Fluid and electrolytes<\/p>\n
Fluid regulation
\nADH (antidiuretic hormone) – released when water levels are low to increase tubular reabsorption<\/p>\n
Electrolyte regulation
\nAldosterone – released when serum sodium is low to increase tubular reabsorption. <\/p>\n
Water balance
\nAssess drinking ability in all patients
\nFluid balance charts
\nInsensible loss, 400 mls skin, 400 mls lungs, metabolic water 400mls day
\nVaries with stress, ambient conditions, fever
\nDaily weight<\/p>\n
Too much water
\nIncreased intake or reduced output
\nIatrogenic fluid overload
\nBig risk in children
\nWater intoxication, polydipsia<\/p>\n
Disease states causing fluid retention
\nRenal impairment
\nHeart failure
\nHypoalbuminaemia
\nHepatic cirrhosis<\/p>\n
Clinical features
\nPolyuria, light colour if normal renal function
\nOedema
\nPulmonary oedema, orthopnoea
\nRaised jugular venous pressure
\nMay contribute to congestive cardiac failure
\nPleural and pericardial effusion
\nAscites
\nReduced electrolyte concentrations
\nOverhydration of cells<\/p>\n
Treatments
\nUnderlying cause
\nDiuretics
\nDialysis \/ haemofiltration
\nReduce sodium intake<\/p>\n
Not enough water
\nCauses
\nLack of water intake
\nVomiting and diarrhoea
\nBurns
\nExcessive sweating – hot environment, increased work load
\nFever
\nDiabetes insipidus
\nOsmotic diuresis
\nDKA, HONK
\nIatrogenic, diuretic use, alcohol<\/p>\n
Features of dehydration
\nDry mouth\/Thirst
\nOliguria then anuria, ureamia
\nReduced CVP
\nTachycardia
\nVasoconstriction and pallor
\nPeripheral venoconstriction
\nPostural hypotension then hypotnesion
\nNausea
\nInelastic skin
\nSunken eyes
\nMuscle cramps
\nIncreased blood viscosity – sluggish circulation
\nImpairment in function of many organs —- confusion —- coma
\nHaemoconcentration – increased plasma sodium
\nElevated haematocrit
\nSunken fontanel<\/p>\n
Treatments in diarrhoea and vomiting
\nReplace water and electrolytes
\nOral rehydration solutions
\nOral or nasogastric fluids
\nSodium and glucose is actively taken up by the duodenum
\nPotassium and sodium are lost from gastrointestinal secretions
\nHypoglycaemia is a problem in diarrhoea and vomiting<\/p>\n
Other treatments
\nHaemorrhage
\nBurns
\nDehydration
\nIntravenous infusions
\nCrystalloids
\nColloids
\nBlood
\nSubcutanious infusions, 60 mls \/ hour
\nPer rectum administration of fluids may be used by people with low skill levels<\/p>\n
Blood volumes 6 months – 500 mls 2 years -1000 mls 5 years – 1.5 litres
\n10 years – 2 litres 12 years – 2.25 litres<\/p>\n
Electrolyte balance<\/p>\n
Normal ranges
\nPotassium, 3.5 – 5 mmol\/L Sodium, 135 – 145 mmol\/L<\/p>\n
Hyponatraemia
\nCauses
\nVomiting Diarrhoea
\nExcessive sweating Impaired tubular reabsorption
\nExcessive diuretic therapy Addisons disease
\nWater excess<\/p>\n
Effects
\nReduced blood volume
\nHypotension
\nHeat exhaustion, (loss of water and sodium)
\nStokers cramp<\/p>\n
Treatment
\nRemove\/treat cause Oral sodium
\nIV. normal saline<\/p>\n
Hypernatraemia
\nCauses
\nWater deficit – increased loss or reduced intake
\nOsmotic diuresis
\nHigh levels of mineralcorticoids
\nCushing`s syndrome<\/p>\n
Effects
\nThirst Increase in blood volume
\nNausea Vomiting
\nConfusion<\/p>\n
Treatment
\nTreat underlying cause Correct over 48 hours<\/p>\n
Hypokalaemia
\nCauses
\nIf you would like to get hold of my books, one on Physiology and another on Pathophysiology, check out my web site campbellteaching.co.uk Funds from selling books helps to finance distribution of resources to students in poorer countries.<\/p>\n
Vomiting Diarrhoea
\nDiuretic therapy Alkalosis
\nIncreased aldosterone levels<\/p>\n
Effects
\nUsually asymptomatic Weakness
\nAtrial and ventricular ectopic beats Cardiac dysrhythmias<\/p>\n","protected":false},"excerpt":{"rendered":"
Fluid and electrolytes Fluid regulation ADH (antidiuretic hormone) – released when water levels are low to increase tubular reabsorption Electrolyte regulation Aldosterone – released when serum sodium is low to increase tubular reabsorption. Water balance Assess drinking ability in all patients Fluid balance charts Insensible loss, 400 mls skin, 400 mls lungs, metabolic water 400mls […]<\/p>\n","protected":false},"author":0,"featured_media":7467,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"video","meta":{"yasr_overall_rating":0,"yasr_post_is_review":"","yasr_auto_insert_disabled":"","yasr_review_type":"","footnotes":""},"categories":[25],"tags":[61,1472,1471,1430],"class_list":["post-7466","post","type-post","status-publish","format-video","has-post-thumbnail","hentry","category-gaming","tag-education","tag-electrolytes","tag-fluids","tag-nursing","post_format-post-format-video"],"yoast_head":"\n