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Water & elcectrolytes

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Water & elcectrolytes

  1. 1. Water & Electrolyte imbalance<br />Dr. Ranjeet Patil<br />
  2. 2. Total Body Water<br />50 to 60% of total body weight<br />80% of total body weight- New-borns<br />Muscle and solid organs have higher water content than fat and bone<br />
  3. 3. Fluid Compartments<br />
  4. 4. Composition of Fluid Compartments<br />Plasma<br />Interstitial fluid<br />Intracellular fluid<br />
  5. 5. Classification of Body Fluid Changes<br />Volume<br />Concentration<br />Composition<br />
  6. 6. Normal Exchange of Fluid and Electrolytes<br />
  7. 7. Signs and Symptoms of Volume Disturbances<br />
  8. 8.
  9. 9. Colloids<br />
  10. 10. Composition of GI Secretions<br />
  11. 11. Daily ReQuirement<br />Sodium: 50–90mMday–1;<br />Potassium: 50mMday–1;<br />Calcium: 5mMday–1;<br />Magnesium: 1mMday<br />
  12. 12. Hyponatremia<br />
  13. 13. Clinical Manifestations<br />
  14. 14. Treatment<br />Mild-Free water restriction<br />Moderate- Administration of sodium- 0.9% NaCl<br />Severe- 3% normal saline- used to increase the sodium by no >1 meq/L per hour until the level reaches 130 meq/L<br />Complications- Pontine Myelinolysis, Seizures, Weakness, Paresis, Akinetic Movements, Unresponsiveness, Permanent Brain Damage and Death<br />
  15. 15. Hypernatremia<br />
  16. 16. Clinical Manifestations<br />
  17. 17. Treatment<br />Treatment of the associated water deficit- 5% D<br />Rate of fluid administration-achieve a decrease in serum sodium concentration of no more than 1 mEq/h <br />Complications- Cerebral Edema and Herniation<br />
  18. 18. Hyperkalemia<br />Hyperkalemiais defined as a serum potassium concentration above the normal range of 3.5 to 5.0 mEq/L<br />
  19. 19. Clinical Manifestations<br />
  20. 20. Treatment<br />Potassium removal <br />Kayexalate<br /> Oral administration is 15–30 g in 50–100 mL of 20% sorbitol <br /> Rectal administration is 50 g in 200 mL of 20% sorbitol <br /> Dialysis <br />Shift potassium <br /> Glucose 1 ampule of D50 and regular insulin 5–10 units IV<br /> Bicarbonate 1 ampule IV <br />Counteract cardiac effects <br /> Calcium gluconate 5–10 mL of 10% solution <br />
  21. 21. Hypokalemia<br />Inadequate intake <br /> Dietary, potassium-free intravenous fluids, potassium-deficient TPN <br />Excessive potassium excretion <br />Hyperaldosteronism<br /> Medications <br />GI losses <br /> Direct loss of potassium from GI fluid (diarrhea) <br /> Renal loss of potassium (gastric fluid, either as vomiting or high nasogastric output) <br />
  22. 22. Clinical Manifestations<br />
  23. 23. treatment<br />Serum potassium level <4.0 mEq/L: <br /> Asymptomatic, tolerating enteral nutrition: KCl 40 mEq per enteral access x 1 dose <br /> Asymptomatic, not tolerating enteral nutrition: KCl 20 mEq IV q2h x 2 doses <br /> Symptomatic: KCl 20 mEq IV q1h x 4 doses <br /> Recheck potassium level 2 h after end of infusion; if <3.5 mEq/L and asymptomatic, replace as per above protocol <br />
  24. 24. Magnesium& Calcium<br />
  25. 25. Magnesium <br />Magnesium level 1.0–1.8 mEq/L: Magnesium sulfate 0.5 mEq/kg in normal saline 250 mL infused IV over 24 h x 3 d <br />Recheck magnesium level in 3 d <br />Magnesium level <1.0 mEq/L: Magnesium sulfate 1 mEq/kg in normal saline 250 mL infused IV over 24 h x 1 d, then 0.5 mEq/kg in normal saline 250 mL infused IV over 24 h x 2 d<br />If patient has gastric access and needs a bowel regimen: <br /> Milk of magnesia 15 mL q24h per gastric tube; hold for diarrhea<br />Hypermagnesemia-Calcium chloride (5 to 10 mL) should be administered to immediately antagonize the cardiovascular effects. If elevated levels or symptoms persist, hemodialysis<br />
  26. 26. Calcium<br />Normalized calcium level <4.0 mg/dL: <br />With gastric access and tolerating enteral nutrition: Calcium carbonate suspension 1250 mg/5 mL q6h per gastric access; recheck ionized calcium level in 3 d <br />Without gastric access or not tolerating enteral nutrition: <br />Calcium gluconate 2 g IV over 1 h x 1 dose; recheck ionized calcium level in 3 d <br />Hypercalcemia- serum level exceeds 12 mg/dL<br />Repletingthe associated volume deficit<br /> Inducing a brisk diuresis with normal saline<br />
  27. 27. Thank you<br />

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