PPt of Fluid Balance

1. Water and Electrolyte Balance

3. Water Loss
• Hypovolemia – Isotonic volume loss. Only ECF loss.
Mild - <2L ; Moderate 2-3 L ; Severe > 3L
Hypotension, Raised blood Urea, Oliguria
• Dehydration – Pure water loss. Inadequate fluid intake, Diabetes
insipidious.
Mild – 5% Wt Loss ; Moderate – 10% ; Severe – 15 %
Severe Thirst, Confusion, Convulsions

4. Water Intoxication
• CCF, Cirrhosis, Nephrotic Syndrome, Renal Failure, TURP
• Drowsiness, Weakness, Nausea, Vomiting, Pedal Edema
• Tachycardia, Hypertension, Pulmonary Edema
• Convulsions, Unconsciousness
• Treatment:- Fluid Restriction. Electrolyte correction

5. HyperNatraemia
• Sodium level is less than 130 mEq/L
• due to water overload (dilutional) or sodium loss.
• Acute-presents as neurological manifestations.
• Chronic-causes pontine myelinolysis. It presents as behavioral
changes, progressive weakness, and cranial nerve palsies.

6. HyperNatraemia
• Hypervolemic hyponatraemia – Water Intoxication
• Hypovolaemic hyponatraemia – Diarrhoea, Vomitting
• Normovolaemic Hyponatraemia – Renal Failure

7. HyperNatraemia
• Dry tongue
• Sunken Eyes
• Dry, Wrinkled Skin
• Irritability, Disorientation
• Pulmonary Edema, Cerebral Edema
• Chronic – Hypothermia, Reduced Tendon Reflexes

8. HyperNatraemia
• Investigations : Serum Electrolytes
• Treatment :- Normal Saline – slow
gradual correction.
• Hypertonic Saline in severe cases

9. Hypernatraemia
• Serum sodium level > 150 mEq/L
• Envolemic – Due to water loss/ Inadequate intake. Bed ridden
patients, Diabetes, CRF
• Hypovolemic – Due to diarrhoea, vomitting
• Hypervolemic – Sodium gain more than water – more salt intake,
Steroid abuse

10. Hypernatraemia
• Pitting Edema, Puffiness of face
• Polyuria
• Dialated veins, Hypertension
• Investigations: Serum Electrolytes
• Treatment:- Salt restriction
• Hypotonic Saline

11. Hypernatraemia
• Pitting Edema, Puffiness of face
• Polyuria
• Dialated veins, Hypertension
• Investigations: Serum Electrolytes
• Treatment:- Salt restriction
• Hypotonic Saline

12. Hypokalemia
• Potassium level less than 3.5 mEq/L
• Diarrhoea of any causes
• villous tumour of the rectum, ulcerative colitis;
• After trauma or surgery. Pyloric stenosis with gastric outlet
obstruction.
• Duodenal fistula, ileostomy;
• Insulin therapy; Poisoning; Drugs like beta agonists. Familial periodic
paralysis.

13. Hyperkalemia
• Slurred speech
• Muscular hypotonia-physical sign
• Depressed reflexes; Paralytic ileus
• Weakness of respiratory muscles
• Cardiac arrhythmias. prolonged QT interval, depression of the ST
segment and inversion of T wave, prominent U wave
• Inability to produce concentrated urine and so causes nocturia and
polyuria.

14. Hyperkalemia
• 15 ml Kcl Syrup (20 mmol of K)
• Injection KCl 40mmol/L in 5 %
dextrose/Normal Saline over 4
hours

15. Hyperkalemia
• Serum Potassium exceeds 6 mEq/L
• Renal failure
• Rapid infusion of potassium
• Transfusion of stored blood
• Diabetic ketoacidosis.
• Adrenal insufficiency
• Metabolic acidosis.
• Potassium sparing diuretics, cyclosporine, beta blockers.
• Insulin deficiency.
• Tissue destruction, burns, trauma, tumour necrosis, crush injury.

16. Hyperkalaemia
• Slurred speech, confusion
• Increased reflexes
• Cardiac Arrythmias – Peak ‘T’ Wave in ECG
• Convulsions

17. Hyperkalaemia
• GI DRIP – 50 ml of 50% Glucose with 10 Units of Insulin slowly
• 10% Calcium Gluconate slow infusion – Carioprotective.
• Diuresis
• Haemodialysis
• ECG monitoring

18. Thank You