fluid e i ppt

8/8/2019 Fluid E I ppt

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Grace AlexanderMSc Nursing I year

PION


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1.Acid-base balance: Refers to homeostasis ofhydrogen ion (H+) concentration in the body fluids.

2. Homeostasis: The tendency to maintain relativelyconstant condition.

3. Fluid volume excess: Increase in body water.

4. Fluid volume deficit: Occurs when there is less

water than normal in the body.5. Extracellular fluid (ECF): Fluid outside the cell

6. Intracellular fluid (ICF): f luid inside the cell

7. Interstitial f luid: Fluid surrounding the cells.


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1. FLUID

2. ELECTROLYTES


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1. ADH

2. ALDOSTERONE

3. THIRST4. ATRIAL NATRIURETIC PEPTIDE


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The normal metabolic activity of tissues results inproduction of2 types of acid.

i. Carbonic acid: Volatile acid derived from CO2

ii. Nonvolatile: Organic acids, uric acid, inorganicphosphates produced from incomplete combustionof carbohydrates, fats, proteins and organicphosphates.

PARAMETER ARTERIAL BLOOD VENOUS BLOOD

pH 7.38 - 7.45 7.35 - 7.45

pCO2 35 - 45 45 - 50

HCO3 23 - 27 meq/L 24 - 25meq/L


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i. Respiratory Acidosis: Hypoventilation results in CO2

retention and a rise in pCO2

causing respiratory acidosis.

ii. Respiratory Alkalosis: Hyperventilation results in CO2

washout and consequent drop in arterial pCO2, causing

respiratory alkalosis.

iii.

Metabolic Acidosis: Increased non-volatile acids in bodycauses in metabolic acidosis.

iv. Metabolic Alkalosis: Decreased non-volatile acids in bodycauses metabolic alkalosis.


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CONDITION CAUSES pH HCO3 PaCO2

Respiratory

Acidosis

Hypoventilation Decreased Normal Increased

Respiratory

Alkalosis

Hyperventilation Increased Normal Decreased

Metabolic

Acidosis

Diabetic

Ketoacidosis

Decreased Decreased Normal

Metabolic

Alkalosis

HCO3 Retention Increased Increased Normal


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Hyponatremia is termed as serum sodium level less than130meq/L

CAUSES

1. Actual deficiency of Sodium

Eg: Excessive Sodium loss in vomiting, diarrhea,diaphoresis.

2. Increase in body water that dilutes sodium excessively

a. Excessive secretion of ADH (SIADH)

b. Nephrotic syndrome

c. CCF


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i. Headache

ii. Muscle Weakness

iii. Fatigue

iv. Apathy

v. Confusion

vi. Abdominal cramps

vii. Orthostatic Hypotension


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i. Restriction of fluids

ii. Hypertonic saline

iii. Diuretics (furosemide)


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Hypernatremia is termed as serum sodium >150 meq/L.It is a serious imbalance that can lead to death if notcorrected. The high level of sodium in the extracellularfluid causes water to shift out of cells.This creates acondition of cellular dehydration.

CAUSES:

Hypernatremia occurs when there is excessive loss ofwater or excessive retention of sodium.

i. Vomiting

ii. Diarrhoea

iii. Diaphoresis

iv. Insufficient ADH


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CLINICAL MANIFESTATION

Thirst, flushed skin, dry mucous membrane, low urine

output, restlessness, increased heart rate, convulsions,postural hypotension.

MANAGEMENT

Replacement of water to restore balance

Fluids with reduced sodium content (like N/2 or N/3or N/5 DNS)


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Hypokalemia is termed as serum potassium < 3.5meq/L.

CAUSES

i. Vomiting

ii. Diarrhoeaiii. Nasogastric Suction

iv. Inadequate dietary intake of potassium

v. Diabetic Ketoacidosis

vi. Drugs such as potassium wasting diuretics,corticosteriods


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CLINICAL MANIFESTATIONS

As potassium is necessary for normal cellular functions,deficiencies results in gastrointestinal, renal,cardiovascular and neurologic disturbances.

Most important effect is on myocardial cells, which tendto cause abnormal, potentially fatal, cardiac rhythms.

MANAGEMENT

Potassium replacement by intravenous or oral route.

Cardiac monitoring

Include foods such as bananas, oranges or orange juice.

Potassium is always diluted before intravenousadministration. Rapid infusion can cause cardiac arrest.


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Hyperkalemia is termed as serum potassium > 5meq/LIt is a serious imbalance as it can cause life threatening

dysarrthymias.

CAUSES

i. Decreased renal function

ii. Metabolic acidosis

iii. Traumatic injuries(loss of potassium fromdamaged cells into ECF)

iv.


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CLINICAL MANIFESTATION1. Cardiovascular: Increased potassium first causes

bradycardia , then tachycardia, there is risk of cardiac

arrest.2. GI System: Explosive diarrhea, vomiting.3. Neuromuscular: Muscle cramps, weakness, paresthesia.4. Others: Irritability, anxiety, abdominal cramps,

decreased urine output.

MANAGEMENT1. Treatment of underlying cause, restricting potassium

intake2. Kayexalate(Polysterene sulfonate) administration

orally or rectally.3. Intravenous administration of calcium gluconate to

decrease effects of potassium on myocardium.4. Administration of Insulin+ glucose or sodium

bicarbonate to promote the shifting of potassium into

cells.


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Calcium in blood is regulated by parathyroid glands,which secrete parathyroid hormone (PTH). Hypocalcemiastimulates PTH secretion. PTH enhances calciumretention by the kidneys, promotes calcium absorption inintestine and mobilizes calcium from the bones to raiseserum level.

CAUSES

1. Diarrhoea

2. Inadequate dietary intake of calcium, Vit D.

3. Multiple blood transfusions(banked blood containscitrates that bind to calcium)

4. Hypothyroidism


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CAUSES1. Hyperthyroidism

2. Immobility(causes stores of calcium in the bones toenter bloodstream)


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It is divided into:

1. FLUID VOLUME DEFICIT

2. FLUID VOLUME EXCESS


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It occurs when there is less water than normal in body.Theyare of two types:

1. Isotonic extracellular fluid deficit(hypovolemia)

2. Hypertonic extracellular fluid deficit(dehydration)


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ISOTONIC ECF DEFICIT HYPERTONIC ECF

DEFICIT

DEFINITION Deficiency of both water and

relative electrolytes.

Deficiency of water

without electrolyte

efficiency.

ETIOLOGY Decreased fluid intake

related to inability to to

obtain or ingest fluids.

Excessive fluid loss related to

vomiting, diarrhea .

Shifting of f luid into

interstitial space(third

spacing)related to increased

capillary permeability.

Increased water loss

related to blood glucose

as in DM,inadequate

ADH production, high

fever, sweating.

Decreased fluid intake

with continued intake

of electrolytes as with

concentrated tube

feedings.


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ISOTONIC ECF

DEFICIT

HYPERTONIC ECF

DEFICIT

CLINICAL

MANIFESTATIONS

BP

Heart RateUrine Output

Hypotension

IncreasedDecreased

Hypotension

IncreasedIncreased or decreased

MANAGEMENT Correct underlying

cause

Replace water andelectrolytes

Correct underlyng

cause

Replace water.


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ISOTONIC ECF EXCESS HYPERTONIC ECF EXCES

DEFINITION Excess of both f luid and electrolytes Excess of body water without

excess electrolytes.

CAUSES Retention of water and electrolytes

related to kidney disease, overload with

intravenous fluid

Overhydration in presence of

renal failure

CLINICAL

MANIFESTATION

BP

PULSE

Increased

Bounding and increased rate

Increased systolic

Decreased rate

MANAGEMENT Correct underlying cause

Restrict water and sodium intake

Diuretics

Digitalis toimprove cardiac output

Dialysis if kidney failure is a factor

Salt restriction

Correct underlying cause

Restrict water intake

Give demeclocycline

(declomycin) to decrease

kidney response to ADH.


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fluid e i ppt

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