Volume Disorders (hypovolemia Hypervolemia) Flashcards
What is an isotonic solution
Overall concentration are equal cell remains constant
What is a hypotonic solution
Outside < inside
*water move into the cell
*cell expands and lyse
What is a hypertonic solution
Outside > inside
*higher concentration
*water move out from cell causing shrinkage
What is the etiology of hypovolemia (volume depletion)
- Acute blood loss (hemorrhage)
- GI losses gastric suctioning
- Sequestration of gut fluid
- Burns
- Diuretic therapy
- Sweat
What are the consequences of hypovolemia
Results in isotonic fluid loss
1. Decreed NA+ without significant affecting osmolaltiy of ECF
2. Little shift of water into or out of IC
3. Stimulates aldosterone
4. Leases to increased reabsorption of Na+ and water from renal filtrate
How does a patients present with hypovolemia
- Dry mucous membranes
- Orthostatic hyoptension
- Decreased urine output
- Thirst
- Postural tachycardia
- Reduced skin turgor
What are the lab findings of hypovolemia
- Elevated Hct
- Elevated WBC count
- Elevated BUN:Creatinine ratio (prerenal)
- Findings are worse with increasing severity
What is the treatment of hypovolemia
- Restore appropriate fluid
*corrected with IV isotonic fluid - Isotonic fluid losses
*use lactated ringer or NS (if no hypercholremia)
*intestinal, biliary, pancreatic, or third space losses
What additional treatment may a person with hypovolemia need?
- Rapid bolus
- Multiple line
*large-bore IV give more fluid, but may be too difficult to place due to venous collapse - LR
*fluid of choice for blood loss
Are colloids indicated for hypovolemia
No colloids are not indicated for tibial rapid resuscitation in most instances
What is a lactate ringer composed of
- Sodium
- Chloride
- Potassium
- Calcium
- Lactate
When should lactate ringer not be used
Patients with renal failure
*critical hyperkalemia
Patients with liver disease
*unable to metabolize lactate-lactic acidosis
Is glucose used to treat hypovolemia
No not used for resuscitation or most replacement
*it has a lower pH can cause hyperglycemia and osmotic dieresis
How to monitor vitamin K when dealing with a hypovolemic patient
- Watch for clinical changes or improvement
- Repeat examination
- Vital
- Central line for monitoring
- Lyes, serum lactate, blood ph
What is the etiology of hypervolemia (fluid excess)
- After treatment of shock
- Increased ADH early post-operative period
*greater NA and water retention - Pre-existing CHF, liver disease, renal failure
- SIADH-TH, brain tumors, abscesses, pneumonia
