1) The document discusses fluid and electrolyte physiology including body fluid compartments, volume homeostasis, and clinical signs of hypo- and hypervolemia.
2) Key concepts covered are cell membrane permeability, osmolarity vs osmolality, and electroneutrality.
3) Treatment for various fluid-electrolyte disorders is reviewed including use of isotonic vs hypotonic IV fluids and management of hyponatremia.
- The document discusses fluid balance and electrolyte physiology. It defines key terms like total body water, intracellular fluid, extracellular fluid, osmolarity, and tonicity.
- Daily fluid intake and losses are summarized, with average intake of around 2-3 liters and losses of around 1 liter through urine, sweat, lungs, and stool.
- Abnormal fluid losses can occur through vomiting, diarrhea, excessive sweating, burns, or bleeding. This can lead to changes in volume, concentration, and composition of body fluids.
- Hypovolemia and hypervolemia are discussed in terms of their signs, symptoms, and treatment approaches like fluid resuscitation or diuretics
This document provides an overview of fluid therapy and electrolyte disturbances. It discusses the basic physiology of body fluids, including total body water content and distribution. It then covers various electrolyte abnormalities like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia, and hypermagnesemia. It also addresses acid-base balance disturbances and different intravenous fluid options for fluid resuscitation and maintenance.
This document discusses electrolyte imbalances, focusing on sodium, potassium, calcium, and magnesium. It provides information on total body water percentages in different age groups. It covers the physiology and normal ranges of various electrolytes, as well as daily electrolyte requirements. Factors that can cause electrolyte imbalances like sodium and potassium deficiencies or excesses are explained. The clinical features, evaluation, and management of conditions like hypernatremia, hyponatremia, and hypokalemia are summarized.
1. Water And Sodium and electrolyte balanceDanaiChiwara
This document discusses water and electrolyte balance in the human body. It covers the following key points:
1. Water makes up 50-70% of total body weight and is distributed between intracellular and extracellular fluid compartments.
2. Homeostasis of water and electrolytes is maintained through regulation of fluid compartments, kidney function, hormone release, and thirst.
3. Disorders of water balance can cause dehydration/volume depletion through hypotonic or isotonic fluid loss, with different biochemical and clinical features in each case. Rapid fluid replacement is needed to correct isotonic losses while hypotonic losses require cautious replacement to avoid cerebral edema.
Water and Electrolyte balance in surgical patientsDaniroxx
To help understand the need for Iv fluid therapy and electrolyte imbalances and their correction in surgical patients. It aims to keep the patient well hydrated with good urine output and avoid vital sign derangements and to avoid complications of wrongly advised fluids.
This document discusses fluid and electrolyte regulation and abnormalities in pediatrics. It covers the composition of body water compartments, daily fluid requirements, types of dehydration and their management, as well as electrolyte abnormalities including hyponatremia, hypernatremia, hypokalemia, and hyperkalemia. Signs and symptoms and treatment approaches are provided for each electrolyte imbalance.
This document discusses water and sodium balance in the human body. It provides details on:
- Distribution of total body water between intracellular fluid and extracellular fluid compartments
- Primary cations and anions found in intracellular fluid and extracellular fluid
- Measurement of electrolytes from serum samples
- Concepts of osmosis, tonicity, and oncotic pressure and their role in fluid movement between compartments
- Causes and manifestations of water and sodium imbalances like volume overload, volume contraction, hypovolemia, and hypervolemia
It also covers hyponatremia (water excess) in detail including definitions, classifications, signs and symptoms, diagnostic approach, and
- The document discusses fluid balance and electrolyte physiology. It defines key terms like total body water, intracellular fluid, extracellular fluid, osmolarity, and tonicity.
- Daily fluid intake and losses are summarized, with average intake of around 2-3 liters and losses of around 1 liter through urine, sweat, lungs, and stool.
- Abnormal fluid losses can occur through vomiting, diarrhea, excessive sweating, burns, or bleeding. This can lead to changes in volume, concentration, and composition of body fluids.
- Hypovolemia and hypervolemia are discussed in terms of their signs, symptoms, and treatment approaches like fluid resuscitation or diuretics
This document provides an overview of fluid therapy and electrolyte disturbances. It discusses the basic physiology of body fluids, including total body water content and distribution. It then covers various electrolyte abnormalities like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia, and hypermagnesemia. It also addresses acid-base balance disturbances and different intravenous fluid options for fluid resuscitation and maintenance.
This document discusses electrolyte imbalances, focusing on sodium, potassium, calcium, and magnesium. It provides information on total body water percentages in different age groups. It covers the physiology and normal ranges of various electrolytes, as well as daily electrolyte requirements. Factors that can cause electrolyte imbalances like sodium and potassium deficiencies or excesses are explained. The clinical features, evaluation, and management of conditions like hypernatremia, hyponatremia, and hypokalemia are summarized.
1. Water And Sodium and electrolyte balanceDanaiChiwara
This document discusses water and electrolyte balance in the human body. It covers the following key points:
1. Water makes up 50-70% of total body weight and is distributed between intracellular and extracellular fluid compartments.
2. Homeostasis of water and electrolytes is maintained through regulation of fluid compartments, kidney function, hormone release, and thirst.
3. Disorders of water balance can cause dehydration/volume depletion through hypotonic or isotonic fluid loss, with different biochemical and clinical features in each case. Rapid fluid replacement is needed to correct isotonic losses while hypotonic losses require cautious replacement to avoid cerebral edema.
Water and Electrolyte balance in surgical patientsDaniroxx
To help understand the need for Iv fluid therapy and electrolyte imbalances and their correction in surgical patients. It aims to keep the patient well hydrated with good urine output and avoid vital sign derangements and to avoid complications of wrongly advised fluids.
This document discusses fluid and electrolyte regulation and abnormalities in pediatrics. It covers the composition of body water compartments, daily fluid requirements, types of dehydration and their management, as well as electrolyte abnormalities including hyponatremia, hypernatremia, hypokalemia, and hyperkalemia. Signs and symptoms and treatment approaches are provided for each electrolyte imbalance.
This document discusses water and sodium balance in the human body. It provides details on:
- Distribution of total body water between intracellular fluid and extracellular fluid compartments
- Primary cations and anions found in intracellular fluid and extracellular fluid
- Measurement of electrolytes from serum samples
- Concepts of osmosis, tonicity, and oncotic pressure and their role in fluid movement between compartments
- Causes and manifestations of water and sodium imbalances like volume overload, volume contraction, hypovolemia, and hypervolemia
It also covers hyponatremia (water excess) in detail including definitions, classifications, signs and symptoms, diagnostic approach, and
Fluids& Electrolytes presentation by Dr. Ahmed SafwatShaju Edamana
This document discusses fluid and electrolyte physiology and abnormalities. It covers the composition and regulation of body water compartments, daily fluid requirements, commonly used IV fluids, dehydration types and management, and electrolyte abnormalities including sodium, potassium, and their causes and treatment. The document provides detailed information on fluid and electrolyte balance in a pediatric population.
This document discusses dyselectrolytemias (fluid and electrolyte disturbances) that commonly occur in intensive care unit patients. It notes that disturbances of sodium, potassium, chloride, calcium, phosphate, and magnesium are increased risk factors for poor prognosis. The document outlines some of the key mechanisms that can lead to electrolyte imbalances, such as reduced kidney perfusion, activation of hormonal systems, and renal tubular damage. It emphasizes that inappropriate fluid and electrolyte administration is often the most important cause of dyselectrolytemias. The document stresses that treatment must be closely monitored with serial electrolyte measurements.
This document discusses dyselectrolytemias (fluid and electrolyte disturbances) that commonly occur in intensive care units. It covers several key points:
- Fluid and electrolyte disturbances are among the most common clinical problems in ICU patients and increase morbidity and mortality. Disturbances can involve sodium, potassium, chloride, calcium, phosphate, and magnesium.
- Critical illnesses like trauma, sepsis, brain damage and heart failure can disrupt fluid and electrolyte homeostasis through mechanisms like reduced kidney perfusion, activation of hormones, and renal tubular damage. Inappropriate fluid/electrolyte administration is also important.
- Hypo- and hypernatremia are independent risk factors for poor prognosis in ICU
This document discusses fluids and electrolytes. It covers total body fluid compartments, including intracellular fluid, extracellular fluid, intravascular fluid, and interstitial fluid. It describes fluid requirements and regulation, causes of hypovolemia, signs and symptoms, treatment with crystalloids and colloids. It also addresses osmolarity, factors that affect fluid distribution between compartments, and third-spacing of fluids.
This document provides information on IV fluids and intraoperative fluid management. It discusses the body's fluid compartments and regulation of fluid balance. Various IV fluid types are described including crystalloids like normal saline, Ringer's lactate, dextrose solutions; and colloids like dextran, gelatin, hydroxyethyl starch, and albumin. Intraoperative fluid requirements are outlined as maintenance fluids, fasting fluid deficit, and third space losses. Blood transfusion guidelines based on hematocrit and hemoglobin levels are also briefly mentioned.
This document discusses fluid and electrolyte imbalances. It begins by describing the normal composition and distribution of body fluids, including the intravascular, interstitial, and transcellular fluid compartments. It then discusses various fluid volume disturbances including hypovolemia and hypervolemia, and their contributing factors and symptoms. Electrolyte imbalances of sodium, potassium, calcium, magnesium, and phosphate are also covered. The document concludes with discussions of acid-base disturbances and intravenous fluid therapy.
Disturbances of fluid and electrolyte balance can cause serious health issues if not properly maintained. The body works to keep fluid volumes and electrolyte concentrations in balance through mechanisms like osmosis and hormone regulation. Imbalances can result from losses or gains of fluids and electrolytes. Common causes of imbalances include dehydration, overhydration, changes in sodium or potassium levels, and issues with antidiuretic hormone regulation. Symptoms vary depending on the type of imbalance but may include altered mental status, heart problems, and neurological issues. Treatment focuses on replacing lost fluids and electrolytes at appropriate rates to restore normal balances.
This document provides guidelines for intravenous fluid therapy for adult surgical patients. It discusses fluid management before, during, and after surgery. Key recommendations include using balanced crystalloid or colloid solutions to treat volume deficits, assessing volume status and response to fluid boluses, achieving euvolemia and minimizing sodium and fluid overload postoperatively, and providing nutrition support while mitigating risks like refeeding syndrome. The guidelines emphasize tailored fluid management based on individual patient factors, goals of fluid resuscitation, and monitoring for fluid balance and adequacy of resuscitation.
Human excretory system for Nurses Class 2.pptxJacobKurian22
The document discusses fluid and electrolyte balance in the human body. It covers topics such as fluid compartments, electrolyte distribution, mechanisms of fluid movement, assessment of fluid status, causes of fluid and electrolyte imbalances, and management of volume deficits and excesses. Specifically, it provides details on:
- The normal distribution of total body water and fluid compartments in a 70kg male.
- How the kidneys and hormones regulate fluid volume and balance sodium levels.
- Common intravenous fluid types used in treatment, including crystalloids and colloids.
- Clinical signs of moderate and severe volume deficits and how to evaluate chronic vs acute deficits.
- Causes of fluid losses or gains in surgical
1. The normal composition of body fluids consists of 55% fluids and 45% solids in males, and 60% fluids and 40% solids in females. Total body water is divided into intracellular fluid (ICF) and extracellular fluid (ECF).
2. ECF contains plasma, interstitial fluid, and transcellular fluids such as lymph and cerebrospinal fluid. ICF volume is about 28L and ECF volume is about 14L in adults.
3. Fluid volumes are regulated through osmosis driven by electrolyte concentrations between compartments. Imbalances can cause conditions such as edema. Hormones and renal control maintain fluid homeostasis.
MED 4 Water and electrolyte disturbance.pdfRaymondLunda1
Total body water is about 60% of body weight in adults. Water is distributed between intracellular fluid (ICF) and extracellular fluid (ECF). Osmotic pressure controls water movement between compartments based on solute content. Common electrolytes include sodium, potassium, chloride, and bicarbonate. Disorders of water and electrolyte balance can cause dehydration or hyperhydration. Hyponatremia is defined as a sodium level below 135 mmol/L and can be hypovolemic, euvolemic, or hypervolemic depending on volume status. Diagnosis involves assessing history, physical exam, labs including osmolality, and imaging tests.
This patient presented with acute onset quadriparesis due to severe hyperkalemia. Laboratory investigations revealed high serum potassium of 8.7 mEq/L, metabolic acidosis, renal dysfunction, and glucosuria. The hyperkalemia was likely due to a combination of factors - decreased renal excretion due to recent initiation of ACE inhibitors and spironolactone for hypertension, worsening of renal function due to NSAID use and UTI, and potassium shift into extracellular space due to severe hyperglycemia and acidosis. Immediate treatment focused on reducing potassium levels while the underlying causes were addressed.
The document discusses body fluids and electrolytes. It describes the functions of body fluids, including transport of nutrients, waste removal, and temperature regulation. Water is the principal body fluid and makes up 50-70% of total body weight. Body fluids are divided into intracellular fluid (ICF) and extracellular fluid (ECF), with ICF making up around 40% of total body water. Factors like fluid intake and output help regulate fluid levels. Disturbances in fluid balance can cause issues like edema, cell dehydration, or cell overhydration. The document also covers electrolytes like sodium, potassium, calcium, and magnesium, their functions, and potential imbalances.
general presentation and management of Fluid & Electrolyte.pptxNatnael21
Discussion about physiology of fluid balance in human and clinical presentation and general management principles of major electrolyte abnormality like hypernatremia hyponatremia hyperkalemia and hypokalemia
This document discusses water and electrolyte balance, focusing on sodium balance. It covers:
- Body fluid compartments and volumes, with two thirds of total body water located intracellularly.
- Factors regulating fluid movement between compartments, including osmolality and oncotic pressure.
- Mechanisms maintaining water and sodium balance, such as thirst, ADH release, and renal reabsorption.
- Common disorders of water and sodium balance like dehydration, edema, hyponatremia, and hypernatremia.
This document provides an overview of fluids and electrolytes including:
- Body water distribution and regulation which is primarily controlled by the kidneys.
- The roles of electrolytes like sodium, potassium, calcium, and magnesium in fluid balance, acid-base balance, and cell function.
- Acid-base imbalances including respiratory and metabolic acidosis and alkalosis.
- Common IV fluids and their properties, uses, and indications.
- Fluid volume deficits and excesses, their causes, signs and symptoms, and nursing interventions focused on fluid balance and electrolyte monitoring.
This document provides an overview of hyponatremia, including:
1) Definitions, epidemiology, physiology, pathophysiology, types, clinical manifestations, diagnosis, and treatment of hyponatremia are discussed.
2) Hyponatremia is defined as a serum sodium concentration less than 135 mEq/L and is the most common electrolyte disorder. It can develop acutely or chronically.
3) Treatment involves addressing volume status, rate of sodium correction based on chronicity, and use of saline or water restriction depending on the type of hyponatremia. Complex formulas are provided to calculate sodium changes from intravenous fluids.
1. Hyponatremia is the most common electrolyte disorder, defined as a serum sodium concentration less than 135 mEq/L. It represents an excess of water relative to sodium.
2. The pathophysiology involves impaired free water excretion leading to a decrease in serum osmolality and brain cell swelling. Types include hypovolemic, euvolemic, hypervolemic, and redistributive hyponatremia.
3. Clinical manifestations range from asymptomatic to neurologic symptoms. Diagnosis involves assessing volume status, plasma and urine osmolality, and urine sodium. Treatment depends on symptoms, acuity, and volume status with goals of correcting sodium at appropriate rates.
This document provides an overview of hyponatremia, including its definition, epidemiology, physiology, pathophysiology, types, clinical manifestations, diagnosis, and treatment. Some key points include:
- Hyponatremia is defined as a serum sodium concentration of less than 135 mEq/L. It represents an excess of water relative to sodium.
- It is a very common electrolyte disorder, occurring in approximately 1-2.5% of hospitalized patients and up to 30% of ICU patients. Mortality is over 50% if sodium drops below 105 mEq/L.
- The kidney regulates sodium levels through ADH secretion, the renin-angiotensin-
Fluids& Electrolytes presentation by Dr. Ahmed SafwatShaju Edamana
This document discusses fluid and electrolyte physiology and abnormalities. It covers the composition and regulation of body water compartments, daily fluid requirements, commonly used IV fluids, dehydration types and management, and electrolyte abnormalities including sodium, potassium, and their causes and treatment. The document provides detailed information on fluid and electrolyte balance in a pediatric population.
This document discusses dyselectrolytemias (fluid and electrolyte disturbances) that commonly occur in intensive care unit patients. It notes that disturbances of sodium, potassium, chloride, calcium, phosphate, and magnesium are increased risk factors for poor prognosis. The document outlines some of the key mechanisms that can lead to electrolyte imbalances, such as reduced kidney perfusion, activation of hormonal systems, and renal tubular damage. It emphasizes that inappropriate fluid and electrolyte administration is often the most important cause of dyselectrolytemias. The document stresses that treatment must be closely monitored with serial electrolyte measurements.
This document discusses dyselectrolytemias (fluid and electrolyte disturbances) that commonly occur in intensive care units. It covers several key points:
- Fluid and electrolyte disturbances are among the most common clinical problems in ICU patients and increase morbidity and mortality. Disturbances can involve sodium, potassium, chloride, calcium, phosphate, and magnesium.
- Critical illnesses like trauma, sepsis, brain damage and heart failure can disrupt fluid and electrolyte homeostasis through mechanisms like reduced kidney perfusion, activation of hormones, and renal tubular damage. Inappropriate fluid/electrolyte administration is also important.
- Hypo- and hypernatremia are independent risk factors for poor prognosis in ICU
This document discusses fluids and electrolytes. It covers total body fluid compartments, including intracellular fluid, extracellular fluid, intravascular fluid, and interstitial fluid. It describes fluid requirements and regulation, causes of hypovolemia, signs and symptoms, treatment with crystalloids and colloids. It also addresses osmolarity, factors that affect fluid distribution between compartments, and third-spacing of fluids.
This document provides information on IV fluids and intraoperative fluid management. It discusses the body's fluid compartments and regulation of fluid balance. Various IV fluid types are described including crystalloids like normal saline, Ringer's lactate, dextrose solutions; and colloids like dextran, gelatin, hydroxyethyl starch, and albumin. Intraoperative fluid requirements are outlined as maintenance fluids, fasting fluid deficit, and third space losses. Blood transfusion guidelines based on hematocrit and hemoglobin levels are also briefly mentioned.
This document discusses fluid and electrolyte imbalances. It begins by describing the normal composition and distribution of body fluids, including the intravascular, interstitial, and transcellular fluid compartments. It then discusses various fluid volume disturbances including hypovolemia and hypervolemia, and their contributing factors and symptoms. Electrolyte imbalances of sodium, potassium, calcium, magnesium, and phosphate are also covered. The document concludes with discussions of acid-base disturbances and intravenous fluid therapy.
Disturbances of fluid and electrolyte balance can cause serious health issues if not properly maintained. The body works to keep fluid volumes and electrolyte concentrations in balance through mechanisms like osmosis and hormone regulation. Imbalances can result from losses or gains of fluids and electrolytes. Common causes of imbalances include dehydration, overhydration, changes in sodium or potassium levels, and issues with antidiuretic hormone regulation. Symptoms vary depending on the type of imbalance but may include altered mental status, heart problems, and neurological issues. Treatment focuses on replacing lost fluids and electrolytes at appropriate rates to restore normal balances.
This document provides guidelines for intravenous fluid therapy for adult surgical patients. It discusses fluid management before, during, and after surgery. Key recommendations include using balanced crystalloid or colloid solutions to treat volume deficits, assessing volume status and response to fluid boluses, achieving euvolemia and minimizing sodium and fluid overload postoperatively, and providing nutrition support while mitigating risks like refeeding syndrome. The guidelines emphasize tailored fluid management based on individual patient factors, goals of fluid resuscitation, and monitoring for fluid balance and adequacy of resuscitation.
Human excretory system for Nurses Class 2.pptxJacobKurian22
The document discusses fluid and electrolyte balance in the human body. It covers topics such as fluid compartments, electrolyte distribution, mechanisms of fluid movement, assessment of fluid status, causes of fluid and electrolyte imbalances, and management of volume deficits and excesses. Specifically, it provides details on:
- The normal distribution of total body water and fluid compartments in a 70kg male.
- How the kidneys and hormones regulate fluid volume and balance sodium levels.
- Common intravenous fluid types used in treatment, including crystalloids and colloids.
- Clinical signs of moderate and severe volume deficits and how to evaluate chronic vs acute deficits.
- Causes of fluid losses or gains in surgical
1. The normal composition of body fluids consists of 55% fluids and 45% solids in males, and 60% fluids and 40% solids in females. Total body water is divided into intracellular fluid (ICF) and extracellular fluid (ECF).
2. ECF contains plasma, interstitial fluid, and transcellular fluids such as lymph and cerebrospinal fluid. ICF volume is about 28L and ECF volume is about 14L in adults.
3. Fluid volumes are regulated through osmosis driven by electrolyte concentrations between compartments. Imbalances can cause conditions such as edema. Hormones and renal control maintain fluid homeostasis.
MED 4 Water and electrolyte disturbance.pdfRaymondLunda1
Total body water is about 60% of body weight in adults. Water is distributed between intracellular fluid (ICF) and extracellular fluid (ECF). Osmotic pressure controls water movement between compartments based on solute content. Common electrolytes include sodium, potassium, chloride, and bicarbonate. Disorders of water and electrolyte balance can cause dehydration or hyperhydration. Hyponatremia is defined as a sodium level below 135 mmol/L and can be hypovolemic, euvolemic, or hypervolemic depending on volume status. Diagnosis involves assessing history, physical exam, labs including osmolality, and imaging tests.
This patient presented with acute onset quadriparesis due to severe hyperkalemia. Laboratory investigations revealed high serum potassium of 8.7 mEq/L, metabolic acidosis, renal dysfunction, and glucosuria. The hyperkalemia was likely due to a combination of factors - decreased renal excretion due to recent initiation of ACE inhibitors and spironolactone for hypertension, worsening of renal function due to NSAID use and UTI, and potassium shift into extracellular space due to severe hyperglycemia and acidosis. Immediate treatment focused on reducing potassium levels while the underlying causes were addressed.
The document discusses body fluids and electrolytes. It describes the functions of body fluids, including transport of nutrients, waste removal, and temperature regulation. Water is the principal body fluid and makes up 50-70% of total body weight. Body fluids are divided into intracellular fluid (ICF) and extracellular fluid (ECF), with ICF making up around 40% of total body water. Factors like fluid intake and output help regulate fluid levels. Disturbances in fluid balance can cause issues like edema, cell dehydration, or cell overhydration. The document also covers electrolytes like sodium, potassium, calcium, and magnesium, their functions, and potential imbalances.
general presentation and management of Fluid & Electrolyte.pptxNatnael21
Discussion about physiology of fluid balance in human and clinical presentation and general management principles of major electrolyte abnormality like hypernatremia hyponatremia hyperkalemia and hypokalemia
This document discusses water and electrolyte balance, focusing on sodium balance. It covers:
- Body fluid compartments and volumes, with two thirds of total body water located intracellularly.
- Factors regulating fluid movement between compartments, including osmolality and oncotic pressure.
- Mechanisms maintaining water and sodium balance, such as thirst, ADH release, and renal reabsorption.
- Common disorders of water and sodium balance like dehydration, edema, hyponatremia, and hypernatremia.
This document provides an overview of fluids and electrolytes including:
- Body water distribution and regulation which is primarily controlled by the kidneys.
- The roles of electrolytes like sodium, potassium, calcium, and magnesium in fluid balance, acid-base balance, and cell function.
- Acid-base imbalances including respiratory and metabolic acidosis and alkalosis.
- Common IV fluids and their properties, uses, and indications.
- Fluid volume deficits and excesses, their causes, signs and symptoms, and nursing interventions focused on fluid balance and electrolyte monitoring.
This document provides an overview of hyponatremia, including:
1) Definitions, epidemiology, physiology, pathophysiology, types, clinical manifestations, diagnosis, and treatment of hyponatremia are discussed.
2) Hyponatremia is defined as a serum sodium concentration less than 135 mEq/L and is the most common electrolyte disorder. It can develop acutely or chronically.
3) Treatment involves addressing volume status, rate of sodium correction based on chronicity, and use of saline or water restriction depending on the type of hyponatremia. Complex formulas are provided to calculate sodium changes from intravenous fluids.
1. Hyponatremia is the most common electrolyte disorder, defined as a serum sodium concentration less than 135 mEq/L. It represents an excess of water relative to sodium.
2. The pathophysiology involves impaired free water excretion leading to a decrease in serum osmolality and brain cell swelling. Types include hypovolemic, euvolemic, hypervolemic, and redistributive hyponatremia.
3. Clinical manifestations range from asymptomatic to neurologic symptoms. Diagnosis involves assessing volume status, plasma and urine osmolality, and urine sodium. Treatment depends on symptoms, acuity, and volume status with goals of correcting sodium at appropriate rates.
This document provides an overview of hyponatremia, including its definition, epidemiology, physiology, pathophysiology, types, clinical manifestations, diagnosis, and treatment. Some key points include:
- Hyponatremia is defined as a serum sodium concentration of less than 135 mEq/L. It represents an excess of water relative to sodium.
- It is a very common electrolyte disorder, occurring in approximately 1-2.5% of hospitalized patients and up to 30% of ICU patients. Mortality is over 50% if sodium drops below 105 mEq/L.
- The kidney regulates sodium levels through ADH secretion, the renin-angiotensin-
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
3. Key Concepts
• Volume status (EABV) “think” saline in ECF
• Cannot be measured in the lab…
• TBW (Total Body Water) “think” [Na+ mEq/L]
Laboratory result… must examine the patient
• IV FLUID orders: Volume - Water - K+ - Acid/base
4. 3 Key Concepts in Fluid and Electrolyte
Physiology
• Cell membrane permeability
• Osmolality
• Electroneutrality
6. Osmolarity vs Osmolality
• Osmolarity is defined as the concentration of the
solute per liter of solution
• Osmolality is concentration of the solute/kg
solvent (usually plasma or urine)
• Sodium accounts for 97-98% of plasma osmolality
(range 287 7 mOsm/Kg)
• mOsm/kg = 2X[Na+ mEq/L] + (glucose mg/dL)/18 + (BUN mg/dL)/2.8
10. Body Fluid Compartments
• Adult humans are 50% - 70% water
• Women and the elderly have higher % of body fat
than young men, and thus less water.
• For all practical purposes, assume that
TBW = 0.60 X WT (kg)
11. Body Fluid Compartments
• 70 kg male (TBW=0.6 X wt)
• IntraCellFluid 28L (70 kg X 40% = 28)
• ECF 14L (70 kg X 20% = 14)
• Extravascular 10.5L (70 kg X 15% = 10.5)
• Intravascular 6.3L (70 kg X 9% = 6.3)
13. Body Fluid Compartments
• The composition of the ECF is roughly the same
as the interstitial space with the exception of
proteins which are trapped within the vascular
lumens.
• The distribution of fluid between these two spaces
is determined by Starling Forces.
14. Volume Homeostasis
• ECF Volume is linked to total body sodium
• Important: Total body sodium is not concentration
• Concentration depends not only on amount of
sodium but also the amount of water
• Total body sodium is regulated by the kidneys
• Input minus output equals accumulation…
15. Volume Depletion
(a.k.a Hypovolemia)
• Decreased ECF volume is always sensed as a decrease in
the “Effective Arterial Blood Volume (EABV)”
• The EABV signals the kidney whether to reabsorb or excrete
sodium.
• No direct measure of the EABV, it is determined by blood
volume, cardiac output, and systemic vascular resistance
• Decreased “EABV” results in Na+ retention and
expansion of ECF volume
18. Management of Hypovolemia
• The primary fluid prescribed for hypovolemia is
Normal Saline
• In the management of hypovolemia, there is no
place for ½NS or D5W….
• Transfusion
• Albumin
• Hetastarch (Hespan ®) or Plasmanate ®
19. IV fluids: continued
• Addition of an isotonic fluid (0.9% NaCl)
expands the ECF but doesn’t change the
IntraCellularFluid
• Addition of a hypotonic fluid (D5W) will cause
movement of water into the cells.
• Addition of a hypertonic fluid (3% saline) will
cause movement of water out of the cells.
20. Why is Normal Saline the “drug of
choice”?
• If you give 1 Liter of Normal Saline (0.9% NaCl),
the NaCl is restricted to the ECF, therefore the
entire liter stays in this space. 75% (750 ml) in
the interstitial fluid and 25% (250 ml) in the
intravascular space.
21. Body Fluid Compartments
• 70 kg male (TBW=0.6 X wt)
• IntraCellFluid 28L (70 kg X 40% = 28)
• ECF 14L (70 kg X 20% = 14)
• Extravascular 10.5L (70 kg X 15% = 10.5)
• Intravascular 6.3L (70 kg X 9% = 6.3)
22. IV Fluids: what about 0.45% saline?
• Think of 0.45% NaCl as 500ml of saline and 500 ml of
water.
• The saline distributes to the ECF compartment alone.
75% (375 ml) in the interstitial space and 25% (125
ml) in the intravascular space.
• The water distributes 66% (330 ml) to the intracellular
space & 33% (170 ml) to the ECF. Of the 170 ml to
ECF, only 25% or 42.5 ml stays in the intravascular
space.
24. When should you use hypotonic
solutions?
• If there is a need to administer water to the patient
(because of a water deficit state)
• Maintenance fluids (not volume replacement)
• D5W, D5¼NS or D5½NS may be used in
combination with bicarbonate if there is a need to
administer base.
25. Clinical Signs & Symptoms of Volume
Expansion
• Jugular venous distension +/- S3 gallop
• Dyspnea
• Ascites – this could be debated
• Pulmonary edema
• Pleural effusions
• Peripheral edema (remember hypoalbuminemia)
26. Management of Hypervolemia
• Goal of treatment
• Removal of extracellular fluid
• Loop Diuretics
• Salt restriction (PO and IV)
• Dialysis/CVVHD
• Phlebotomy
• Rotating tourniquets
28. Calculate the Water Deficit…
• [0.6] x (wt in Kg) X [{Na/140} – 1]
The water deficit should be fixed in the form of water (D5W or tap
water).
Water repletion is over and above the maintenance fluids which may be
either isotonic or hypotonic.
29. How do you write IV Fluid orders?
Input – output = accumulation
• Volume balance
• Water balance
• Potassium (deficit, CKD, Mg++, presence of
acidosis or alkalosis)
• Acid base (administration of bicarbonate or HCl)
30. Case I: Mild Hyponatremia
• 65 yo WF smoker @ small cell carcinoma
• No evidence of CHF on physical exam
• Na+ 122 mEq/l K+6.1
• Mild respiratory acidosis GFR normal
• No dyrenium, amiloride, or aldactone
• Positive history for Lovenox (DVT) for 2 weeks
31. Case I: hyponatremia - continued
• PE: normal vitals (no tilt) comfortable at rest
extremities - no edema no confusion
• Random U Na+ elevated at 40 mEq/L
• Uosm 600 TSH is WNL
• 1) Differential Diagnosis
• 2) IV fluid orders (NPO for cardiac evaluation)
32. Patient receives saline
• Diagnosis = SIADH
• IV saline administered: 1 liter = 300mosm
• Urine 600 mosm, provides for excretion of 300
mosm of sodium chloride in 500ml of urine
• Allows patient to “keep” 500 ml of water
• Sodium falls to 119 mEq/L
33. Case II: HIV possible sepsis
• 25 yo male with HIV
• Admitted with streptococcal sepsis with meningitis
• History of IVDA with baseline CKD
• ARF = BUN 80mg% creatinine 2.5mg%
• Volume depletion on exam
• NPO (unresponsive) Mild metabolic acidosis
• Sodium 133 mEq/L
• IV fluids?
34. Case III: history of CHF
• 70 yo diabetic, known CHF, mild CKD
• Admitted with acute coronary syndrome
• NPO for cardiac cath
• Recent increase in diuretics caused acute deterioration in
GFR: BUN > 110 creat 2.2mg%
• Euvolemic on exam (maybe a little dry?)
• Na+ 125mmole/L
• IV Fluids?
35. Case IV: DKA
• 45 yo WF IDDM X 20 yrs
• Non-functional glucometer…
• N&V for 18 hrs… indigestion/pain for 2 hrs
• No dyspnea No blood in emesis or stool
• ‘too sick’ to administer insulin
• PMH - DM HBP Lipids CKD
36. DKA: continued
• 130/60 tilting to 95/50 P110 R24 Afebrile
Neck: veins impossible to assess
Lungs: few rales, WOB increased
Cor: I/VI m, soft S3, increased HR
Abd:benign, non-distended Ext: 1+edema
• WBC 12K Hct 35% 2+proteinuria 5-10
WBC/HPF
• EKG: 2mm ST elevation III and AVF
37. DKA: continued
• Na+ 131 K+ 3.2 Cl- 104
• HCO3 5mEq/l BUN 70 Creat 2.0
• anion gap 22 mEq
• pH 7.18 pCO2 18 pO2 80
• (1.5)(HCO3) + 8 [+/- 2mEq] = pCO2
• Dx? Volume status? Na+? K+?
• acid/base issues? IV fluids?
38. Case V: Rhabdomyolysis
• 24 yo SWAT team member of GPD
• August 1998 “106 degrees in the shade”
• full gear running drill - collapse in field
• BP 100/60 P 130 T 102.8 rectal
• Skin warm Neck veins: nl Lungs: clear
• Cor: increased HR MS: tender back/gluteal
region, no edema
39. Rhabdo: continued
• Urine looks red… scant volume… heme +
• U Na+ <10 FeNa+ low Na+ 149
• K+ 5.9 Anion gap 22 Bun 15 Creat 2.4
• Ca++ 6.5 Phos 8.5 CPK 50,000
• “As you rapidly cool down the patient:”
• Diagnosis? Volume status?
• Cause of Hyperkalemia?
• IVF orders?
40. Case VI: Ascites
• 65 yo retired engineer with known cirrhosis
• ETOH exposure Hx GIB/varices
• Meds: Beta blocker Aldactone Furosemide
(no NSAID’s)
• Decreased intake for several days; increasing abd
pain - severe, diffuse, no radiation; minimal
emesis no gross hemorrhage in stool
41. Ascites: continued
• PE: barely awake confabulates barely follows
• tremulous T 101.8 BP 90/60 red palms spider
angiomata muscle wasting massive ascites very
tender abdomen guaiac positive stool 1+ edema 2+
ankles
• Lab: WBC 20K Hct 34% Bili 4 albumin 2.4 INR
2.5 AG 12 Na+128 K+ 5.0 FeNa<1; ascites with
3000 WBC and positive gram stain
• BUN 80 Creat 3mg% Decreased U Na+ < 15
43. Case VII – Metabolic acidosis
• Patient with recurrent diarrhea complains of
muscle weakness
• No carpopedal spam, Trousseau’s of Chvostek’s
• EKG reveals ST-segment and T-wave changes
and PVC’s compatible with hypokalemia
45. Case VIII: Chronic Li+
• 40 yo female NPO X 48 hours post complicated
cholecystectomy
• Admission [Na+] = 146 mmoles
• Developes profound hypotension requiring
transfer to ICU (without myocardial infarction)
• Current [Na+] = 175 mmoles
• IV fluid orders?
46. Case IX: AKI
• 60 yo attorney ANURIC AKI SEPSIS
• MSOF: lungs, cardiac, liver, renal, bone marrow,
nutrition, skin, CNS
• Intermittent HD
• [Na+] 130 [K+] 3.3 BUN 40 mg% Creat 5mg%
• IVF orders? TPN? Tube feeds?
47. Case X: acute water intoxication
• 20 yo SMU student brought to ER by fraternity
• Unresponsive hypothermic hypotensive
• Sodium 106 mEq/L Mild azotemia
• Calculated water load > 8 liters…
• IVF?
48. Summary
• Most common error in writing IV Fluid orders:
• 1) administration of NS in pts with SIADH
• 2) inadequate volume replacement in sepsis or
pre-renal azotemia
51. Symptoms and Signs of Hyponatremia
Symptoms
Lethargy
Headache
Apathy
Muscle Cramps and weakness
Anorexia
Nausea
Agitation
Psychosis
Signs
Abnormal sensorium
Depressed deep tendon reflexes
Hypothermia
Pathologic reflexes
Pseudobulbar palsy
Seizures
*Tentorial Herniation
*Cheyne-Stokes respiration
*Coma
Death
52. Acute Symptomatic Hyponatremia
• Duration <48 hrs
• Increase serum [Na] rapidly by approximately 2 mM/L/hr until
resolution of symptoms.
• Full correction probably safe, but not necessary
• Hypertonic Saline 1-2 ml/kg/hr
• Coadministration of Furosemide
Note: The sum of urinary cations (U Na + U K ) should be less than the concentration of infused sodium
to ensure excretion of electrolyte free water.
54. • Duration >48 hrs or unknown
• Initial increase in serum [Na] by 10% or 10 mM/L
• Hypertonic Saline 1-2 ml/kg/hr
• Co-administration of Furosemide
• Perform frequent neurologic evaluations; correction rate may be reduced
with improvements in symptoms
• Perform frequent measurement of serum and urine electrolytes
• At no time should correction exceed rate of 1.5 mM/L/hr, or increment of 15
mmol/day
• Change to water restriction upon 10% increase of [Na], or if symptoms resolve
Chronic Symptomatic Hyponatremia
Note: The sum of urinary cations (U Na + U K ) should be less than the concentration of infused sodium
to ensure excretion of electrolyte free water.
55. Severe Hyponatremia (<125 mM/L)
Symptomatic Asymptomatic
Acute
Duration < 48 hrs
Chronic
Duration > 48 hrs
Emergency Correction Needed
•Hypertonic Saline 1-2 ml/kg/hr
•Coadministration of Furosemide
Some Immediate Correction Needed
•Hypertonic Saline 1-2 ml/kg/hr
•Co-administration of Furosemide
•Change to water restriction upon 10% increase of [Na],
or if symptoms resolve
•Perform frequent measurement of serum and urine
electrolytes
•Do not exceed 1.5 mM/L/hr, or 20 mM/d
Chronic
Rarely < 48 hrs
Long Term Management
•Identification and Treatment of Reversible
etiologies
•Water Restriction
•Demeclocycline 300 mg to 600 mg bid
•Urea 15 to 60g qd
•V2 receptor antagonists
No immediate
correction needed
Treatment of Severe Euvolemic Hyponatremia (<125 mmol/L)
56.
57. Treatment of Asymptomatic Chronic
Hyponatremia
• Fluid Restriction
• Pharmacologic Inhibition of Vasopressin Action
• Lithium
• Demeclocycline
• V-2 receptor antagonist
• Increase solute Excretion
• Furosemide + 2-3 g of NaCl/day
• Urea 30 g/d
• Increased dietary protein intake
58. Management of Non-Euvolemic
Hyponatremia
SM Lauriat, T Berl: The Hyponatremic patient: Practical Focus on Therapy. J Am Soc Nephrol, 1997,
8(11):1599-1607.
• Hypovolemic Hyponatremia
• Volume restoration with isotonic saline
• Identify and correct etiology of water and sodium losses
• Hypervolemic Hyponatremia
• Water Restriction
• Sodium Restriction
• Substitute loop diuretics instead of thiazide diuretics
• Treatment of stimulus for sodium and water retention
• V2-receptor antagonist
60. Guidelines for the Treatment of
Symptomatic Hypernatremia
• Correct at a rate of 2 mM/L/hr
• Replace half of the calculated water deficit over the first 12-
24 hrs.
• Replace the remaining deficit over the next 24-36 hrs.
• Perform serial neurologic examinations - prescribed rate of
correction can be decreased with improvement in
symptoms
• Measure serum and urine electrolytes every 1-2 hrs.
Note: If U[Na] + U[K] is less than the concentration of P[Na], then there are ongoing water losses that
need to be replaced
61. Treatment of Hyponatremia
• Three Key Questions
• Is the patient symptomatic?
• What is the duration of Hyponatremia?
• Are there any risk factors for the development of
neurologic complications?