Fluid and Electrolyte Management - PowerPoint Presentation

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Fluid and Electrolyte Management

Presented by :

sajede

sadeghzade

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Total Body WaterWater constitutes approximately 50 to 60% of total body weight.

Lean tissues such as muscle and solid organs have higher water content than fat and bone.

The highest percentage of TBW is found in newborns, with approximately 80% of their total body weight comprised of water

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Fluid Compartments

TBW is divided into three functional fluid compartments: plasma, extravascular interstitial fluid, and intracellular

fluid.

Intracellular water makes up approximately 40% of an individual's total body weight, with the largest proportion in the skeletal muscle mass.

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Composition of Fluid CompartmentsThe ECF compartment is balanced between sodium, the principal

cation

, and chloride and bicarbonate, the principal anions

.

The intracellular fluid compartment is comprised primarily of the

cations

potassium and magnesium, and the anions phosphate and proteins

.

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Normal Exchange of Fluid and Electrolytes

The healthy person consumes an average of 2000 mL of water per

day :

75% from oral intake and the rest extracted from solid

foods

Daily water losses

include :

800 to 1200 mL in

urine

250 mL in

stool

600 mL in insensible

losses (

the skin (75%) and lungs (25

%))

To clear the products of metabolism, the kidneys must excrete a minimum of 500 to 800 mL of urine per day, regardless of the amount of oral intake.

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Disturbances in Fluid Balance

Extracellular volume deficit is the most common fluid disorder in surgical

patients

Acute volume deficit is associated with cardiovascular and central nervous system signs

chronic deficits display tissue signs, such as a decrease in skin turgor and sunken

eyes

Increase BUN

Urine osmolality > Plasma osmolality

Urine Na > 20

mEq

/L

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Disturbances in Fluid BalanceThe most common cause of volume deficit in surgical patients is a loss of GI

fluids

sequestration secondary to soft tissue injuries, burns, and intra-abdominal processes such as peritonitis, obstruction, or prolonged surgery can also lead to massive volume deficits

.

Extracellular volume excess may be iatrogenic or secondary to renal dysfunction, congestive heart failure, or cirrhosis.

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HyponatremiaA low serum sodium level occurs when there is an excess of extracellular water relative to sodium. Extracellular volume can be high, normal, or low

In

most cases of hyponatremia, sodium concentration is decreased as a consequence of either sodium depletion or

dilution

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Excess of Solute Hyponatremia

untreated

hyperglycemia or

mannitol

administration

When hyponatremia in the presence of hyperglycemia is being evaluated, the corrected sodium concentration should be calculated

For every 100 mg/

dL

increase in plasma Glucose above normal the plasma Na should decreased by 1.6

mEq

/L

extreme

elevations in plasma lipids and proteins can cause

pseudohyponatremia

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Sign and Symptoms of Hyponatremia

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Hypervolemic Hypernatremiaiatrogenic administration of sodium-containing

fluids

mineralocorticoid

excess :

Hyperaldosteronism

Cushing

syndrom

Congenital adrenal

hypreplasia

Urine Na > 20

mEq

/L and urine osmolality > 300

mosm

/L

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Normovolemic Hypernatremiarenal

causes :

diabetes

insipidus

Diuretic use

Renal disease

Non renal causes :

Water loss from GI

Water loss from skin

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Hypovolemic Hypernatremia

Same causes as normovolemic hyponatremia

Urine Na < 20

mEq

/L

Urine Osmolality < 300

mOsm

/L

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Hyperkalemia

Serum K > 5

mEq

/L

excessive potassium

intake

increased release of potassium from

cells

impaired

potassium excretion by the kidneys

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Sign and Symptoms of Hyperkalemia

GI symptoms

include:

nausea

, vomiting, intestinal colic, and diarrhea.

Neuromuscular symptoms range from weakness to ascending paralysis to respiratory

failure

Early

cardiovascular signs may be

apparent ECG

changes and eventually lead to hemodynamic symptoms of arrhythmia and cardiac arrest

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Hypokalemia

inadequate potassium

intake

excessive

renal potassium

excretion

potassium

loss in pathologic GI secretions

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Hypokalemia

The change in potassium associated with alkalosis can be calculated by the following formula

:

K decrease by 0.3

mEq

/L for every 0.1 increase in pH

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GOOD LUCK