Fluid & ElectrolytesFluid & ElectrolytesDr. Faiez AlhmoudDr. Faiez AlhmoudAlbashir Teaching HospitalAlbashir Teaching HospitalWhy do we care about fluids in the Why do we care about fluids in the body?body?Fluids factsFluids factsOver half of our body eight is fluid materialOver half of our body eight is fluid material! Fluids are "#$ of an adult%s body eight ! Fluids are "#$ of an adult%s body eight ! 'g adult male has "#$ ( ) *+ ,iters! 'g adult male has "#$ ( ) *+ ,iters! -nfants have more ater ) &.!/#$ of 01! -nfants have more ater ) &.!/#$ of 01! Elderly have less ater ) *.!.#$ of 01! Elderly have less ater ) *.!.#$ of 01! 2ore fat means 3ater 4female has .#!..$5! 2ore fat means 3ater 4female has .#!..$5! 2ore muscle means 6ater 4male has ..!"#$5! 2ore muscle means 6ater 4male has ..!"#$5! -nfants and elderly are more prone to fluid imbalance! -nfants and elderly are more prone to fluid imbalance! -n adults7 a loss of 8ust 9:. of body fluid eight can ! -n adults7 a loss of 8ust 9:. of body fluid eight can be fatal 42arathon runners5. be fatal 42arathon runners5. 3 3VARIATIONS IN FLI! "ONT#NTVARIATIONS IN FLI! "ONT#NTAGE & GENDERAGE & GENDER0ody Fluid ; Function0ody Fluid ; Functionlightly decreasedDecreased or absent6 / enta, stat+s Formal >lightly fussy -rritable or lethargicDehydration in 2hi,drenDehydration in 2hi,drenDegrees !f Dehydration in ad+,tsi,d=ed=8% of tota, body water @ =/=A8,itAar>ed thirstBo,ig+riaB0tABp+,seBRARB BCB Dry *+-o+s &ar>ed thirstBo,ig+riaB0tABp+,seBRARB BCB Dry *+-o+s & &ow grade fe.erA &ow grade fe.erA)e.ere= D% )e.ere= D% of of tota, body water @ 8/8A8,itA tota, body water @ 8/8A8,itA)y*pto*s of *ar>ed dehydration p,+s3 )y*pto*s of *ar>ed dehydration p,+s3)ysto,i- b,ood press+re drop 660 ** 0g or be,ow7 )ysto,i- b,ood press+re drop 660 ** 0g or be,ow7Beha.iora, -hanges 6rest,essnessB irritabi,ityB de,iri+* Beha.iora, -hanges 6rest,essnessB irritabi,ityB de,iri+*& disorientationB7 & disorientationB7$ata, evere5.$ind #ype of Dehydration $ind #ype of Dehydration 4-sonatremic7 Hyponatremic7 Hypernatremic5.4-sonatremic7 Hyponatremic7 Hypernatremic5.Gi.e dai,yaintenan-eAGi.e dai,yaintenan-eAGi.e Defi-it as fo,,ows3 Gi.e Defi-it as fo,,ows3

Half volume over / hours7 half volume over 9" Half volume over / hours7 half volume over 9" hourshours4EEception; in Hypernatremic Dehydration74EEception; in Hypernatremic Dehydration7replace deficit over */ hours5.replace deficit over */ hours5.(f hae*orrhageis the -a+se for E2$"DCacDed red cells folloed by hypotonic -M CacDed red cells folloed by hypotonic -M fluids is administeredfluids is administered-n situations here the blood loss is less -n situations here the blood loss is less than 9 , Formal >aline or =inger lactate than 9 , Formal >aline or =inger lactate may be usedmay be usedCatients ith severe E@FMD accompanied Catients ith severe E@FMD accompanied by severe heart 7 liver7 or Didney disease by severe heart 7 liver7 or Didney disease cannot tolerate large volumes of fluid and cannot tolerate large volumes of fluid and sodium & need monitoring 4sodium & need monitoring 42"C72"C7 E4#RA2E&&'&AR $&'(D "!&'EE42E))E@FME is increased fluid retention in the E@FME is increased fluid retention in the intravasular and interstitial spacesintravasular and interstitial spacesE#(!&!G% AND R()5 $A2#!R)4EMFME5Heart failure Heart failure=enal failure =enal failure@irrhosis of liver @irrhosis of liver-ncreased ingestion of high sodium foods -ncreased ingestion of high sodium foodsEEcessive amount of -M fluids containing sodium EEcessive amount of -M fluids containing sodiumElectrolyte free -M fluids Electrolyte free -M fluids>epsis >epsisDecreased colloid osmotic pressure Decreased colloid osmotic pressure,ymphatic and venous obstruction,ymphatic and venous obstruction @ushing%s syndrome & glucocorticoids@ushing%s syndrome & glucocorticoids 2&(N(2A& AN($E)#A#(!N 4EMFME54EMFME5@onstant irritating cough@onstant irritating coughDyspnoea & cracDles in lungsDyspnoea & cracDles in lungs@yanosis7 pleural effusion@yanosis7 pleural effusionFecD vein distentionFecD vein distention0ounding pulse &elevated 0C0ounding pulse &elevated 0C>B gallop>B gallopCitting & anasacraedemaCitting & anasacraedema1eight gain1eight gain-ncreased @MC& C@1C-ncreased @MC& C@1C@hange in level of consciousness@hange in level of consciousness&AB (N"E)#(GA#(!N 4EMFME5serum osmolality V+&.mOsm: Dgserum osmolality V+&.mOsm: Dg,o 7 normal or high sodium,o 7 normal or high sodiumDecreased hematocrit S V *.$TDecreased hematocrit S V *.$TLrine specific gravity belo 9.#9#Lrine specific gravity belo 9.#9#Decreased 0LF SV /mg: dlT Decreased 0LF SV /mg: dlT ANAGEEN# 4EMFME54EMFME5Diuretics Scombination of potassium Diuretics Scombination of potassium sparing and potassium depletingsparing and potassium depletingdiureticsTdiureticsT-n people ith @HF; A@E inhibitors and -n people ith @HF; A@E inhibitors and lo dose of beta blocDers are used lo dose of beta blocDers are used A lo sodium diet A lo sodium diet E4#RA2E&&'&AR $&'(D "!&'E )0($#3 #0(RD )CA2(NG6shift7Fluid that shifts into nonfunctioning Fluid that shifts into nonfunctioning spaces and remain there is called as spaces and remain there is called as third space fluid third space fluid @ommon sites are abdomen 7 pleural @ommon sites are abdomen 7 pleural cavity7 peritoneal cavity and G- lumen cavity7 peritoneal cavity and G- lumen R()5 $A2#!R)6shift7 @rushing in8uries7 ma8or tissue trauma@rushing in8uries7 ma8or tissue trauma2a8or surgery2a8or surgeryEEtensive burnsEEtensive burnsCancreatitisCancreatitisCerforated peptic ulcers ! peritonitisCerforated peptic ulcers ! peritonitis-ntestinal obstruction-ntestinal obstruction,ymphatic obstruction ,ymphatic obstruction HypoalbumenemiaHypoalbumenemia2&(N(2A& AN($E)#A#(!N4shift5sDin pallorsDin pallor@old eEtremities@old eEtremities1eaD and rapid pulse1eaD and rapid pulseHypotension Hypotension OliguriaOliguriaDecreased levels of consiousnessDecreased levels of consiousness

&AB (N"E)#(GA#(!N Elevated hematocrit & 0LF levelElevated hematocrit & 0LF levelAs in the iso!osmolarAs in the iso!osmolarANAGEEN#6shift7Treat the causeXFor burns and tissue in8uries large volume For burns and tissue in8uries large volume of isosmolar -Mfluid is administeredof isosmolar -Mfluid is administeredXAlbumin is administered for protein deficitAlbumin is administered for protein deficitX-M fluid intaDe is maintainedafter ma8or -M fluid intaDe is maintainedafter ma8or surgery to maintain Didney perfusion surgery to maintain Didney perfusion XCaracentesis or tapping for ascitis or Caracentesis or tapping for ascitis or pleural effusion pleural effusion (N#RA2E&&'&AR $&'(D "!'&E E42E))3WA#ER (N#!4(2A#(!N -@FMEis increase in amount of ater -@FMEis increase in amount of ater inside the cellsinside the cellsE#(!&!G% 6(2$"E7Administration of eEcessive amount of Administration of eEcessive amount of hyposmolar -M fluidsS#.*.$saline or hyposmolar -M fluidsS#.*.$saline or .$deEtrose in aterT.$deEtrose in aterT@onsumption of eEcessive amount of tap @onsumption of eEcessive amount of tap ater ithout ade?uate nutritional intaDeater ithout ade?uate nutritional intaDe

4>chizophreniaScompulsive ater 4>chizophreniaScompulsive ater consumptionT5consumptionT5>-ADH results from innapropriate ADH >-ADH results from innapropriate ADH secretion resulting in innapropriate retention secretion resulting in innapropriate retention of ingested:infused ater of ingested:infused ater 2&(N(2A& AN($E)#A#(!N) 6(2$"E7 HeadachesHeadaches0ehavioral changes 0ehavioral changes ApprehensionApprehension-rritability7 disorientation and confusion-rritability7 disorientation and confusion-ncreased -@C < pupillary changes and -ncreased -@C < pupillary changes and decreased motor and sensory functiondecreased motor and sensory function0radycardia7 elevated 0C7 idened pulse 0radycardia7 elevated 0C7 idened pulse pressure & altered respiratory patterns7 pressure & altered respiratory patterns7 0abinsDi%s response flaccidity7 pro8ectile vomiting7 0abinsDi%s response flaccidity7 pro8ectile vomiting7 papilledema7 delirium7 convulsions &comapapilledema7 delirium7 convulsions &coma&AB!RA#!R% $(ND(NG) 6(2$"E7 ,o serum sodium level! 9+. mE?:,,o serum sodium level! 9+. mE?:,decreased hamatocritdecreased hamatocritANAGEEN# 6(2$"E7 Early administration of -M fluids containing Early administration of -M fluids containing sodium chloride can prevent >-ADHsodium chloride can prevent >-ADHoral fluids such as 8uices or soft drinDs can be oral fluids such as 8uices or soft drinDs can be given orally every hourgiven orally every hourCerform neurologic checDs every hour to see if Cerform neurologic checDs every hour to see if cranial changes are presentcranial changes are present2onitor fluid intaDe 7 -M fluids and fluid output 2onitor fluid intaDe 7 -M fluids and fluid output hourly and eight dailyhourly and eight dailyAdminister antiemetics for food and fluid Administer antiemetics for food and fluid retention retention (N#RA2E&&'&AR $&'(D "!&'E DE$(2(#>evere hypernatremia and dehydration >evere hypernatremia and dehydration can cause -@FMDcan cause -@FMD=elatively rare in healthy adults=elatively rare in healthy adults@ommon in elderly people and in those @ommon in elderly people and in those conditions that result in acute ater lossconditions that result in acute ater loss>ymptoms include confusion7 coma7 and >ymptoms include confusion7 coma7 and cerebral hemorrhagecerebral hemorrhage

Assess*ent of f,+id and Assess*ent of f,+id and E,e-tro,ytes (*ba,an-eFE,e-tro,ytes (*ba,an-eFObservation of general condition of the patient7 Observation of general condition of the patient7 including including vital signsvital signs7 7 necD veinsnecD veins7 7 sDinsDin7 and 7 and mucous membranesmucous membranes7 7 eighteight7 7 presence of presence of edemaedema andandappetite.appetite.Type of fluid lost.Type of fluid lost.@haracter and volume of urine & specific gravity @haracter and volume of urine & specific gravity Assessment of blood electrolytes level.Assessment of blood electrolytes level.0lood urea nitrogen and creatinine level.0lood urea nitrogen and creatinine level.Fre?uency and character of stool.Fre?uency and character of stool.2easuring and recording intaDe and output.2easuring and recording intaDe and output.The rules of fluid replacement;The rules of fluid replacement;=eplace blood ith blood=eplace blood ith blood=eplace plasma ith colloid or ,==eplace plasma ith colloid or ,==esuscitate ith colloid or ,==esuscitate ith colloid or ,==eplace E@F depletion ith saline=eplace E@F depletion ith saline=ehydrate ith deEtrose=ehydrate ith deEtroseHyponatremicpt. needs Hyponatremicpt. needs F>> or hypertonic saline F>> or hypertonic salineHypernatremicpt. needsHypernatremicpt. needs OF >L@@E>>FL,=E>L>@-TAT-OFL=-FA=R OLTCLTL=-FA=R OLTCLTL=E 0,OOD C=E>>L=E COO=COO= -FD-@ATO=-FD-@ATO=Ho much fluid to give KHo much fluid to give K1hat is your starting point K1hat is your starting point Kerum Malues of ElectrolytesCations (+)Cations (+) 2on-entration 2on-entration)odi+* )odi+* :=8 E :?8 *EGH& :=8 E :?8 *EGH&Cotassi+* Cotassi+* =A8 / ?A8 *EGH&=A8 / ?A8 *EGH&2a,-i+* 2a,-i+* I/:0A8 *gHd&I/:0A8 *gHd&agnesi+* agnesi+* :A8 /