine—daily output of urine is about 1500 ml/day. Minimum 30 ml/hr urine is required to excrete the toxic metabolites from the body. Feces—about 100 ml/day water is lost through this route normally. Lungs—about 400 ml/day water is lost in expired air from the lungs. Skin—about one liter water is lost daily through skin as perspiration meant for thermoregulation. The loss occurring through skin and lungs is called insensible loss.
- The input and output of water are finally balanced in the body
- This regulation is mainly done by the hormones: • ADH (Antidiuretic hormone) -secreted in response to rise in plasma osmolality that causes increased reabsorption of water in the distal renal tubules. Aldosterone—produced by the zona glomerulosa of the adrenal cortex. • Renin-angiotensin mechanism—releases renin by the juxtraglomerular cells in response to decrease in renal plasma flow.
- Disturbances in Water Balance • Hypovolemia • Hypervolemia
- Hypovolemia It is due to diminished water intake (pure water depletion). Causes Decreased water intake—due to inability to swallow, e.g. painful ulcers in oral cavity, esophageal obstruction. Excess loss of water—loss from gut, e.g. vomiting, diarrhea, Insensible loss from skin and lungs, e.g. fever, Loss from lungs, e.g. after tracheostomy.
- Symptoms of Hypovolaemia
- Treatment If swallowing is possible, increase oral intake of water. If there is difficulty in swallowing or in case of severe hypovolemia, give intravenous 5% dextrose or dextrose saline.
- Causes Rapid and excess infusion of IV fluids Water retention enema Fluid retention due to cardiac or renal failure Excess absorption of fluid from prostatic fossa during transurethral resection of prostate ADH secreting tumor, e.g. oat cell tumor of lung
- Clinical features Nausea, vomiting, drowsiness, weakness, convulsions and coma Patient passes large amount of dilute urine. Although patient appears to be in shock, but on examination, pulse and blood pressure normal, neck veins distended, pedal edema.
- Treatment Restrict water intake Very slow intravenous infusion of hypertonic saline.
- Four important disorders are: • Hypernatremia Hyponatremia Hyperkalemia Hypokalemia
- It is the sodium excess in body (more than 150 mmol/l)
- Causes Mismanaged fluid administration (excess saline in postoperative period) Mineralocorticoid excess.
- Clinical features Puffiness of face, pitting edema, weight gain, distended jugular veins. Pulmonary edema may occur in neglected cases
- Treatment Water administration orally or through Ryle’s tube 5% dextrose IV
- It is the sodium depletion in body (less than 135 mmol/l).
- Causes Excess vomiting or Ryle’s tube aspiration causing loss of intestinal secretions. Intestinal fistula. Severe diarrhea. Postoperative hyponatremia—it is due to prolonged administration of sodium free solutions (5% dextrose) intravenously. Syndrome of inappropriate anti-diuretic hormone secretion (SIADH)—it is due to excess ADH secretion following surgery or trauma, more often seen in elderly patients. Excess ADH causes water retention and increase in ECF volume. This in turn leads to decreased aldosterone secretion and excess loss of sodium in urine. • Pseudohyponatremia—serum osmolality depends on various solutes like sodium, glucose, urea, plasma lipids and proteins. Out of these, sodium is most abundant and others have less concentration. However, when their concentration becomes very high, the relative concentration of sodium becomes less. So despite normal concentration, the serum sodium levels become less and it is termed as pseudohyponatremia.
- Treatment Treat underlying cause. IV infusion of isotonic saline or Ringer’s lactate.