7. fluid electrolyte imbalance.pptx

 Fluid and electrolyte balance is a dynamic process that is crucial for life  It plays an important role in homeostasis  Imbalance may result from many factors, and it is associated with the illness  TOTAL BODY FLUID 60% OF BODY wt Intracellular Extracellular fluids...

 Fluid and electrolyte balance is a dynamic process that is crucial for life  It plays an important role in homeostasis  Imbalance may result from many factors, and it is associated with the illness  TOTAL BODY FLUID 60% OF BODY wt Intracellular Extracellular fluids fluids Interstiti Trancellul Intravascul al fluid ar fluid ar fluid 15 % of body eg. eg. C S wt Plasma F OSMOSIS Fluid shifts through the membrane from the region of high solute concentration until region of low solute concentration to the solution the are of equal concentration A substance to move from an area of high concentrationto one of the lower concentration   KIDNEY  SKIN  LUNGS  GI TRACTS  Abnormally decreased or increased fluid volume or rapid shift from one compartment of body fluid to another  Hypovolemia  Hypervolemia HYPOVOLEMIA: Fluid volume deficit HYPERVOLEMIA: Fluid volume excess  May occur as a result of: Reduced fluid intake Loss of body fluids Pathophysiology DECREASED FLUID VOLUME Stimulation of ↑ ADH Secretion Renin-Angiotensin- thirst center Aldosterone in System Activation ↑ Water resorption hypothalamus ↑ Sodium and Person complains of ↓ Urine Output Water Resorption thirst ↑ Urine specific gravity except with osmotic diuresis  acute weight loss  Oliguria  Low bp  Sunken eyes  Dizziness  Weakness  Decreased skin turgor  Concentrated urine  Fluid Management Oral rehydration therapy – Solutions containing glucose and electrolytes. E.g., Pedialyte, Rehydralyte. IV therapy – Type of fluid ordered depends on the type of dehydration and the clients cardiovascular status. Diet therapy – Mild to moderate dehydration. Correct with oral fluid replacement.  It refers to an isotonic expansion of the ECF caused by abnormal retention of water and sodium in approximately the same proportion in which they normally exist in the ECF.  It is most often secondary to an increase in total body water.  Common Causes:  Congestive Heart Failure  Early renal failure  IV therapy  Excessive sodium ingestion  SIADH  Corticosteroid  Signs/  Symptoms Increased BP   Weight gain  Bounding pulse  Venous distention  Pulmonary edema  Dyspnea  Orthopnea (diff. breathing when supine)  crackles  Pharmacological therapy Diuretics such as thiazide diuretics and loop diuretics Thiazide diuretics: hydrochlorothiazide Loop diuretics: furosemide, torsemide  Potassium supplement THE MAIN ELECTROLYTE IMBALANCE ARE SODIUM HYPONATREMI DEFICIT: A EXCESS HYPERNATREM : IA POTASSIUM DEFICIT: HYPOKALEMIA EXCESS: HYPERKALEMIA CALCIUM HYPOCALCEM DEFICIT : IA EXCESS HYPERCALCEM : IA  It results from loss of sodium containing fluids (or) hypo-Osmolality with a shift of water into the cells  CAUSES GI LOSS: diarrhea, vomiting, RENAL LOSS:suction Nasogastric Diuritics, adrenal insufficiency, a SKIN LOSS: Burns, wound drainage wasting renal diseases  Muscle APATHY Weakness Postural Nausea and hypotensi Abdominal Weight on Cramps Loss In severe hyponatremia: mental confusion, delirium, shock and coma  MEDICAL MANAGEMENT Sodium replacement administration of sodium by mouth eat and drink Lactated ringers solution (0.9% sodium chloride) is prescribed Serum sodium must not increase greater than 12meq/L in 24 hours to avoid neurological damages  Hyper nateremia is a higher than normal sodium level exceeding (145meq/L) CAUSES Gain of sodium in excess of water Inadequate water intake Increased serum sodium concentration  Dry, sticky mucous Firm, rubbery membranes tissue turgor DEATH Tachycardia Manic excitement  MEDICAL MANAGEMENT  Gradual lowering of the sodium level by the 0.3% infusionsodium chloride of a hypotonic electrolyte solution Diuretics also may be prescribed to treat the sodium gain  Potassium is major ICF cation, with 98%of the body potassium being intracellular metabolic function.  Potassium is critical for many cellular  The kidneys are the primary route for and potassium loss 90% of daily potassium is eliminated by kidney. intake  It may be caused by a massive intake of potassium CAUSES:  Excess potassium intake -excessive or rapid parenteral -potassium containing drugs administration  Shift of potassium out of cell -acidosis, crush injury, tissue catabolism(fever) -renal disease, adrenal insufficiency, ACE  Failure to eliminate potassium inhibitors  Immediate ECG Should be obtained  Serum potassium level from vein without IV  Restriction of dietary potassium fluid infusion  Potassium containing diuretic  IV calcium gluconate administration  Hypokalemia can results from abnormal losses of potassium from a shift of potassium dietary potassium intake from ECF to ICF or rarely from deficient  CAUSES  Potassium loss  Shifts of potassium into cells  Lack of potassium intake  It is treated with oral or IV replacement  Administer 40 to 80 meq/ day of potassium  When oral administration of potassium  For patient at risk for hypokalemia diet is not containing potassium should be provided feasible the IV route is indicated  More than 99% of the body’s calcium is located  It is a major component of bone and in skeletal system teeth, with blood calcium about 1% of skeletal calcium is  Calcium plays a major role in exchanged nerve impulses and helps to regulate transmitting contraction muscle and relaxation, including cardiac  Any condition that causes a decreased in the production of PTH may result in the CAUSES development of hypocalcemia  Multiple blood transfusion  Chronic renal failure  Elevated phosphorous  Chronic alcoholism  Alkalosis  Numbness  Tingling of finger, toes and  circumoral region Anxiety  Hyperactive deep tendon  reflex Bronchospasm  diarrhoea  video https://www.youtube.com/watch?v=kvmwsTU0InQ&feature=y outu.be  IV Administration of calcium like calcium gluconate calcium chloride calcium gluceptate  Vitamin D therapy be initiated to increase  Increasing the dietary intake of calcium calcium absorption from GI tract at least 1,000 to 1,500mg/day  Hypercalcemia [excess of calcium in the plasma] is dangerous imbalance when severe  Hypercalcemia crisis has a mortality rate as Multiple high myeloma as 50% if not treated properly  Prolonged CAUSES immobilization  Vit D over dose  Thiazide diuretics [slight elevation]  Muscular  weakness  Constipation  Anorexia  Nausea &  vomiting Hypoactive deep tendon reflexes  Dehydration Calcium stones  Administer fluids to dilute serum calcium and promote its excretion by the kidney  IV administration of 0.9% sodium calcium level chloride  Administering furosemide increases solution calcium temporarily dilutes the serum  Calcitonin is administered to lower the excretion serum THANK YOU