The document discusses fluid, electrolyte, and acid-base disturbances. It covers fluid compartments and regulation, electrolyte composition and balance, acid-base balance mechanisms, causes and assessment of dehydration, and management of dehydration through oral rehydration and intravenous fluids. Common electrolyte imbalances like hyponatremia and causes of hyponatremia are also mentioned.
Professor Mridul M. Panditrao, deals with this basic, complicated but very important topic for not only post- graduates but also for under-graduates. Various complicated issues have been discussed in detail, mainly from clinical point of view.
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
Fluid Therapy is the administration of fluids to a patient as a treatment or preventative measure. It can be administered via an intravenous, intraperitoneal, intraosseous, subcutaneous and oral routes. 60% of total bodyweight is accounted for by the total body water.
Different fluids can be
cyrstalloids, colloids, hypertonic saline, hypotonic saline, ringer lactate.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Professor Mridul M. Panditrao, deals with this basic, complicated but very important topic for not only post- graduates but also for under-graduates. Various complicated issues have been discussed in detail, mainly from clinical point of view.
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
Fluid Therapy is the administration of fluids to a patient as a treatment or preventative measure. It can be administered via an intravenous, intraperitoneal, intraosseous, subcutaneous and oral routes. 60% of total bodyweight is accounted for by the total body water.
Different fluids can be
cyrstalloids, colloids, hypertonic saline, hypotonic saline, ringer lactate.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Objectives
By the end of this presentation the student will
be able to:
-Identify differences among adults, children, and
infants related to fluid requirements, fluid therapy,
and electrolytes..
- Fluid Pressures & movements.
- Explain the causes and clinical manifestations of
the four major types of acid-base imbalances.
3. Introduction
Stable internal environment is maintain by the
balance of body water and electrolyte .
Balance disturbance is very common problem
usually found in association with several disease
conditions ,correction of imbalance and
maintenance of fluid and electrolyte are prime
important for disease management .
8. Body fluids
• Water is the largest component of human body.
• Water is essential for life.
• Present in every cell
• Surrounds every cell
9.
10. Variation in body fluid content
Neonates contain more water than adults: 75–
80% water with proportionately more ECF than
adults. At birth, the amount of ISF is
proportionally three times larger than in an adult.
By the age of 12 months this has decreased to
60%, which is the adult value. Total body water
as a percentage of total body weight decreases
progressively with increasing age.
11. Body fluids
Cellular fluid compartments
The two body fluid compartments are
intracellular and extracellular.
The fluid inside the cell is called intracellular
fluid(ICF).
The fluid outside the cell is called extracellular
fluid (ECF).
13. Two‐thirds of body fluid is found inside the
cell and one‐third of the fluid outside the cell.
The interstitial compartment contains 80% of the
ECF, and 20% is in the intravascular
compartment as plasma
14. Body fluids
Intracellular fluid
•• The ICF is primarily a solution of potassium
and organic anions, proteins, and so on.
•• The cell membranes and cellular metabolism
control the constituents of this ICF.
•• ICF is not consistent in the body. It represents
a collection of fluids from all the different cells.
16. Distribution Of Total Body Water
Fluid Compartments Infants Older children
• Intracellular Fluid (ICF) 40% 35 - 40%
• Extracellular Fluid (ECF) 35 -40% 20 - 25%
- Interstitial ---- 15%
- Trans vascular (plasma) ---- 5%
- Transcellular ---- 1 -3%
Total body water 75 -80% 60%
17. Body fluids
Regulation of body water is control by it´s intake
and excretion .
Intake is stimulate by thirst ,thirst regulate by
hypothalamus and also by the volume of body
water .
Kidney regulate the water balance and osmolality of
body fluid under the influence of ADH (antidiuretic
hormone ) and natriureteric peptides .
18. Body fluids
Natriureteric peptide are body´s defense against
volume expansion .
Osmolality is the number of osmotically active
particles per 1000g of water in solution - milli
osmole (mOsm/kg) .
Antidiuretic hormone secretion is regulate by
intracellular , plasma osmolality and the volume of
ECF.
19. Body fluids
Antidiuretic hormone secretion is inhibited when
excessive water is administered resulting dilution
of the body fluids and hypotonicity .
The ADH act primarily by increasing the
permeability of the renal collecting ducts to
water .
20. Fluid Pressures & movements
• ECF and ICF fluid shifts occur related to
changes in pressure within the compartments
• Fluid flows only when there is a difference in
pressure
• Always fluid moves from area of low
concentrations to area of high concentrations
21. Fluid Shifting
• 1st space shifting- normal distribution of
fluid in both the ECF compartment and ICF
compartment.
• 2nd space shifting- excess accumulation of
interstitial fluid (edema)
• 3rd space shifting- fluid accumulation in
areas that are normally have no or little
amounts of fluids (ascites)
22. Fluid and Electrolyte Transport
Passive Transport Systems
• Diffusion
• Filtration
• Osmosis
Active Transport System
• Pumping
• Requires energy expenditure
23. Diffusion
Molecules move across a biological membrane
from an area of higher to an area of lower
concentration
Membrane types :-
Permeable
Semi-permeable
Impermeable
24. Filtration
• Movement of solute and solvent across a
membrane caused by hydrostatic (water
pushing) pressure .
• Occurs at the capillary level .
• If normal pressure gradient changes edema
results from “third spacing”.
26. Osmosis
• Movement of solvent
from an area of lower
solute concentration to
one of higher concentration.
• Occurs through
a semipermeable
membrane using osmotic
(water pulling) pressure.
28. Electrolyte Composition Of Body Fluids
Electrolyte have capability of conducting an
electric current in solution and it may be charge
positively (cations) or charge negatively (anions).
sodium chloride is the principal osmotic agent in
ECF regulation of body water depend on
regulation of sodium .
29. kidney is main organ in regulation of water and
sodium balance –ADH . aldosterone and thirst
mechanism .
Both renal and extrarenal mechanisms play role in
regulation of potassium balance which include
aldosterone production and promotion of
potassium movement into the cells by alkalosis
and insulin
31. Crystalloid
• Water and electrolyte solution
• Does not remain within the intravascular
space but rather distributes to the entire
extracellular space
• Only impacts on the intracellular space if it
causes a change in extracellular osmolarity
33. Isotonic Fluids
• Osmolality is similar to that of serum.
• These fluids remain intravascular momentarily,
thus expanding the volume.
• Helpful with patients who are hypotensive or
hypovolemic.
• EXAMPLES:
• 0.9% sodium chloride solution (154 mEq Na/L
308 mOsm/L)
35. Hypotonic Fluids
Less osmolarity than serum (meaning: in general
less sodium ion concentration than serum)
These fluids DILUTE serum thus decreasing
osmolarity.
Water moves from the vascular compartment into
the interstitial fluid compartment interstitial
fluid becomes diluted Osmolarity decreases
water is drawn into adjacent cells.
36. Hypotonic Fluids
- The purpose of hypotonic fluids is to replace
cellular fluids, because its lower osmotic
pressure(hypotonic) as compared with plasma.
• Less salt or more water than isotonic ,It may used
to treat hypernatremia (hypotonic Na solutions).
• If infused into blood, RBCs draw water into cells
( can swell & burst )
• Solutions move into cells causing them to enlarge.
• 0.45% Sodium Chloride
• 0.33% Sodium Chloride
37. Hypotonic Fluids
Complications of excessive use of hypotonic
solutions include:
• Intravascular fluid depletion.
• Decreased blood pressure.
• Cellular edema.
• Cell damage
38. Hypertonic solution
• Solution of higher osmotic pressure greater
than of ECF.
• If infused into blood, water moves out of cells
& into solution (cells wrinkle or shrivel)
• Solutions pull fluid from cells
• 3% NaCl
• 5% NaCl
• TPN
• D10%
• DNS
40. Crystalloids Advantages
• Inexpensive.
• Greater urine output.
• Replace interstitial fluid.
Disadvantages:
• Short duration of hemodynamic improvement.
• Peripheral edema.
• Pulmonary edema.
• Intravascular half-life is about 20-30 min.
41. Colloid
• Colloid is a term used to describe fluids which
contain large molecules (Differing molecular
weight & chemical structure).
• It remain in the circulation (vascular space)
longer until they are broken down , may be
preferred for increasing intravascular space.
• Natural & synthetic plasma protein
• It has Higher incidence of severe adverse
reactions.
44. Acid-Base Balance
Acid-base balance is an essential part of fluid
and electrolyte management .
An acid is a chemical substance that dissociates
in solution, resulting hydrogen ions (pH below
7.0 ) .
A base is a substance that combines with acid to
form salts
45. Acid-Base Balance
A buffer is a substance that reduces the change in
free hydrogen ion concentration of a solution
when an acid or base is added .
The concentration of hydrogen ions determines
the acidity of fluids and it is dependent on the
ratio of pCO₂and bicarbonate .
46. The term pH is used to indicate acidity
,alkalinity and neutrality.
pH = alkalinity
pH = acidity
A neutral solution has a pH of 7.0
Body pH Regulation Mechanisms :-
- Chemical buffer system of the body .
- Respiratory regulatory mechanism .
- Renal mechanisms
47. Body pH Regulation Mechanisms
Chemical buffer system of the body :-
A buffer is a substance that can absorb or donate H⁺
ion .The four important chemical buffer systems is:-
- Bicarbonate-carbonic acid buffer is most
important system that convert strong acid to a
weak carbonic acid . .
- Phosphate buffer .
- Hemoglobin buffer.
- Protein buffer .
48. Respiratory regulatory mechanism :-
Provide support to the bicarbonate-carbonic acid
buffer system by eliminating excess CO₂
Through rapid breathing .
Renal mechanisms:-
It helps in the elimination of excess acid and
base by reabsorption of bicarbonate in the
proximal tubules and excretion of H⁺ ion as
phosphate buffer salts and ammonium ions .
49. Fluid imbalance
The imbalance may occur when the normal
physiological requirements of body fluids is not
maintained to replace obligatory urinary and
insensible losses and the water required for
metabolic activity
50. Fluid imbalance
The requirement of fluid depend on :-
body weight .
body surface area .
Metabolic rate .
Individual age .
51. Dehydration
Dehydration is the most common fluid imbalance
due to excessive loss of body water .it is clinical
state that results from fluid deprivation .
It is more common in infant and children .
Important causes is diarrhea and vomiting .it may
also occur in diabetes insipidus ,hyperglycemia
and renal losses .
52. Dehydration types based on type of fluid loss :-
Isotonic dehydration : most common with
proportionate loss of water and solutes from ECF.
ICF remains intact as there is no redistribution of
fluid .
Hypotonic dehydration : the depletion of the
solutes in ECF is much more than the water losses .
Hypotonicity of ECF leads to shift of water from
ECF to ICF causing further contraction of ECF and
shock .
53. Hypertonic dehydration :
excess loss of water proportionate to the solutes
causing movement of water from the cell in the
ECF leading to intracellular dehydration .
54.
55. Dehydration types based on severity :-
Mild :-
When the total fluid loss reaches 5% or less .
Sign and symptoms ( S&S) :-
• No dehydration .
• Thirsty .
• Less than 5% of body weight is lost
56. Moderate :-
When the total fluid loss reaches 5 -10%
S&S :-
• Dry skin and mucous membranes .
• Thirst .
• Decreased urine output .
• Muscle weakness .
• Drowsiness .
• Light headache .
• Sunken fontanels .
• BP , PR (tachycardia) ,shallow rapid RR .
• Crying with tears
57. Severe :-
When the total fluid loss reaches more than 10%
considered in emergency case .
S&S:-
• extreme thirst .
• Very dry mouth ,skin and mucous membranes .
• Sunken eyes and fontanels .
• No tears .
• Dry skin that lacks elasticity and slowly ‘‘bounces back ’’when
pinched into fold .
• Rapid heartbeat ,rapid and shallow breath .
• Delay capillary refill for more than tow seconds .
59. Assessment of dehydration
The successful management of dehydration in
infant and children can be possible by accurate
assessment of degree of dehydration and
initiation of rehydration therapy according to the
child condition .
Clinical history and physical examination are the
major aspect of assessment of hydration status .
62. Laboratory Investigations
Essential for further assessment of fluid and
electrolyte deficits
- Serum electrolyte ,blood urea and creatinine
,acid base status ,plasma osmolality , hematocrit
values and urine specific gravity
64. Management Of Dehydration
Dehydration to be manage after accurate
assessment of dehydration status .
In severe dehydration required to maintain vital
function by rapid intravenous infusion (100 to
120ml /kg ) of isotonic , iso-osmotic solution
(ringer lactate) or normal saline or plasma to
achieve normal urine output , correction of
potassium deficit and acidosis .
65. Management Of Dehydration
Total correction of fluid and electrolyte deficit
can be achieve safely and rapidly through oral
rehydration therapy ORT in most of cases .
Intravenous rehydration is recommended if there
is severe cases or there is persistent vomiting ,
paralytic ileus or unconscious child or too sick to
drink ORS .
66. Management Of Dehydration
Hydration should be assessed at regular interval
to determine whether rehydration therapy is
essential furthermore or not .
Mother should be involved during rehydration
therapy .
Intake and output is vital responsibility of the
nurse .
67. Fluid Maintenance
• 100 mL/kg for first 10 kg
• 50 mL/kg for next 10 kg
• 20 mL/kg for remaining kg
• Add together for total mL needed per 24-hour
period.
• Divide by 24 for mL/hour fluid requirement.
71. Rehydration Solution
Dosage:
• Children 0-2. ¼ to ½ cup after each loose
stool. Max 2 cups/day.
• Children 2-9. ½ to 1 cup after each loose
stool. Max 4 ½ cups/ day.
• 10+ yrs. Approximately 2 L/day.
74. Hyponatremia
Is the termed when serum sodium level is less
than 130 mEq/L it occurs due to water retention
,sodium loss or both .
Is commonly found in hospitalized children with
acute diarrhea, pneumonia, meningitis, sepsis,
heart failure ,hepatic failure and renal disease .
75. Etiology Of Hyponatremia
Primary sodium deficit with sodium depletion
resulting in :
1- renal sodium losses in prematurity, chronic
diuretic therapy, osmotic diuresis in diabetes
mellitus, adrenal insufficiency .
76. 2- extrarenal sodium losses due to vomiting,
diarrhea, nasogastric drainage, burn and
excessive sweating .
3- nutritional deficit in water intoxication, poor
sodium concentration in IV fluid, paracentesis,
CSF drainage and burns .
77. Primary water excess with water gain due to :
Excess IV fluid, tap ware enema,
hypothyroidism and syndrome of inappropriate
ADH secretion .
Abnormal retention of sodium and water in :
nephrotic syndrome, liver cirrhosis CCF and
renal failure .
78. Clinical Manifestation
• The features depend on the severity of the
condition usually if the sodium level between 120
to130mEq/L the patient may be a symptomatic .
• Restlessness .
• Confusion .
• Convulsion .
• Hypotension .
• Unconsciousness .
79. Management
Symptomatic hyponatremia is managed by
administering 10ml/kg sodium chloride (saline)
at rate 1ml/minute in 24 to 48 hours.
Restrict fluid in some cases (renal failure) to
avoid pulmonary oedema and CCF .
Furosemide with 3 percent saline if CNS
symptoms are associated with condition .
80. Hypernatremia
Is the termed when serum sodium level is more
than 150 mEq/L . It is result from deficit of water
with respect to sodium stores due to water loss in
diarrhea, vomiting, diuresis, and burn or
excessive sodium intake .
81. Etiology of Hypernatremia
Excessive sodium gain in faulty preparation of
ORS formula, excessive sodium bicarbonate
during resuscitation, IV administration of
hypertonic saline, high Na⁺ content in breast
milk and salt poisoning .
Excessive water loss or deficit in diabetes
mellitus ,poor water in take ,increased insensible
loss in fever and hyperventilation .
82. Clinical Manifestation
• Irritability .
• Confusion .
• Twitching .
• Seizer .
• Tough and doughy skin and subcutaneous
tissue .
• Metabolic acidosis with deep rapid breathing .
83. Management
• Rapid IV Ringer Lactate or saline to correct
hypovolemia .
• Specific treatment of underline cause.
• Withholding diuretics, hypokalemia and
hypercalcemia treatment ad correction of
faulty ORS therapy .
84. Hypokalemia
Is the termed when serum potassium level is
more than 3.5 mEq/L the most common causes
are acute gastroenteritis AGE, septicemia,
diuretic therapy and hepatic failure
85.
86. Etiology Of Hypokalemia
• Reduced potassium intake in PEM .
• High renal losses of potassium in diuretic
therapy, renal tubular defect, acid-base
imbalance(alkalosis, diabetic ketoacidosis)
endocrinopathies .
• High extrarenal losses of potassium in diarrhea,
vomiting, frequent enemas,
87. Clinical Manifestation
Hypokalemia affect the bioelectric processes
(muscle contraction, nerve conduction and
myocardial pacing.
The features is :-
Weakness of the skeletal muscle, hypotonia,
diminished reflexes, abdominal distention,
paralytic ileus, respiratory distress, arrhythmias,
ECG changes, hypokalemic nephropathy and
polyuria .
88.
89.
90. Management
• Administration of potassium over 24 to 48 hours.
• Treat underline cause.
• Oral administration is safer than IV route.
• In life-threating hypokalemia and ECG changes
rapid correction is recommended
• Potassium infusion at rate of 0.3 to
0.35mEq/kg/hour till ECG become normal
91. Management
• Infusion rate should not exceed 0.6 mEq/kg /hour.
• Infusion fluid should not contain more than 40
mEq/L of potassium.
• High rate and concentration cause cardiac
depression .
• Potassium should be administered only when
urinary flow is stablished
92.
93. Hyperkalemia
• Hyperkalemia is defined as a potassium
concentration > 5.5 mmol/L.
• Hyperkalemia is a true medical emergency.
• The most serious effect of hyperkalemia is
cardiac toxicity, which does not correlate well
with the plasma [K].
94. Hyperkalemia
Earliest ECG changes include:
- increased T wave amplitude with
- tall T waves (especially in leads V2-V3).
More severe hyperkalemia results in a
prolonged PR interval and QRS duration,
atrioventricular conduction delay, and loss of P
waves.
95. The terminal event is usually ventricular
fibrillation or asystole which are resistant to the
treatment until hyperkalemia is corrected.
Hyperkalemia causes also a partial
depolarization of cell membranes, which is
manifested as weakness that may progress to
flaccid paralysis and hypoventilation.
96. Causes of hyperkalemia:
Increased [K⁺] intake (e.g. iatrogenic, rapid
transfusion of relatively old blood).
Transcellular shift (most common cause).
Tumor lysis syndrome.
Rhabdomyolysis,
intravascular hemolysis.
97. Causes of hyperkalemia:
Metabolic acidosis, especially in renal failure or
in renal tubular acidosis.
- Less evident with lactic acidosis.
Succinylcholine, especially in patients with
anterior motor neuron disease, myopathies burns
or prolonged immobilization.
- Familial periodic paralysis.
98. Causes of hyperkalemia:
Impaired renal [K⁺] excretion:
Renal failure with GFR < 10 mL/min, and
oliguria < 500 mL/day.
Diabetic nephropathy.
Adrenal insufficiency, hyporeninemic
hypoaldosteronism.
Drug related ([K⁺]-sparing diuretics, (angiotensin-
converting enzyme) ACE inhibitors, non-selective
beta-blockers, cyclosporine, NSAIDs).
99. Treatment Of Hyperkalemia
Calcium: A physiologic membrane antagonist
of [K⁺].
- Calcium gluconate (10 ml 10% solution)
should be immediately given over 2-3 min to
prevent potassium-induced cardiotoxicity.
- Ca chloride is preferable in patients with
circulatory instability.
100. Treatment Of Hyperkalemia
The duration of the therapeutic effect is limited
(20-30 min).
The dose can be repeated if no change in the
ECG is seen after 5-10 min.
Ca should be used cautiously in patients with
digitalis toxicity.
101. Treatment Of Hyperkalemia
Induction of intracellular shift of potassium:
Glucose-insulin:
Pediatric: IV 0.5 g/kg glucose with 0.1 units/kg
regular insulin over 30 min (use 25% glucose).
Neonate: 2 mL/kg 10% dextrose with 0.05
units/kg regular insulin.
102. Treatment Of Hyperkalemia
Na bicarbonate should be reserved for severe
hyperkalemia associated with metabolic acidosis.
The onset of action is nearly immediate, with a
duration of 1-2 h
103. Treatment Of Hyperkalemia
Beta2-adrenergic agonists (salbutamol) are
readily available by the IV or by the inhalation
route and directly induce cellular uptake of [K⁺].
The onset of action is in 30 min.
These drugs may lower [K⁺] by 0.5-1.0 mmol/L
and this effect may last for 2-4 h.
104. Treatment Of Hyperkalemia
Increase of potassium excretion:
Loop and thiazide diuretics (if renal function is
adequate).
Cation exchange resins (kayexalate).
Usual dose is 25-50 g PO, mixed with 100 ml
20% sorbitol (lasts for 4-6 h) or 50 g in tap water
administered as a retention enema (should be
avoided in postoperative patients).
108. Acid-base imbalances
are common in children and fall into four
categories: respiratory acidosis, respiratory
alkalosis, metabolic acidosis, and metabolic
alkalosis.
The body will compensate for these
disturbances by using a renal or a respiratory
buffering mechanism. These responses are
monitored by ABG analysis.
109. Respiratory acidosis
can be caused by any condition that decreases a
child’s respiratory effort. Slowed or shallow
respirations will result in a buildup of carbon
dioxide, which
combined with water forms carbonic acid and
leads to acidosis ( pH , pCO2).
110. Clinical Conditions Associated With Respiratory
Acidosis :
Head trauma . Asthma.
General anesthesia . Croup or epiglottitis.
Drug overdose . Cystic fibrosis.
Brain tumor . Atelectasis.
Sleep apnea . Muscular dystrophy.
Mechanical underventilation . Pneumothorax.
111. Acidosis causes central nervous system
depression. As a result, the child will be
lethargic, confused, and disoriented, may
complain of a headache, and, if not treated,
may become comatose. Efforts to improve
ventilation help correct the underlying cause
of respiratory acidosis. Without correction,
the body, via the kidneys, will retain
bicarbonate to help neutralize the increased
acid.
112. The kidneys attempt to compensate is slow and
does not correct the underlying respiratory
problem.
Compensation is a body process to restore blood
pH to normal by changing the partial pressure of
carbon dioxide (pCO2) or the bicarbonic ion
concentration.
114. Respiratory alkalosis
occurs when the carbon dioxide level is too low.
This most commonly occurs from conditions that
cause the child to hyperventilate (e.g., anxiety,
pain, meningitis, gram-negative septicemia,
early response to salicylate poisoning,
mechanical overventilation).
child will often feel numbness or tingling in toes
and fingers, lightheadedness, and confusion, and
may faint
115. Renal compensation for respiratory alkalosis is
rarely seen clinically because the underlying
condition is often corrected before the kidneys
have time to respond.
the kidneys would retain free hydrogen ions and
excrete bicarbonate. The child’s urine pH would
increase as a result of the increased bicarbonate
excretion.
116. Clinical Manifestations
• Tachypnea
• Numbness, tingling of
toes and fingers
• Lightheaded, dizzy
• Syncope
• Diaphoresis
Management Approaches
• Monitor blood gases
• Encourage slow
ventilation
• Use rebreathing
oxygen masks or bag
• Administer sedative, if
ordered
• Monitor vital signs
117. Metabolic acidosis
is most commonly caused by a loss of bicarbonate
in the stool or an increase in ketone bodies (e.g.,
acetoacetic acid, acetone, beta-hydroxybutyric
acid) in the blood. These conditions most
frequently result from diarrhea and diabetic
ketoacidosis. Children are often confused,
lethargic, and tachycardic..
118. The body compensates by increasing the depth and
rate of respirations in order to blow off carbon
dioxide, thus decreasing pCO2 and carbonic acid
119. Clinical Manifestations
• Confusion
• Lethargy
• Deep, rapid
respirations
• Acetone odor to breath
• Tachycardia
• Cold, clammy skin
(mild acidosis)
• Warm, dry skin (severe
acidosis)
Management Approaches
• Correct underlying
problem
• Administer sodium
bicarbonate
• Administer oxygen
• Correct DKA with
insulin or glucose
• Monitor vital signs
120. Metabolic alkalosis
occurs as a result of bicarbonate retention or
hydrogen ion loss. It is most commonly seen in
children with prolonged vomiting as emesis is
acidic stomach contents. It can also occur with
ingestion of large quantities of bicarbonate
antacids, massive blood transfusions, loss of
nasogastric fluids due to gastric suction, and
hypokalemia.
121. A child experiencing metabolic alkalosis is often
weak and dizzy and may complain of muscle
cramps. The respiratory response would be to
increase pCO2 by decreasing the rate and depth
of respirations (hypoventilation).
122. Clinical Manifestations
• Slow, shallow
respirations
• Tremors, muscle
twitching
• Disorientation
• Seizures
Management Approaches
• Correct underlying
problem
• Administer sodium
NaCl and KCl
• Replace loss of fluids
• Take seizure precautions
• Monitor intake and
output
• Monitor electrolyte
status
123. Normal Arterial Blood Gas Values
pH 7.35 - 7.45
PaCO2 35 - 45 mm Hg
PaO2 70 - 100 mm Hg **
SaO2 93 - 98%
HCO3
¯ 22 - 26 mEq/L
%MetHb < 2.0%
%COHb < 3.0%
Base excess -2.0 to 2.0 mEq/L
CaO2 16 - 22 ml O2/dl