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Published byAlbert Bates Modified over 6 years ago
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Fluid volume deficit, excess and water intoxication
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Fluid Volume Disturbances
Fluid Volume Deficit (Hypovolemia)
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Fluid Volume Deficit Mild – 2% of body weight loss
Moderate – 5% of body weight loss Severe – 8% or more of body weight loss
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THREE TYPES OF deficit Hyperosmolar fluid volume deficit- water loss is greater than the electrolyte loss Isosmolar fluid volume deficit – equal proportion of fluid and electrolyte loss
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Fluid Volume Deficit Pathophysiology – results from loss of body fluids and occurs more rapidly when coupled with decreased fluid intake
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Fluid Volume Deficit Clinical manifestations Acute weight loss
Decreased skin turgor
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Fluid Volume Deficit - Oliguria - Concentrated urine
- Postural hypotension - Weak, rapid, heart rate - Flattened neck veins - Increased temperature - Decreased central venous pressure
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ETIOLOGY AND RISK FACTORS
Severe vomiting Traumatic injuries Ileostomy Burns Use of diuretics
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LABORATORY FINDINGS Increased osmolality(> 295 mOsm/ kg)
Increase BU (>25 mg / L ) Elevated hematocrit (> 55%) Increased specific gravity of urine ( > 1.030)
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MANAGEMENT Management of fluid in patient with fluid deficit should aim at Replacing deficit Correcting ongoing losses Maintenance
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Management of mild deficit
Mild fluid volume loss can be corrected with oral fluid replacement
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Management of moderate/severe volume deficit
IV fluids needed
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Fluid Volume Excess (Hypervolemia)
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Fluid Volume Excess Pathophysiology – may be related to fluid overload or diminished function of the homeostatic mechinisms responsible for regulating fluid balance
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ETIOLOGY AND RISK FACTORS
Heart failure Renal disorders Cirrhosis of liver Increased ingestion of high sodium foods Excessive amount of IV fluids containing sodium Electrolyte free IV fluids SIADH,Sepsis decreased colloid osmotic pressure lymphatic and venous obstruction Cushing’s syndrome & glucocorticoids
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Why does heart failure leads to oedema
Reduced renal perfusion--- activates renin angiotensin aldosterone mechanism---- results in fluid retention
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Why does renal failure cause oedema?
Why does liver failure cause oedema
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CLINICAL MANIFESTATION
Dyspnea & crackles in lungs pleural effusion Neck veins prominant Bounding pulse &elevated BP Pitting & sacral edema Weight gain Increased CVP Change in level of consciousness
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Fluid Volume Excess
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LAB INVESTIGATION serum osmolality <275mOsm/ kg
Decreased hematocrit [ < 45%]
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MANAGEMENT Diuretics Restrict fluids In people with HF, ACE inhibitors
A low sodium diet
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Water intoxication At the onset of this condition fluid outside the cells has an excessively low amount of solutes in comparison to inside the cells, the fluid shifts through osmosis into the cells in order to balance its concentration. This causes the cells to swell. In the brain, this swelling increases ICP
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features headache personality changes
changes in behavior, confusion, irritability difficulty breathing during exertion cramping, nausea, vomiting, seizures, brain damage, coma or death due to cerebral oedema
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Risk factors Psychiatric conditions-polydipsia
Over replacement of IV fluids Heat stress
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management Restriction of fluids is sufficient in mild cases
If severe diuretics needed
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Thank you!!
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