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8/3/2019 Fluids and Electrolyte Imbalance
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Fluids and electrolyte imbalance
8/3/2019 Fluids and Electrolyte Imbalance
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Objectives:Objectives:
At the end of this lecture the student should beAt the end of this lecture the student should be
able to:able to:
y Define Fluids and electrolyte imbalance
imbalance.
y Deffrentiate between Hyponatremia,
Hypernatremia and hypokalemia
y Discuss causes of Hyponatremia.
y List signs , symptoms and treatment of
hypokalemia
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overview
sodium, Electrolytes are salts thatconduct electricity and are found in
the body fluid, tissue, and blood.
Examples are chloride, calcium,magnesium, and potassium
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y Sodium (Na+) is concentrated in the
extracellular fluid (ECF) and potassium
(K+) is concentrated in the intracellular
fluid (ICF). Proper balance is essential for
muscle coordination, heart function, fluid
absorption and excretion, nerve function,
and concentration
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y The kidneys regulate fluid absorption
and excretion and maintain a narrow
range of electrolyte fluctuation.
y Normally, sodium and potassium are
filtered and excreted in the urine and
feces according to the body's needs
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y Too much or too little sodium orpotassium, caused by poor diet,dehydration, medication, and disease,
results in an imbalance.
y Too much sodium is called hypernatremia;too little is called hyponatremia.
y Too much potassium is calledhyperkalemia; Too little is calledhypokalemia.
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y Incidence and Prevalence
Hyponatremia is the most common
electrolyte imbalance. It is associated with
kidney disease such as ne phroticsyndrome and acute renal failure (ARF).
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yMen and women with healthy kidneys
have equal chances of experiencing
electrolyte imbalance, and people with
eating disorders such as anorexia and
bulimia, which most often affect
women, are at increased risk. Very
young people and old people areaffected more often than young adults.
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HyponatremiaHyponatremia
Causes
Hyponatremia is caused by conditions
such as water retention and renalfailure that result in a low sodium levelin the blood.
y
Pseudohyponatremia occurs when toomuch water is drawn into the blood; itis commonly seen in people withhypoglycemia (low blood sugar
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Psychogenic polydipsia occurs in people
who compulsively drink more than four
gallons of water a day.
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Hypovolemic hyponatremia (with low
blood volume due to fluid loss) occurs
in dehydrated people who rehydrate
(drink a lot of water) too quickly, inpatients taking thiazide diuretics, and
after severe vomiting or diarrhea.
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y Hypervolemic hyponatremia (high blood
volume
y due to fluid retention) occurs in people with
liver cirrhosis, heart disease, or nephrotic
syndrome. Edema (swelling) often develops
with fluid retention.
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Euvolemic hyponatremia (decrease in
total body water) occurs in people with:
, adrenal gland disorder,hypothyroidism
and disorders that increase the release of
the antidiuretic hormone (ADH), such
as tuberculosis, pneumonia, andbrain trauma
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Signs and SymptomsSigns and Symptoms
Symptoms of hyponatremia are related to
the severity and the rate at which the
conditions develop.
The first symptoms are fatigue,
weakness, nausea, and headache. More
severe cases cause confusion, seizure,
coma, and death.
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TreatmentTreatment
The goal of treatment
Is to restore electrolyte balance forproper hydration and use of total bodyfluid. Sodium deficiency must becorrected slowly because drastic changein sodium level can cause brain cellshrinkage and central pontinemyelinolysis (damage to the pons regionof the brain). Methods include
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y Fluid and water restriction
y Intravenous (IV) saline solution of 3%
sodium
y Salt tablets
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y Conivaptan (Vaprisol®) has been
approved by the U.S. Food and Drug
Administration (FDA) to treat
hypervolemic hyponatremia andeuvolemic hyponatremia in some
hospitalized adults. Vaprisol is
administered intravenously (i.e., into avein).
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y Blood sodium levels should be closely
monitored in patients who receive this
medication.
y Side effects include injection site
reactions, headache, thirst, and lowpotassium levels.
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HypernatremiaHypernatremia
y Hypernatremia is high sodium in the
blood that occurs with excessive fluid
loss. When fluid is lost and not
replaced, sodium is not adequately
excreted from the body
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causescauses
y Diabetes insipidus (caused by deficiencyof or insensitivity to ADH)
y Diarrhea
y
Diuretic medicationy Excessive salt intake
y Excessive vomiting
y Heavy respiration (e.g., exercise,
exertion)y Severe burn
y Sweating
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y It is associated with the same symptoms
as hyponatremia, and also causes the
following:
y Delerium
y Irritability
yMuscle twitching
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y Hypernatremia commonly affects older
hospitalized people, 50% of whom have
underlying diseases that, when
combined with excessive sodium and
fluid loss, are fatal.
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HypernatremiaHypernatremia
y Hypernatremia commonly affects older
hospitalized people, 50% of whom have
underlying diseases that, when
combined with excessive sodium andfluid loss, are fatal.
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TreatmentTreatment
Treating hypernatremia involves slowly
replenishing water loss, usually over 48 hours,
through drinking or intravenous (IV) solution.In cases of diabetes, the imbalance is treated
with adequate water intake and nonsteroidal
anti-inflammatory drugs or with synthesized
hormones (e.g., desmopressin) that aid in fluid
retention and decrease urination
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y Some drugs used to treat electrolyte
imbalance may be unsafe for pregnant
women and should not be taken before
consulting a physician.
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y An abnormally low level of potassium
(K+) is called hypokalemia. The adrenal
gland makes a hormone (aldosterone)
that signals the kidneys to excrete orconserve potassium, based on the
body's needs. In hypokalemia, the
adrenal gland retains the hormone andthe kidneys conserve potassium when
more is needed
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CausesCauses
y
The most common cause of potassium
depletion is diuretic medication that
increases urination. Diuretics areprescribed for medical conditions and
are used in weight-loss programs. Other
causes include:
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y Diarrhea
y Dietary deficiency
y Excessive sweating
yMagnesium deficiency (causes
overexcretion of fluid)
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Signs and SymptomsSigns and Symptoms
Symptoms of deficiency include cardiac
arrhythmia, muscle pain, general
discomfort or irritability, weakness, andparalysis
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DiagnosisDiagnosis
Diagnosis may require urinalysis and
blood tests to determine the amount of
potassium being excreted by thekidneys
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TreatmentTreatment
y
Treatment involves potassiumsupplements, proper diet, and intravenous(IV) solution. The best way to maintain an
adequate potassium level is to eat foodssuch as sweet potatoes, bananas, avocados,spinach, and oranges. Patients takingdiuretic medication are also givenpotassium supplements. Potassium isgiven slowly to avoid hyperkalemia.
y