A brief overview of disorders related to Fluid and electrolyte imbalance in body

1. Fluid and Electrolyte Imbalance
and associated disorders
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2. Fluids
• Fluid is a major component of our body. 60% of body weight is water(40% ICF and
20% ECF). It serves a vital role in our health by :
 Aiding in Normal Cellular Function
 By Serving as a medium for metabolic reactions with in the cell.
 Acting as a transporter and helping in excretion of waste products
 Acting as a Lubricant
 Acting as an Insulator
 Acting as a Shock Absorber
 BODY FLUID COMPARTMENTS
• Intracellular fluid (ICF)- located within the cell ; provides the cell within the
internal aqueous medium necessary for its chemical functions
• Extracellular fluid (ECF)-Constitutes interstitial fluid, intravascular fluid,
cerebrospinal fluid , intraocular fluid, synovial fluid , lymphatic fluid and secretions
of gastrointestinal tract.
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5. Management
• Mild to moderate Dehydration- Oral Fluid
Replacement –Oral and Oral Rehydration
Solution (ORS)
• For Severe Dehydration –IV Fluid and
Electrolyte Replacement
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6. Hypervolemia
 Causes
• Excessive sodium and/or fluid intake:
– IV therapy containing sodium
– As a Transfusion reaction to a rapid blood transfusion
– High intake of sodium
• Sodium and water retention:
– Heart failure
– Liver cirrhosis
– Nephrotic syndrome
– Corticosteroid therapy
– Hyperaldosteronism
– Low protein intake
• Fluid shift into the intravascular space:
– Fluid remobilization after burn treatment
– Administration of hypertonic fluids e.g. mannitolor hypertonic saline solution
– Administration of plasma proteins, such as albumin
 Treatment-
• Fluid Restriction and Diuretics and treating the underlying cause
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7. SIGNS AND SYMPTOMS OF HYPERVOLEMIA
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8.  Edema = the buildup of fluid in the body's
tissue
 Causes
• Venous insufficiency, heart failure, kidney
problems, low protein levels, liver problems,
deep vein thrombosis, infections,
angioedema, certain medications, and
lymphedema.It may also occur due to
prolonged sitting or standing and during
menstruation or pregnancy.
 Types
• Pitting- when, after pressure is applied to a
small area, the indentation persists after the
release of the pressure. Peripheral pitting
edema, resulting from water retention. It can
be caused by systemic diseases, pregnancy ,
either directly or as a result of heart failure,
or local conditions such as varicose veins,
thrombophlebitis, insect bites, and
dermatitis.
• Non-pitting edema is observed when the
indentation does not persist. It is associated
with such conditions as lymphedema,
lipedema, and myxedema.
 Treatment depends on the underlying cause.
• If the underlying mechanism involves
sodium retention, decreased salt intake and
a diuretic
• Elevating the legs and support stockings
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9.  Third Spacing
• Occurs when too much fluid moves
from the intravascular space (blood
vessels) into the interstitial or "third"
space-the nonfunctional area
between cells.
 Causes
• Increased fluid volume -caused by
overzealous fluid replacement or
renal dysfunction
• Increased capillary hydrostatic
pressure often accompanies heart
failure
• Hyponatremia and or Hypoalbunemia
disrupting colloidal osmotic pressure
• Increased capillary permeability
results from burns and other forms of
tissue trauma.
• Lymphatic system obstruction
 Phases of third-spacing
1. Loss phase, increased capillary
permeability leads to a loss of proteins
and fluids from the intravascular space
to the interstitial space.
• This phase lasts 24 to 72 hours after the
initial insult that led to the increased
capillary permeability. Signs and
symptoms include weight gain, decreased
urinary output, and signs of hypovolemia,
such as tachycardia and hypotension.
2) Reabsorption phase, tissues begin to
heal and fluid is transported back into
the intravascular space.
• Signs of hypovolemia resolve, urine
output increases, the patient's weight
stabilizes, and signs of shock (if any) begin
to reverse. If the patient was given fluid
resuscitation during the loss phase,
monitor for fluid overload as interstitial
fluid shifts back to the intravascular space.
 Treatment
• To stabilize the patient's volume status,
administer crystalloids, colloids, or a
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10. ELECTROLYTES
Normal Blood Electrolyte Range
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11. Sodium
• Extracellular ion.
• Sodium regulates water movement (osmosis) across the cell membrane as water moves
from places with lower sodium concentration to places with higher sodium concentration.
HYPERNATREMIA
• Serum sodium levels above 145 mEq/L
 Causes
• 3 types of hypernatremia
1) Dehydration along with low total body sodium commonly caused by
heatstroke, burns, extreme sweating, vomiting, and diarrhea.
2) low total body water with normal body sodium caused by diabetes insipidus,
renal disease, hypothalamic dysfunction, sickle cell disease and certain drugs
3) Increased total body sodium which is caused by increased ingestion, Conn's
syndrome, or Cushing's syndrome.
 Symptoms
• Dehydration, nausea, vomiting, fatigue, weakness, increased thirst, excess
urination. Some patients may have no obvious symptoms at all
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12. Treatment of Hypernatremia
If Shock Present treat with IV saline
infusion
Once Patient is stable –identify cause of
hypernatremia
Calculate the patient’s free water deficit, and
replace it at a steady rate using a
combination of oral or IV fluids. Lowering the
sodium level too quickly can cause cerebral
edema.
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13. Hyponatremia
 Blood Sodium concentration lower than 135 mEq/L
• Causes
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15. Treatment of Hyponatremia
If a person has Treatement
Sodium level is <120 mEq/L hypertonic saline
Low total body water and low sodium fluids
High total body water (such as due
to heart failure or kidney disease)
fluid restriction, salt restriction
and diuretic
Normal volume of total body water- fluids
In non-emergent situations, it is important to correct the sodium slowly to minimize risk
of osmotic demyelination syndrome.
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16. Potassium
• Intracellular
HYPERKALEMIA-concentration of serum potassium >5 mEq/L
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18. Treatment of Hyperkalemia
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19. HYPOKALEMIA
Serum concentration of
potassium <3.5 mEq/L
Treatment
Replacing the body's potassium-either orally or
intravenously.
Because low potassium is usually accompanied
by low magnesium, patients are often given
magnesium alongside potassium
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20. Calcium
• Most plentiful electrolyte in the
body,
• Used to form the bones
• Mainly absorbed and excreted
through the GI system.
• Majority of calcium resides
extracellularly, and it is crucial for
the function of neurons, muscle
cells, function of enzymes,
and coagulation.
• The parathyroid gland is
responsible for sensing changes
in calcium concentration and
regulating the electrolyte
with parathyroid hormone.
 HYPERCALCEMIA
• Serum concentration of
calcium>10.5 mg/dL.
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21. Treatment of
Hypercalcemia
• Primary treatment of
hypercalcemia consists
of administering IV
fluids.
• If the hypercalcemia is
severe and/or
associated with cancer,
it may be treated with
bisphosphonates.
• For very severe
cases, hemodialysis may
be considered .
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22. HYPOCALCEMIA
• Serum calcium levels >
8.5 mg/dL.
 Causes
• Hypoparathyroidism
• vitamin D
• malnutrition
• blood transfusion,
• ethylene glycol
intoxication
• pancreatitis
 Symptoms
• muscle cramping or
twitching,
• numbness around the
mouth and fingers.
• Shortness of breath, low
blood pressure, and
cardiac arrhythmias.
 Treatment
• Either oral or IV
calcium.
• Replacing Magnesium
also if
hypomagnesaemia is
present]
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23. Magnesium is mostly found in the bones and within cells and is important in control of
metabolism and is involved in numerous enzyme reactions.
 HYPERMAGNESEMIA
• Serum magnesium concentration
>2.5 mg/dL.
 Causes
• abnormal kidney function.
• use of antacids or laxatives that contain
magnesium.
 Symptoms
• Mild symptoms include nausea, flushing,
tiredness. Neurologic symptoms are seen
most commonly including decreased deep
tendon reflexes. Severe symptoms include
paralysis, respiratory failure, and bradycardia
progressing to cardiac arrest.
 Treatment
• If kidney function is normal, stopping the
source of magnesium intake is sufficient.
• Diuretics
• Dialysis
 HYPOMAGNESEMIA
 Causes
• G.I. losses such as vomiting and diarrhea.
• Kidney losses from diuretics,
• alcohol use,
• hypercalcemia,
• genetic disorders.
• Low dietary intake
 Symptoms
• Hypomagnesemia is typically associated
with other electrolyte abnormalities. For
this reason, there may be overlap in
symptoms seen in these other electrolyte
deficiencies. Severe symptoms include
arrhythmias, seizures, or tetany.
 Treatment
• Administration of Magnesium orally or IV
and treating other electrolyte deficiencies.
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24. Chloride- is part of gastric acid (HCl), which plays a role in absorption of electrolytes, activating
enzymes, and killing bacteria.
 HYPERCHLOREMIA
 Causes
• Excess chloride intake (e.g., saltwater
drowning)
• fluid loss (e.g., diarrhea, sweating)
• metabolic acidosis.
•
 Symptoms
• Usually asymptomatic with mild
hyperchloremia.
• Symptoms associated with hyperchloremia
are usually caused by the underlying cause of
this electrolyte imbalance.
 Treatment
• Treat the underlying cause, which commonly
includes increasing fluid intake.
 HYPOCHLOREMIA
 Causes
• Gastrointestinal losses (e.g., vomiting)
• Kidney losses -(e.g., diuretics)
• Greater water or sodium intake relative to
chloride
 Symptoms
• Usually asymptomatic with mild
hypochloremia.
• Symptoms associated with hypochloremia
are usually caused by the underlying cause of
this electrolyte imbalance.
 Treatment
• Treat the underlying cause, which commonly
includes increasing fluid intake.
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25.  Hyperphosphatemia is an electrolyte disorder in
which there is an elevated level of phosphate in
the blood.
 Signs and Symptoms
• Ectopic calcification
• Secondary hyperparathyroidism
• Renal Osteodystrophy
 Causes
• Kidney failure
• Pseudohypoparathyroidism
• Hypoparathyroidism
• diabetic ketoacidosis
• tumor lysis syndrome
• Rhabdomyolysis
• Diagnosis
• Blood phosphate levels > 1.46 mmol/L (4.5
mg/dL)
 Treatment
• Eating a phosphate low diet
• Antacids, like calcium carbonate, that bind
phosphate.
• IV normal saline
• Dialysis
• Hypophosphatemia is an electrolyte disorder in
which there is a low level of phosphate in the
blood
 Signs and Symptoms
• Weakness
• trouble breathing
• loss of appetite
 Complications
• seizures, coma, rhabdomyolysis, or softening of
the bones.
 Causes
• Alcoholism,
• Refeeding in those with malnutrition
• diabetic ketoacidosis, burns, hyperventilation,
and certain medications.
• It may also occur in the setting of
hyperparathyroidism, hypothyroidism, and
Cushing syndrome.
 Diagnosis
• blood phosphate concentration of less than 0.81
mmol/L (2.5 mg/dL).
 Treatment
• depends on the underlying cause.
• Phosphate may be given by mouth or by
injection into a vein.
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26. Management of Recurrent Vomitting
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27. SHOCK
Shock is the state of insufficient blood flow to the tissues of the body as a result of problems
with the circulatory system
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28. Management of Shock
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29. • Syncope/ Fainting
• is a loss of consciousness and muscle strength
characterized by a fast onset, short duration,
and spontaneous recovery.
 Causes: It is caused by a decrease in blood flow
to the brain, typically from low blood pressure
which can be due to :
 Treatment
• Loosening clothes,positioning the person on the
ground, with legs slightly elevated or sitting
leaning forward and the head between the
knees for at least 10–15 minutes, preferably in a
cool and quiet place.
• Respiratory stimulants- aromatic ammonia
• Cold towel on patient’s forhead
• For individuals who have problems with chronic
fainting spells, therapy should focus on
recognizing the triggers and learning techniques
to keep from fainting.
• At the appearance of warning signs counter-
pressure maneuvers that involve gripping
fingers into a fist, tensing the arms, and crossing
the legs or squeezing the thighs together can be
used to ward off a fainting spell. After the
symptoms have passed, sleep is recommended.
• If fainting spells occur often without a triggering
event, syncope may be a sign of an underlying
heart disease. And the treatment is much more
sophisticated and may involve pacemakers and
implantable cardioverter-defibrillators
depending on the precise cardiac cause.
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