water and electrolyte imbalance.ppt
TRANSCRIPT
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Indra WijayaDepartment of Internal Medicine
Faculty of Medicine, UPHSiloam Lippo Village Hospital
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FLUID
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FLUID / WATER BALANCE•Normal plasma osmolality 275-290
mosmol/kg
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ETIOLOGY
I. ECF volume contractedA. Extrarenal Na+ lossB. Renal Na+ and water lossC. Renal water loss
II. ECF volume normal or expandedA. Decreased cardiac outputB. RedistributionC. Increased venous capacitance
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Sign and Symptoms•General weakness - fatigue•Delirium•Hangover•Thirsty•Hypotension•Dry mouth•Skin turgor •Decreased urin volume
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TREATMENT• I.V line Hidration 1 - 2 liters!
•Normonatremic and most hyponatremia: normal saline (NaCl 0.9%)
•Hypernatremia: half-normal saline (NaCl 0.45%)/ D5% infusion.
•Hemorrhage, anemia, or intravascular volume depletion: blood transfusion / colloid
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ETIOLOGYExcessive sodium and fluid intake:• IV therapy containing sodium• Transfusion reaction to a rapid blood transfusion.• High intake of sodium
Sodium and water retention:• Heart failure• Liver cirrhosis• Nephrotic syndrome• Corticosteroid therapy• Hyperaldosteronism• Low protein intake
Fluid shift into the intravascular space:• Fluid remobilization after burn treatment• Administration of hypertonic fluids• Administration of plasma proteins, such as albumin
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Sign and Symptoms•Shortness of breathing
•Paroxysmal nocturnal dyspneu
•High JVP
•Ascites
•Edema
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TREATMENT
Treat etiology / underlying cause
Loop Diuretics – monitor BP
Dialysis
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SODIUM
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Na < 135 mmol/L
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CLINICAL FEATURES
•Maybe asymptomatic
•Nausea and malaise
•Headache, lethargy, confusion, and obtundation
•Stupor, seizures, and coma: Na < 120 mmol/L
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TREATMENT
• Asymptomatic hyponatremia associated with ECF volume contraction isotonic saline
• Hyponatremia associated with edematous states restriction of Na+ and water intake
• Euvolemic and hypervolemic hyponatremia nonpeptide vasopressin antagonists
0.5–1.0 mmol/L per hor
10–12 mmol/L over the first 24 h
ODS
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Na+ > 145 mmol/L
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ETIOLOGY
•Primary hypodipsia
•Renal
•Extra renal• Skin• Respiratory tract• GI tract• CDI• NDI
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CLINICAL FEATURES
•Polyuria or thirst•Altered mental status•Weakness•Neuromuscular irritability•Focal neurologic deficits•Coma or seizures
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TREATMENT•correct the water deficit
5% dextrose / half-isotonic saline
•treating the underlying cause:• stop ongoing water loss• CDI desmopressin intranasally• NDI amiloride• Low-salt diet in combination with low-dose
thiazide diuretic therapy NDI+CDI
Plasma [Na+] should be lowered by 0.5 mmol/L per h and < 12 mmol/L over the first 24 h
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POTASSIUM
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K+ < 3.5 mmol/L
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ETIOLOGYI. Decreased intake
II. Redistribution into cellsA. Acid-baseB. HormonalC. Anabolic stateD. Other
III. Increased lossA. RenalB. Non Renal
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CLINICAL FEATURES
•Fatigue
•Myalgia
•Weakness of lower extremities
•Diaphragm paralysis
•ECG?
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TREATMENT
•Potassium chloride: p.o / i.v
•Potassium bicarbonate and citrate hypokalemia associated with chronic diarrhea/RTA
The maximum concentration of administered K+ should be no more than 40 mmol/L via peripheral vein
60 mmol/L via central vein
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K+ > 5 mmol/L
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ETIOLOGY
I. Renal Failure
II. Decreased distal flow
III. Decreased K+ secretionA. Impaired Na+ reabsorptionB. Enhanced Cl- reabsorption
(chloride shunt)
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CLINICAL FEATURES
•Weakness
•Flaccid paralysis
•Hypoventilation
•Cardiac toxicity
•ECG?
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TREATMENT
•Calcium gluconate
•10 units of regular insulin and 50 gram of glucose
•Diuretics
•Cation-exchange resin
•Dialysis
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