Body fluids and electrolytes
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in this presentation info about physiology of fluid and electrolytes of the body with its disorder and its managment
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Body fluids and electrolytes
- 1. Body Fluids and Electrolytes
- 2. Body Fluids ∗ Total amount of fluid in the human body is approximately 60% of body weight ∗ Body fluid has been divided into two compartments – ∗ Intracellular fluid (ICF) ∗ Inside the cells ∗ 60% of total body water ∗ Extracellular fluid ∗ Outside the cells ∗ 40% of total body water
- 3. PERCENTAGE OF H2O IN TISSUES
- 4. Average 70 kg person Total body weight 42 L total H2O 60% 28 L Intracellular fluid (ICF) 40% 14 L Extracellular fluid (ECF) 20% ( ¾ ISF and ¼ plasma water ) • 10.5 L Interstitial fluid (ISF) 15% • 3.5 L Plasma water 5%
- 5. Body Fluid Compartments Extracellular fluid includes ∗ Interstitial fluid ∗ Present between the cells ∗ Approximately 75% of ECF ∗ Plasma ∗ Present in blood ∗ Approximately 25% of ECF ∗ Also includes ∗ Lymph ∗ synovial fluid ∗ aqueous humor ∗ cerebrospinal fluid * vitreous body * endolymph * perilymph * pleural, pericardial and peritoneal fluids
- 7. ∗ Plasma membrane ∗ Separates ICF from surrounding interstitial fluid ∗ Blood vessel wall ∗ Separate interstitial fluid from plasma Barriers separate ICF, interstitial fluid and plasma
- 8. Composition of body fluids ∗ Organic substances ∗ Glucose ∗ Amino acids ∗ Fatty acids ∗ Hormones ∗ Enzymes * Inorganic substances * Sodium * Potassium * Calcium * Magnesium * Chloride * Phsophate * Sulphate
- 9. Difference ECF ∗Most abundant cation - Na+, ∗ muscle contraction ∗ Impulse transmission ∗ fluid and electrolyte balance ∗Most abundant anion - Cl- ∗ Regulates osmotic pressure ∗ Forms HCl in gastric acid ICF ∗Most abundant cation - K+ ∗ Resting membrane potential ∗ Action potentials ∗ Maintains intracellular volume ∗ Regulation of pH ∗ Anion are proteins and phosphates (HPO4 2- ) Na+ /K+ pumps play major role in keeping K+ high inside cells and Na+ high outside cell
- 10. Sodium Na+ ∗ Most abundant ion in ECF ∗ 90% of extracellular cations ∗ Plays pivotal role in fluid and electrolyte balance as it accounts for half of the osmolarity of ECF
- 11. Chloride Cl- ∗ Most prevalent anion in ECF ∗ Moves easily between ECF and ICF because most plasma membranes contain Cl- leakage channels and transporters ∗ Can help balance levels of anions in different fluids
- 12. Bicarbonate HCO3 - ∗ Second most prevalent extracellular anion ∗ Concentration increases in blood passing through systemic capillaries picking up carbon dioxide ∗ Chloride shift helps maintain correct balance of anions in ECF and ICF
- 13. Potassium K+ ∗ Most abundant cation in ICF ∗ Establish resting membrane potential in neurons and muscle fibers ∗ Maintains normal ICF fluid volume ∗ Helps regulate pH of body fluids when exchanged for H+
- 14. Magnesium ∗ Mg2+ in ICF (45%) or ECF (1%) ∗ Second most common intracellular cation ∗ Cofactor for certain enzymes and sodium-potassium pump ∗ Essential for synaptic transmission, normal neuromuscular activity and myocardial function
- 15. Normal serum osmolality = 280 – 295 mOsm/kg Serum Osmolality
- 17. ∗ Na+ level > 145 mEq/L Causes “THE MODEL” ∗ M MEDICATIONS (hypertonic saline, TPN), MEALS (excess intake of Na+ ) ∗ O Osmotic Diuresis (e.g. Mannitol) ∗ D Diabetes Insipidus ∗ E Excessive H2O Loss (vomiting, diarrhea, diuresis, sweating) ∗ L Low H2O intake Hypernatremia
- 18. Sign and Symptoms “FRIED” ∗ F Fever (low grade), Flushed Skin ∗ R Restless (Irritable, Confusion, Seizures), Respiratory Paralysis ∗ I increased fluid retention and Blood Pressure ∗ E Edema ∗ D Decrease urine output, Dry mouth Hypernatremia
- 19. Medical management ∗Diuretic Therapy ∗Hydration therapy D5W followed by ¼ or ½ N.S ∗Check underlying cause Note Avoid rapid correction to avoid Brain Edema Hypernatremia
- 20. ∗ Establish documented onset (acute, < 24 h; chronic, >24h) ∗ In acute hypernatremia, correct the serum sodium at an initial rate of 2-3 mEq/L/h (for 2-3 h) (maximum total, 12 mEq/L/d). ∗ Measure serum and urine electrolytes every 1-2 hours ∗ Perform serial neurologic examinations and decrease the rate of correction with improvement in symptoms ∗ Chronic hypernatremia with no or mild symptoms should be corrected at a rate not to exceed 0.5 mEq/L/h and a total of 8-10 mEq/d (eg, 160 mEq/L to 152 mEq/L in 24 h). ∗ If a volume deficit and hypernatremia are present, intravascular volume should be restored with isotonic sodium chloride prior to free-water administration Treatment recommendations for symptomatic hypernatremia
- 21. Causes ∗Hypovolemic excess diuretics, Hypoaldosteronism, vomiting, NG suction, Burns, Pancreatitis, Sweating. ∗Euvolemic SIADH, CNS abnormalities ∗Hypervolemic Renal failure, CHF, Liver failure, Iatrogenic (dilutional) Hyponatremia
- 22. Hyponatremia
- 23. Clinical Manifestations ∗Symptomatic BUT less impaired Headache, Irritability, Nausea, Vomiting, Mental slowing, Unstable Gait, Confusion, Disorientation Usually seen in Chronic cases ∗Life Threatening Coma, Convulsions, Respiratory arrest and death from cerebral edema and brain herniation Seen in Acute cases Hyponatremia
- 24. 1. maximum correction for chronic Hyponatremia: ≤12 mmol/L in the first 24 h ≤18 mmol/L in the first 48 h 2. even lower (≤8 mmol/L in any 24h period) if any of the following are present: • serum Na ≤105 mEq/L • hypokalemia • alcoholism and/or malnutrition • liver disease 3. maximum correction for acute hyponatremia: not ascertained, but much lower risk Treatment Guidelines of Hyponatremia
- 25. Short term ∗isotonic saline infusion ∗hypertonic saline infusion ∗vaptan (conivaptan, tolvaptan) Treatment Guidelines of Hyponatremia Long term ∗fluid restriction ∗demeclocycline ∗furosemide + NaCl ∗mineralocorticoids ∗urea ∗vaptan (tolvaptan) Note vaptans (conivaptan, tolvaptan) are vasopressin receptor antagonist
- 26. ∗ choose desired correction rate of plasma [Na+ ] (e.g., 1.0 mEq/L/h) ∗ obtain or estimate patient’s weight (e.g., 70 kg) ∗ multiply weight X desired correction rate and infuse as ml/h of 3% NaCl (e.g., 70 kg X 1.0 mEq/L/h = 70 ml/h infusion) Hypertonic Saline Correction
- 27. ∗ Tremor ∗ Incontinence ∗ Hyperreflexia, pathological reflexes ∗ Quadriparesis, quadriplegia ∗ Dysarthria, dysphagia ∗ Cranial nerve palsies ∗ Mutism, locked-in syndrome Cerebral Pontine Myelinolysis
- 28. ∗ Normal K+ = 3.5 – 5.3 mEq/L Causes ∗ Iatrogenic overdose ∗ Blood transfusion ∗ Renal failure ∗ Diuretics ∗ Acidosis ∗ Tissue injury (e.g. Burn) ∗ hemolysis Hyperkalemia
- 29. Signs and symptoms ∗Weakness ∗Parasthesia ∗Decreased deep tendon reflexes ∗Areflexia ∗Paralysis ∗Respiratory failure Hyperkalemia ECG Changes ∗Peaked T waves ∗Depressed ST segment ∗Prolonged PR interval ∗Wide QRS ∗Bradycardia ∗Ventricular fibrillation
- 30. ∗ IV calcium (cardioprotective) ∗ IV NaHCO3 ∗ Glucose and Insulin ∗ Albuterol ∗ Sodium polystyrene sulfonate (kayexalate) ∗ Furosamide ∗ Dialysis Treatment of Hyperkalemia
- 31. Causes ∗Insufficient supplementation ∗Vomiting ∗Diarrhea ∗Intestinal fistula ∗Insulin ∗Hyperaldosteronism (Conn’s) of Steroids (Cushing’s) ∗Alkalosis ∗Amphotericin ∗Certain antibiotics Hypokalemia
- 32. Manifestations ∗Weakness, Tetany ∗Nausea and vomiting ∗Ileus ∗Parasthesia Hypokalemia ECG Findings: ∗Flat T wave ∗U wave ∗ST depression ∗PAC, PVC ∗AF
- 33. Hypokalemia Treatment Comments Mild (3-3.4 mmol/l) Oral Replacement • Monitor Daily K+ level • Consider I.V if not tolerated Moderate (2.5-2.9 mmol/l) Asymptomatic Oral Replacement • Monitor Daily K+ level • Consider I.V if not tolerated Severe (<2.5 mmol/l) Symptomatic • I.V Replacement • 40mEq in 1L 0.9N.S BID or TID • Standard infusion rate 10mmol/hr • Maximum infusion rate 20mmol/hr • Check Mg2+ level If hypomagnesaemic: initially give 4ml MgSO4 50% (8mmol) diluted to 10ml with NaCl 0.9% over 20min • monitor K+ level after each 40mmol Hypokalemia Treatment Guidelines
- 34. ∗ Calcium concentration, both total and free, is characterized by a high physiological variation, depending on age, sex, physiological state (eg, pregnancy), and even season (owing to the seasonal variation of vitamin D) ∗ Normal Adult Calcium = 8.9 -10.1 mg/dl Corrected Ca = [0.8 x (normal albumin - patient's albumin)] + serum Ca level Note: The normal albumin level is defaulted to 4 mg/dL Standard Units or 40 g/L if using SI Units Calcium
- 35. Causes ∗Excessive Ca2+ supplementation ∗Hyperparathyroidism (1 and 3) ∗Immobility ∗Milk alkali syndrome ∗Bone Paget’s disease ∗Neoplasms, Paraneoplastic ∗Metastasis ∗Excessive Vitamin D or A ∗Sarcoid ∗Thiazides Hypercalcemia
- 36. Manifestations ∗Renal Stones ∗Bone Pain ∗Abdominal groans ∗Psychiatric symptoms ∗Polyuria ∗Polydipsia ∗Constipation Hypercalcemia ECG Changes ∗Short QT interval ∗Prolonged PR interval
- 37. Treatment ∗Volume expansion with N.S ∗Furosamide Others ∗Steroids ∗Calcitonin ∗Bisphosphonate ∗Dialysis Hypercalcemia
- 39. Causes ∗Acute Pancreatitis ∗Vit. D deficiency ∗Sepsis ∗Osteoplastic metastasis ∗Diuretics ∗Renal failure ∗Short bowel syndrome, intestinal fistula ∗Hypomagnesaemia Hypocalcaemia
- 40. Manifestations ∗Perioral numbness ∗Confusion, seizures ∗Abdominal cramps ∗Stridor, laryngospasm ∗Tetany ∗Depression, hallucinations ∗Chvostek’s, Trousseau’s signs Hypocalcaemia ECG Findings ∗Prolonged QT, ST segment ∗Peaked T wave
- 41. ∗ Calcium Gluconate ∗ Calcium PO ∗ Vitamin D Hypocalcaemia Treatment
- 42. THE END