2013 Fluids and Electrolytes 1st Part

7/25/2019 2013 Fluids and Electrolytes 1st Part

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Fluids and Electrolytes (Part1)Dr. R. MendozaSeptember 2, 2013Group 2big

REASONS WHY CHILREN AN A!L"SHA#E IFFEREN" FL!I RE$!IRE%EN"S1. Higher metabolic rate

& daily ater turno!er i" 1#$ o% totalbodyater &'()*

2. +arger "in "ur%ace area in relation to body"ize& 2-3 o% adult

3. /rone to greater lo"" o% uid. mmaturity o% the idney

& nability to concentrate urine

WA"ER'() Maor 4omponent"51. ntracellular 6luid &46*2. 7tracellular 6luid &746*

a. nter"titial uidb. /la"ma

Fig 1. Body weight-water ratios

'IR"H5 total ody ater is *+&,-. o/total ody t (ECF 0 ICF), and in%ant"appear edematou". 6luid lo"" due topo"tnatal diure"i" and increa"ed groth o%cell" occur" during the 1"t2 hour" andcontinue" %or 1-2 ee". 46 ill then begreater than 746. /hy"iologic eight lo"""hould not eceed 10$8 in%ant ill regainlo"t eight by three ee".

PRE&"ER%5 ha!e higher percentage o%total body ater, around 90$.

1S"YEAR5 '() decrea"e" toapproimately :0$ o% body eight, ith46 and 746 le!el" approimating that o%adult".

P!'ER"Y5 male" and %emale" de!elop

di;erent le!el" due to di;erence" in%at capillarypermeability, lo"" o% albumin re"ultingto uid "hi%t %rom intra!a"cular to 3rd"pace".

CO%PAR"%EN"S OF 'OY WA"ER

Intracellular> 30-0$

Etracellular> 20-2#$

nter"titial uid > 1#$/la"ma > #$8

up to 10% in newborn inants (have 50-60% ct!

Fig ". #ota$ body water and distribution

%O#E%EN" OF 'OY FL!IS

un diin ang &as $apuyot' didto&agadto ang tubig1. Hydrostatic Pressure-

2. i2usion- mo!ement o% particle" don aconcentration gradient &higher to loerconcentration*

3. Os3osis- due to protein and "odiumconcentration8 di;u"ion o% ater acro""a "electi!ely permeable membrane.

. Acti4e trans5ort- mo!ement o% particle"up a concentration gradient8 re?uire"energy8 eempli@ed by Aa-B C'/a"epump


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ECF HO%EOS"ASIS IS %AIN"AINE 'Y61. Hydrostatic Pressure&(lood /re""ure*

)ove&ent is ro& higher to $owerpressure

- /umping action o% the heart- More prominent in arterial end- Dri!e" uid out o% the intra!a"cular

"pace

- C;ected by5a. diameter o% blood !e""el in!ol!edb. !olume o% etracellular uid"

2. Oncotic Pressure&"motic pre""ure*- /rimarily due to albumin &cannot cro""

the intra!a"cular membrane becau"eo% it" high molecular eight8e"tabli"he" a gradient beteen theintra!a"cular and inter"titial "pace"*

- Dra" ater into the intra!a"cular

"pace- Depend" on5a. le!el o% non-di;u"ing protein" in

pla"ma and inter"titial uid".b. concentration o% electrolyte",

e"pecially AaE

igher so$ute so$utions draw water.

Fig *. +api$$ary ,uid echange

Ct the arterial end, there i" high hydro"taticpre""ure, dri!ing ater out o% the capillarie"and into the inter"titial "pace. Ct the

!enou" end, there i" an increa"e in oncoticpre""ure due to higher albumin to aterratio, "o ater i" dran bac into theintra!a"cular "pace.

F"ually t7ere is a net 3o4e3ent o/ 8uidout o/ t7e intra4ascular s5ace8 ece""uid at !enou" end i" ab"orbed bylymphatic".

F'i""ue per%u"ion i" maintained by 746homeo"ta"i"5

intra!a"cular !olume blood o toorgan"

oygen deli!ery

Fro& past notes/HYDROSTATIC PRESSURE INCREASESDUE TO:a. enous obstruction

#hro&boph$ebitis (in,a&&ation o

veins!

epatic obstruction

#ight c$othing on etre&ities

ro$onged standing

b. 2a$t or water retention +ongestive heart ai$ure

3ena$ ai$ure

FAC"ORS AFFEC"IN9 "HEE:"RACELL!LAR FL!I

a. Plas3a Dehydration > G lo""e", !omiting,

renal lo""e"5% 4 &oderate dehydration

Cnemia > !ery diluted pla"ma !olume

/olycythemia > !ery concentratedblood

Heart %ailure > !enou" in"u=ciency

cau"e" damming and "ub"e?uentblood !olume &(I*

Cbnormal pla"ma o"molality

Hypoalbuminemiab. Interstitial

Heart %ailure

+i!er %ailure

Aephrotic "yndrome

EE%A- accumulation o% uid in the inter"titial

"pace"

Causes o/ ede3a6

1. ncrea"ed hydro"tatic pre""ure2. +oered pla"ma o"motic pre""ure > $iverai$ure

3. ncrea"ed capillary membranepermeability

$&ost a$ways due to a diseasedengue he&orrhagic ever (,uids anda$bu&in $ea out o intravascu$ar space!

. +ymphatic channel ob"truction > tu&ors'&asses

SOL!"ES


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- di""ol!ed particle", u"ually in ater&uni!er"al "ol!ent*

ELEC"ROLY"ES &charged particle"*1; Cations

- po"iti!ely charged particle"- AaE, BE, 4a2E, HE

- mo!e again"t the concentrationgradient, re?uire AaE-BE-C'/a"e pump

4a > 0

B > 39 Aa > 23

7ample54on!ert 2000 mg o% Aa to me?

me? 2000


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2 &AaE* E &gluco"e*iotensin Syste3- important regulator o% renal AaEecretion

AaEbalance i" the main regulator 5 where

8a9goes' water o$$ows

Bidney determine" "odium balance > alter"

the percentage o% @ltered AaEreab"orbedin the nephron depending on the !olume"tatu" o% the patient

Sodium reab"orption can occur in all area"

o% the idney.

Maority &:#$* o% "odium i" reab"orbed in

the proimal collecting tubule &/4'* anddi"tal loop o% Henle. % there i" a need toreab"orb more "odium, the di"talcollecting tubule &D4'* and collectingduct" al"o help &regulated by aldo"terone*.


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Fig 5. 3enin-ngiotensin-$dosterone 2yste&

Fig 6. 8ephron structure

Re>ulation o/ #olu3e1. Iolume epan"ion

- nhibition o% AaEreab"orption incollecting duct"

2. Iolume depletion- Renal retention o% AaE

7;ecti!e !olume i" the !olume in the

intra!a"cular "pace that i" "en"ed by thereceptor" in the body.

% there i" heart %ailure, there i" !olume

o!erload. C lot o% uid i" in theintra!a"cular area" but there i" !ery loe;ecti!e !olume8 !ery little goe" toidney, mo"t "tay in the inter"titial "pace.

Renin i" produced in the utaglomerular

apparatu".

Cngioten"in ha" a !a"ocon"trictor e;ect

(/

FL!I HO%EOS"ASIS %AIN"AINE 'Y1. on 'ran"port

2. )ater Mo!ement3. Bidney 6unction

(ody uid" are5

- 7lectrically neutral- "motically maintained &"peci@c

number o% particle" per !olume o% uid*

OS%OLALI"Y IS"!R'ANCES

HYPER"ONIC S"A"E

Fig:. )ove&ent o ,uid in hypertonic states.

n the hypertonic "tate, 746 ha" higher"odium concentration8 uid lea!e" the cell,leading to cell "hrinage.

Mo"t dreaded complication > brain

hemorrhage &"eizure*

In correctin>? loer Na@>radually;

HYPO"ONIC S"A"E

746&/I*

Na@ 0 1+33olBL

H2

46

4ell

(lood !e""el


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Fig ;. )ove&ent o ,uids in hypotonic state.

n hypotonic "tate, 46 ha" higher "odium

concentration8 uid enter" the cell, leadingto cell "elling.

Mo"t dreaded complication > increa"ed 4/

leading to brain"tem herniation. Also corrected >raduallythough not a"

"lo a" hypertonia.

ISO"ONIC S"A"E

Fig ulation o/ Sodiu3

Cb"orbed throughout the G'

Bidney i" the principal "ite o% AaEecretion

Renal tubule reab"orption a;ected by

hormone"5& Cldo"terone

746&/I*

Na@ 1+33olBL

464ell

H2

(lood !e""el

746 &/I* Na@ G 1+&1+33olBL

H2

46

4ell

H2

746 &6*Na@ G1+&1+33olBL

(lood !e""el


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& Renin@@

LactatedRin>ers

130 109 2L - 1.# -

Isotonic Saline(NSS)

1# - 1# - - - -

-;. NaCl #1 - #1 - - - --;+. NaCl - - - - -

Ionosol %'(I%')

2# 20 22 23 - - 1.#

Nor3osol %(N%)

0 13 0 - 1: - 1

Nor3osol R(NR)

10 # 9L - 2 - 1

D#0.#$ Aa4l i" not a!ailable in the

/hilippine". 'o prepare D#0.#$5 #00 ml o%ASS E #00 ml D#)ater.

Rec7ec i/ you 7a4e corrected t7edeJcit. ou "till ha!e to account %or themaintenance hich i" 2-3 m7?i4en o4er a5eriod o/ , 7ours Knot rapidly!!

& 6luid o% choice "hould contain a AaEconcentration o%


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PO"ASSI!%

%ainly /ound in 3uscles

/la"ma concentration i" not alay"

reecti!e o% the total body content &i% youare acidotic, HEgoe" into the cell inechange %or pota""ium*

AaE-BE-C'/a"e pump maintain" BE

concentration 7change" ith H ion" to maintain acid-

ba"e balance

Mo"tly ab"orbed in the "mall inte"tine

Cldo"terone i" the principal hormone

regulator in "ecretion

F!NC"IONS OF PO"ASSI!%

mu"cular contraction &particularly cardiac*

neuromu"cular contraction, including"mooth mu"cle"

dietary "ource"5

- dried %ruit" &prune"*, %ruit" &banana,cantaloupe, grape%ruit, orange,apricot", a!ocado*

- !egetable" &"pinach, broccoli, greenbean"* nut"

- mil, meat- co;ee J cola- "alt "ub"titute"

CA!SES OF HYPOALE%IA6

Spuriou" > arti@cial decrea"e in BEle!el"

'ran"cellular "hi%t"

Decrea"ed intae

7trarenal cau"e"5

- Diarrhea- +aati!e"- Seating

Renal lo""e"5- Di"tal renal tubular acido"i"- 'ubular toin"- Diabetic etoacido"i"- +o urine chloride

ELEC"ROCARIO9RAPHIC (EC9) C7an>esin Hy5oale3ia6

6lattened ' a!e

Depre""ed S' "egment

Cppearance o% a a!e

Fig 10. >+@ changes in hypoa$e&ia.

Seletal %uscle

& Mu"cle eane"" and cramp"& /araly"i"

9astrointestinal %otility& 4on"tipation& leu"

'ladder Function

& rinary Retention

sth&atics on sa$buta&o$Aa$butero$ areso&eti&es constipated because their&edications drive potassiu& bac into thece$$.

PO"ASSI!% REPLACE%EN"

Maintenance Re?uirement

& 20 -30 m7? o% B4l per liter o% I6 oncepatient ha" !oidedHypoalemia

& Hypoalemia &ileu", mu"cle eane"",74G change"*

o do"e o% intra!enou" pota""ium 0.#-1m7?C (a$thoughdoc so&eti&es gives 50 &>C!D inusion isvery painu$.

Era$ potassiu& is avai$ab$e (contains 10&>C! but does not taste good.

HYPERALE%IA

Serum BEle!el K :.# m7?

/re"ent in "e!ere acido"i", renalin"u=ciency

CA!SES OF HYPERALE%IA6

Spuriou" laboratory !alue

ncrea"ed intae


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'ran"cellular "hi%t"5

& Ccidemia& Rhabdomyoly"i"& 'umor ly"i" "yndrome& Hemoly"i"& Digitali" toicity& (eta blocer"

& 7erci"e& n"ulin de@ciency

ecreased ecretion6& Renal %ailure& /rimary adrenal di"ea"e& Renal tubular di"ea"e& Drug"

o C47 inhibitor"

o BE"paring diuretic"

o 4yclo"porin

o ASCD"

o 'rimethoprim

EC9 CHAN9ES IN HYPERALE%IA

)ide, tall and tented &peaed* ' a!e"

/rolonged /-R inter!al

)ide, at or ab"ent / a!e

S-' "egment depre""ion

)idening o% the RS comple

/rogre"" to !entricular @brillation

C"y"tole may al"o occur

3eCuest or $ong $ead ==.

Fig 11.a >+@ changes in hypera$e&ia.

Fig 11.b >+@ changes in hypera$e&ia.

"REA"%EN" FOR HYPERALE%IA

4alcium gluconate > "tabilize" the heart

AaH43> "tabilize" the heart in 30 min

Gluco"e and in"ulin > increa"ed gluco"e

&and con"e?uently BE* uptae into cell"

Aebulized "albutamol > !ery %a"t uptae o%

BEinto "eletal mu"cle" &to be u"ed a"initial treatment only*

+oop diuretic > remo!e" BEthrough urinary

ecretion

Bayealate Hemodialy"i" or peritoneal dialy"i"

" goa$s/ stabi$ie the heart to preventarrhyth&ia' and to re&ove potassiu& inthe body. 3e&e&ber/ &edicines used tostabi$ie the heart do not he$p in re&oving

potassiu& ro& the body.

CALCI!%

99$ %ound in the bone"

M/R'CA475 blood coagulation, cellularcommunication, eo


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& 4alcitonin

%A9NESI!%

3rdmo"t common intracellular cation

#0-:0$ i" %ound in the bone"

Aece""ary co%actor %or a lot o% coenzyme"

Aormal pla"ma !alue

& 1.# > 2.3 mg 1.9 m7? 0.9 mmol


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/recaution"5

& Aeedle "hould be "ecurely in !ein& Gi!e "loly& 7ce""i!e admini"tration "hould be

a!oided to pre!ent po"t acidotic tetanyand hypernatremia

N(e "trong and tae heart, all you ho hopein the +ord.O /"alm 3152

Re%erence"5 Dr. MendozaV" +ecture and Slide",

S7RICM, WCQ note"

nternet &picture", article"*

/repared by5 7na, Aadine, Cndy7dited by5 Cndy

Sources6Dr. Ru%onX" ppt

CndreX"DermatologyWCQ note"

Google5 picture"/roo%reader5







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2013 Fluids and Electrolytes 1st Part