1. Angel Das Y.L 2nd year MBBS student
FLUID IMBALANCE
Angel Das Y.L
2nd year MBBS student

2. TOTAL BODY WATER

4. COMPOSITION OF FLUID COMPARTMENTS
ECF compartment – Na+,Cl-,HCO3-
ICF compartment – K+,Mg2+,Phospates & proteins
Conc: gradient – Na+-K+ pump

5. Movement of BODY FLUIDS
Diffusion
Osmosis
Active Transport
Filtration

6. DIFFUSION Fluid Solutes High Solute Concentration
Low Solute Concentration

7. Low Solute Concentration, High Fluid Concentration
OSMOSIS
Fluid
Low Solute Concentration, High Fluid Concentration
High solute
Concentration,
Low Fluid
Concentration

8. ACTIVE TRANSPORT ATP ATP ATP ATP Na + Na + Na + Na + Na + Na + Na +
K +
K +
K +
K +
K +
K +
ATP
K +
K +
K +
K +
K +
K +
K +
K +
K +
ATP
K +
K +

9. FLUID BALANCE
Normally INTAKE = OUTPUT

10. Disorders in fluid balance
BODY FLUID CHANGES
Disorders in fluid balance
Volume
Composition
Concentration

11. Volume Changes
Extracellular volume deficit most common fluid disorder. either
Acute
Chronic

12. Acute Chronic CVS & CNS signs
Tissue signs such as decrease in skin turgor & sunken eyes

13. Weight loss

14. Cardiac
Collapsed neck Veins
Tachycardia
Hypotension

15. Renal
.Azotemia
Oliguria GI
.Ileus

16. Common Cause – Volume deficit in Surgical Patients
Loss of GI fluids- Nasogastric suction,Vomitting,Diarrhea
Sequestration secondary to soft ts injuries, burns & intra abdominal processes such as peritonitis, obstruction or prolonged surgery

17. Extra cellular Volume Excess
Iatrogenic
Renal dysfunction
Secondary to
CHF
Cirrhosis

18. Generalized
Weight Gain
Edema

19. Cardiac Increased cardiac output Increased central venous pressure
Distended neck Veins
Murmur

20. GI
Bowel Edema
Pulmonary
Pulmonary edema

21. Volume Control By osmoreceptors & baroreceptors ↑ ADH Secretion
DECREASED FLUID VOLUME
Stimulation of thirst center in hypothalamus
↑ ADH Secretion
Renin-Angiotensin- Aldosterone System Activation
↑ Water resorption
Person complains of thirst
↑ Sodium and Water Resorption

23. Concentration Changes
Hyponatremia & Hypernatremia
Composition Changes
K+ abnormalities
Ca2+ abnormalities
Mg2+ abnormalities

24. FLUID THERAPY
Type of fluid- vol. status, conc, or compositional abnormality Lactated ringer soln & normal saline – isotonic useful in replacing GI loss & correcting extra cellular volume deficit

25. Alternative Resuscitative Fluids
Hypertonic saline solutions
-in closed head injuries
-increase cerebral perfusion & intracranial pressure
-decrease brain edema

26. 2.Colloids – Volume expanders
-but under severe hemorrhagic shock – worsens edema
-4 types – Albumin, dextrans, hetastarch & gelatins

27. Pre operative Fluid Therapy
Volume deficit – fluid replacement – isotonic crystalloid-depending on serum electrolyte values
Close monitoring

28. Intra operative Fluid Therapy
Hemodynamic instability during anesthesia avoided by correcting known fluid loss & providing adequate maintenance fluid therapy-pre operatively
Saline administration

29. Post Operative Fluid Therapy
Based on patient’s vol status & ongoing fluid loss
Initially- isotonic
Later –dextrose & normal saline