FLUIDS AND ELECTROLYTES Flashcards

(63 cards)

1
Q

At birth, TBW constitutes about ??, thereafter, it declines to about ?? by the end of infancy

A

75-80% of body weight,
about 60% and remains so

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2
Q

The total body water (TBW) in early fetal life is

A

about 90%

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3
Q

Intracellular compartment contains what percent of TBW

A

(2/3rd of TBW, 30-40%)

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4
Q

Extracellular compartment contains what percent of TBW

A

(1/3rd of TBW,20-25%)

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5
Q

The extracellular fluid (ECF) is further distributed into ?

A

intravascular space as plasma water (5%) and also into the extravascular (interstitial) space (15%)

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6
Q

TBW in males remains at 60%, but TBW in females decreases to approximately ?? WHY?

A

in females decreases to approximately 50% of body weight.
Because, At puberty, there is increased muscle mass of males and more body fat in females, fat has very low water content and muscle has high water content.

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7
Q

Is difference in the ECF volume between post-pubertal females and males.?

A

There is no significant difference in the ECF volume between post-pubertal females and males.

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8
Q

what forces are responsible for the MAINTENANCE OF FLUID BALANCE?

A

The equilibrium between the intravascular fluid and the interstitial fluid is a product of the balance of hydrostatic, osmotic and oncotic forces, this is necessary for proper tissue perfusion

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9
Q

Q
describe Hydrostatic pressure and what happens in Decreased HP?

A

The hydrostatic pressure (HP)of the intravascular space is due to the pumping action of the heart

HP drives fluid out of the intravascular space into the interstitial space at the arterial ends of the capillaries.

Decreased HP e.g in heart failure causes movement of fluid into the venous ends of the capillaries.

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10
Q

what force determines the distribution of water between the compartments

A

Osmotic forces due to electrolytes in body fluid is important in determining the distribution of water between the compartments

Each compartment has one major solute, which because of its restriction within the compartment acts to hold water within it

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11
Q

Water moves along osmotic gradient from compartment of ?? to that of ?? until an equilibrium is reached.

A

of low osmolality
of high osmolality until an equilibrium is reached

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12
Q

describe WATER BALANCE

A

In the steady state, water intake must equal water output
Maintenance fluid is the fluid required to keep an individual in homeostasis or steady state
Water loss is usually via evaporation from the skin and respiratory tract (insensible loss) , sweat, urine and stool
Net water intake is derived from ingested water, from food and water produced from oxidation

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13
Q

Plasma osmolality and water balance;

Plasma osmolality is determined by?? and is normally maintained within a narrow limit of??

A

by plasma sodium ion conc
and is normally maintained within a narrow limit of (285-295mOsm/kg)

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14
Q

Plasma osmolality and water balance;

The regulatory system is governed by ?? which influence??

A

by osmo-receptors in the hypothalamus
which influence both thirst and secretion of anti diuretic hormone (ADH)

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15
Q

how can Plasma osmolality be measured??

A

Plasma osmolality can be measured directly using osmometers as well as indirectly by estimation by calculation.

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16
Q

whats the formula to measure Plasma osmolality??

A

Plasma osmolality=2(Na+) +glucose/18 + BUN/2.8

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17
Q

what is osmolal gap and Increase osmolal gap may occur due to?? examples of condition with Increase osmolal gap??

A

Measured values are generally greater than calculated value by 10mOsm/kg, this is osmolal gap

Increase osmolal gap may occur due to increased unmeasured osmoles e.g Hyperglycaemia, mannitol , ethanol

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18
Q

In children with hypoalbuminemia, the decreased oncotic pressure of the intravascular fluid contributes to

A

the development of edema

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19
Q

Six (6) Disease states that disrupt the body water balance include;

A

Hypoalbuminaemia
heart failure
renal impairment
Sequestration of fluid in third space/ interstitial space
Burns
Haemorrhage

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20
Q

Whats an electrolyte?? list examples, and general function?

A

An electrolyte is a substance that dissociates into ions in solution and acquire the capacity to conduct electricity

Sodium, potassium, bicarbonates, chloride, calcium, magnesium and phosphates are examples of electrolytes

The blood electrolytes—sodium, potassium, chloride, and bicarbonate—help regulate and maintain acid-base balance and water balance

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21
Q

what are the dominant cation and anion in the ECF??
the most abundant cation in the ICF??
the most abundant anions in the ICF??

A

Sodium and chloride are the dominant cation and anion, respectively, in the ECF.

Potassium is the most abundant cation in the ICF.

Proteins, organic anions, and phosphate are the most abundant anions in the ICF

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22
Q

Electrolyte balance
The amount of fluid in a compartment depends on ?? If the electrolyte concentration is high,?? if the electrolyte concentration is low??

A

The amount of fluid in a compartment depends on concentration of electrolytes in it. If the electrolyte concentration is high, fluid moves into that compartment (osmosis). Likewise, if the electrolyte concentration is low, fluid moves out of that compartment.

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23
Q

How does The kidneys help maintain electrolyte concentrations??

A

The kidneys help maintain electrolyte concentrations by filtering electrolytes and water from blood, returning some to the blood, and excreting any excess into the urine.

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24
Q

hyponatremia definition

A

The normal blood level of Na varies between 135-145mmol/l
Hyponatremia is defined as Na conc below 135mmol/l.

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25
Etiology of hyponatremia? depends on?
The etiology of hyponatremia depends on the volume status of the patient; VOLUME DEPLETION (CCF, Diarrhoea, diuretics) -----> Decrease in effective circulating volume -----> Reduced GFR and increase in salt and water reabsorption by the proximal convoluted tubule+ secretion of ADH -----> Increased water reabsorption from the collecting tubules and subsequent hyponatremia
26
Hypervolemic hyponatremia- characterized by? and four (4) disease conditions causing it
Characterised by an increase in total body Na and water, however the increase in total body water exceeds that of Na (excess free .water retention) There is low plasma Na, presence of oedema Example of such disease condition include; 1. congestive cardiac failure (CCF) 2. Liver cirrhosis 3. Nephrotic syndrome 4.acute/chronic kidney diseases
27
Hypovolemic hyponatremia characterized by? and disease conditions causing it?
there is deficit in total body Na and TBW with a disproportionately greater Na loss Characterized by evidence of fluid depletion, hypotension, tachycardia. conditions casuing it; 1. Renal loss- diuretic use, osmotic diuresis, renal salt wasting 2. Extra renal- diarhoea, vomiting, drains, fistula, effusion, ascites
28
Euvolemic hyponatremia/Normovolemic hyponatremia (SIADH) causes?
The plasma osmolality is usually normal causes; 1. Inflammatory CNS diseases (meningitis, encephalitis) 2. CNS tumors 3.Pulmonary diseases (severe asthma, pneumonia 4.Drugs e.g cyclophosphomide, vincristine nb; cyclophosphomide alkylating agent commonly used in chemotherapy, SIADH is a side effect. Vincristine is a chemotherapy medication same side effect
29
SIADH, characterized by?? what confirms its diagnosis?? and management??
High level of ADH is secreted at low plasma osmolality The presence of hyponatremia with high urine osmolality(>100mOsm/kg) and urine Na>20-30mEq/L confirms the diagnosis There is impaired excretion of free water because of the ADH secretion, subsequently, urine osmolality exceeds that of the plasma Management is by fluid restriction
30
Clinical features of hyponatremia; the early and advanced features?
early features; (HNL) Headache Nausea and vomiting Lethargy and confusion Advanced manifestations include; Seizures Coma decorticate posturing Dilated pupils Papilloedema Cardiac arrythmia Cerebra oedema occurs at Na values <125mEq/L
31
Cerebra oedema occurs at Na values?
<125mEq/L
32
Complications of hyponatremia
Hyponatremia in association with increased intravascular volume can lead to poor prognosis in pulmonary oedema, hypertension(from hypervolemia) and heart failure Poor growth and development, sensorineural hearing loss, risk factor for mortality in birth asphyxia in neonates
33
Complications of hyponatremia
Hyponatremia in association with increased intravascular volume can lead to poor prognosis in pulmonary oedema, hypertension(from hypervolemia) and heart failure Poor growth and development, sensorineural hearing loss, risk factor for mortality in birth asphyxia in neonates
34
Treatment of hyponatraemia
Treat underlying aetiology Calculate Na+ deficit= (130- serum Na) × 0.6 × body weight in kg The estimated deficit is given as normal saline/WHO ORS Rise of serum Na should not exceed 10mEq/L in the first 24 hrs(rapid correction of hyponatremia leads to pontine myelinosis) In hypervolemic state, the treatment of hyponatremia is fluid restriction and diuretics In symptomatic hyponatremia treat with 3-5ml/kg of 3% sodium chloride In hypotension, treat with 20ml/kg of normal saline
35
rapid correction of hyponatremia leads to ?? Rise of serum Na should not exceed??
Rise of serum Na should not exceed 10mEq/L in the first 24 hrs(rapid correction of hyponatremia leads to pontine myelinosis)
36
hypernatraemia definition?
Defined as increase in serum sodium concentration > 150mEq/L
37
hypernatraemia CAUSES?
Deficiency of ADH hormone (diabetes insipidus, where the urine SG<1010 and Urine osmolality < plasma osmolality) •Inadequate intake of water (urine SG > 1010 and urine osmolality >plasma osmolality) •Excessive intake of Na
38
Features of hypernatraemia
Intense thirst •Lethargy •Coma •Convulsion
39
Complication of hypernatraemia
Osmotic shift of water from neurons leads to shrinkage of the brain and tearing of the meningeal vessels with intracranial hemorrage
40
Treatment of hypernatraemia
•Identify and treat the underlying cause • infusion of quarter isotonic saline with5% dextrose • Rapid correction may result in cerebral oedema •The time for correction is directly proportional to the level of plasma Na, usually not less than 24 hrs •Monitor serum Na 4hrly and value should not fall below o.5mEq/L/hr
41
hypokalemia definition?
Normal serum concentration is 3.5-5mmol/L •Hypokalemia is defined as serum K <3.5mmol/L
42
CAUSES of hypokalemia
Increased loss- diarrhea, vomiting, NG tube suctioning, drugs like loop diuretics, thiazides, Renal tubular acidosis, Decreased intake- malnutrition, anorexia nervosa Intracellular shift- alkalosis, high insulin state ECG changes- depression of the ST segment, T wave depression and U wave elevation
43
Clinical features of hypokalemia
Symptoms are related to muscular and cardiac function •Abdominal distension, paralytic ileus, floppy neck, cardiac arrythmias •Hypokalemia promotes the binding of digoxin to myocytes , potentiating its action and decreasing its clearance hereby leading to digoxin toxicity
44
management of hypokalemia
Identify and treat the underlying cause Oral KCL should be preferred as much as possible, it is safe and effective 2-4mmol/kg/day in 3-4 divided /day IV KCL should be given in fluids with non dextrose solution to minimize stimulation of insulin release IV KCL 0.2-0.3mmol/L in half strength saline over 2hours under cardiac monitoring Potassium containing fluid like Darrows solution can also be used, the strength depends on the K deficit and duration of correction
45
hyperkalemia definition
Potassium level > 5.5mmol/L
46
CAUSES
Renal insufficiency, acidosis, insulin deficiency, hypoaldosteronism, hyperkalemic renal tubular acidosis, old blood transfusion, thrombocytosis, leucocytosis Tissue catabolism- rhabdomyolysis, drugs like spironolactone, ACEi
47
Features of hyperkalemia
Muscle weakness Cardiac conduction defects- tall tented T waves, short QT interval, widening of QRS complex, loss of P wave
48
Treatment of hyperkalemia
Withhold all K containing fluid, oral intake of K and K sparing medication Use of agents which cause a rapid influx of potassium intracellularly Calcium gluconate is used in symptomatic patients for cardioprotective effects, as it antagonizes the membrane effects of potassium Sodium bicarbonate Insulin and glucose Salbutamol Removal of K 1. Sodium polystyrene sulfonate an exchange resin which exchanges sodium for potassium in the gut 2. Dialysis Treat the cause of hyperkalemia
49
FLUID AND ELECTROLYTE THERAPY; The three classifications of fluid therapy?
1. maintenance 2. deficit 3. Replacement
50
Maintenance fluid therapy is to ?
Maintenance fluid therapy is to replace estimated normal physiologic urine output and insensible losses in patients with reduced or no oral intake
51
Deficit fluid is ?
Deficit fluid is that lost by a patient usually prior to medical care in clinical situations such as gastrointestinal illness with vomiting and diarrhea, traumatic injuries with significant blood loss, and inadequate intake of fluids over a period of time.
52
Deficit fluid is ?
Deficit fluid is that lost by a patient usually prior to medical care in clinical situations such as gastrointestinal illness with vomiting and diarrhea, traumatic injuries with significant blood loss, and inadequate intake of fluids over a period of time.
53
Replacement fluid
Replacement fluids are defined as those given to meet ongoing losses after commencement of medical treatment. E.g. fluid loss in patients with chest tubes in place, uncontrolled vomiting, continuing diarrhea, or externalized cerebrospinal fluid shunts.
54
daily maintenance water and electrolytes requirements formula?
Holliday-Segar formula
55
Dehydration severity of dehydration can be assessed using parameters such as ?
skin turgor, urine output, buccal mucosa, patient’s weight, tear production, depressed anterior fontanelle and thirst
56
what fluid therapy is preferred ?
oral route for fluid therapy is preferred except when it is not clinically indicated
57
symptoms? in minimal or no dehydration, mild to moderate and severe dehydration
check note
58
WHO ;Clinical assessment for degree of dehydration associated with diarrhoea is as follows
check note
59
Types of dehydration
Hypotonic Isotonic Hypertonic Depending on the serum sodium value
60
TREATMENT BASED ON THE DEGREE OF DEHYDRATION; MINIMAL OR NO DEHYDRATION
MINIMAL OR NO DEHYDRATION – replacement of fluid loss <10 kg body weight: 60–120 mL oral rehydration solution (ORS) for each diarrheal stool or vomiting episode; >10 kg body weight: 120–240 mL ORS for each diarrheal stool or vomiting episode OR To replace ongoing losses, 10 mL per kg for every loose stool and 2 mL per kg for every episode of emesis should be administered.
61
MILD /MODERATE DEHYDRATION treament?
Rehydration therapy with ORS ; 50-100ml/kg over 3-4hours ORT is considered to be unsuccessful if vomiting is severe and persistent or if ORT cannot keep up with the volume of stool losses. I.V fluid may become necessary
62
SEVERE DEHYDRATION treatment?
Rapid intravenous rehydration is the preferred treatment in this group of patients. if the patient can drink, give ORS by mouth until the drip is set up. start 100 ml/kg Ringer's Lactate Solution (if not available normal saline may be used) divided as follows: infants under 12 months first give 30 ml/kg in 1 hour (repeat once if radial pulse is still very weak or not detectable) then give 70ml/kg in 5 hours older first give 30 ml/kg in 30 minutes (repeat once if radial pulse is still very weak or not detectable) then give 70ml/kg in 2 1/2 hours Monitor the serum electrolyte, urea and creatinine Monitor the urine output Give supplemental zinc (10 - 20 mg) to the child, every day for 10 to 14 days. Feeding should be continued to prevent malnutrition
63
Fluid resuscitation in burns use what formular?
Parkland formula Give half of your calculated volume in the first 8hours from the time of injury, while the remaining half should be given in the following 16 hours Target urine output of 1ml/kg/hour, stable vital signs (blood pressure, pulse rate and volume