Post Contents List
- 1 Fluid and Electrolytes balance in patients–
- 2 The ratio of intravascular to extravascular is 1:3.
- 3 Osmolality –
- 4 Water Balance
- 5 Kidney excretes water by —
- 6 CausesBacterial Infections LISTERIA MONOCYTOGENES Causes Diagnosis Symptoms Treatment. Read more ... » of renal loss of sodium and water :
- 7 VomitingNausea and Vomiting. Read more ... » leads to loss of H+ ions resulting in meta. bolie alkalosis.
- 8 .DiarrhoeaCANNABIS SATIVA BHANGA NARCOTICS MADKARI DRAVYA. Read more ... » leads to loss of HCO-3 ions resulting in metabolic acidosis.
- 9 Insensible water loss is 500 ml / day.
- 10 -Insensible water loss is increased in fever, heat exposure, exercise and sweating.
- 11 Sweat is hypotonic
- 12 Pathophysiology of Hypovolemia —-
- 13 Treatment of Hypovolaemia Oral fluids —-
- 14 Treatment of Hyperkalemia—
Fluid and Electrolytes balance in patients–
Water is –General—
- · 50% of body weight in women
- · 60% in men
Water is contained in the body in two major compartments :
- 1. ECF (Extra-cellular fluid) – 25%
- 2. ICF (Intra-cellular fluid) – 75%
ECF is present in the blood vessels i.e. intravascular compartment and outside the blood vessels in the interstitium i.e. extravascular.
- a. Intravascular or Plasma water
- b. Extravascular or Interstitial fluid
The ratio of intravascular to extravascular is 1:3.
- in mosmol/Kg (miliosmol per Kg) is the particle concentration of a fluid.
- ECF osmolality = ICF osmolality
- ECF particles are Na+, (1-, HCO-3
- ICF contains K+, organic phosphate esters (ATP1, creatine phosphate, phospholipids). .
- K + concentration reflects the amount of ICF because the ICF mainly contains potassium and potassium is mainly contained in the ICF.
- Na+ concentration tells about the ICF.
- Organic solutes or osmolytes are inositol, betaine, glutamine.
- Ineffective osmoles like urea do not contribute to water shift but volume of ICF and ECF.
- Fluid shift between ICF and ECF is determined by starling forces, capillary’ hydraulic pressureChronic Long-term Complications Of Diabetes Mellitus. Read more ... » and colloid osmotic pressure.
Normal plasma osmolality is 275 – 290 mosmol/Kg Water intake = Water excretion
– Loss of water occurs from Urine
- Respiratory tract
- Maximal urine osmolality is 1200 mosmol/kg. 600 mosmols must be excreted per day. Minimum urine output is 500 ml /day.
- Water intake by thirst is regulated by osmoreceptors located in anterolateral hypothalamus.
- Osmotic threshold for thirst is 295 mosmol/kg.
- water excretion is regulated by AVPSIADH or Syndrome of inappropriate ADH (AVP). Read more ... » (Arginine vasopressin peptide) also called A (Antidiuretic hormone), synthesized in hypothalamus and ‘secreted by the posterior pituitaryHypothalamic, Pituitary And Other Sellar Masses. Read more ... » gland.
- Baroreceptors in carotid sinus act like osmoreceptors. Osmotic threshold for AVP release is 280 – 290 mosmol/kg.
- Tonicity depends mainly on Na+ concentration.AVPsecretion is regulated by –
- · Thirst
- · Volume
- · NauseaNausea and Vomiting. Read more ... »
- · Pain
- · Stress
- · Hypoglycemia
- · Pregnancy
- · Drugs.
Kidney excretes water by —
- 1. Filtration and delivery of water and electrolytes to nephron.
- 2. Reabsorption of Na+ and (1- in thick ascending limb of loop of Henle and distal nephron.
- 3. No reabsorption of water from collecting ducts in absence of AVP (Arginine vasopressin).
- SodiumRenin and Hypertension Low renin and High Renin essential hypertension with Treatment. Read more ... » balance [Na+ is pumped out by Na+ K+ ATPase pump.]
- 90% of Na+ is extracellular.
- Sodium intake - Increased Na+ intake results in increased Na renalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » excretion to maintain Na+ balance.
- Sodium excretion - Effective circulating volume keeps normal GFR.
- Decreased effective circulating volume results in decreased GFR.
- 2/3 of filtered Na+ is reabsorbed in PCT (proximal convoluted tubule, 1/3 in thick ascending limb of loop of henle, 5% by thiazide sensitive Na+, Cl cotrasporter.
- Final Na+ reabsorption occurs in collecting ducts.
- HYPOVOLEMIA occurs due to volume depletion, and salt and water loss.
CausesBacterial Infections LISTERIA MONOCYTOGENES Causes Diagnosis Symptoms Treatment. Read more ... » of renal loss of sodium and water :
- · Diuretics
- · Diabetes mellitusOphthalmologic Complications of DM (Diabetes Mellitus). Read more ... » (excretion of glucoseGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... » and urea
- leading to osmotic diuresis)
- · Hyperalimentation (high protein)
- · Mannitol
- · Tubular and interstitial disorders
- · AcuteBacterial Infections LISTERIA MONOCYTOGENES Causes Diagnosis Symptoms Treatment. Read more ... » tubular necrosis.
Causes of obligatory renal Na+ and water loss:
- When the GFR is <25 ml /min there is obligatory renal Na+ loss as in :
- · Decreased ECF
- · Hypoaldosteronism (Mineralocorticoid deficiency)
- · Central diabetes insipidusChronic Long-term Complications Of Diabetes Mellitus. Read more ... » (CDI)
- · Nephrogenic diabetes insipidus.
Causes of extra renal loss of sodium and water Extrarenal loss occurs from
- · GITToxoplasma Infection Transmission Clinical Manifestations Diagnosis Treatment. Read more ... »
- · Skin
- · Respiratory tract
- · Burns
- · Pancreatitis – 3rd space accumulation which is sequestration of fluid in space which is neither extracellular nor intracellular
- · Peritonitis.
VomitingNausea and Vomiting. Read more ... » leads to loss of H+ ions resulting in meta. bolie alkalosis.
.DiarrhoeaCANNABIS SATIVA BHANGA NARCOTICS MADKARI DRAVYA. Read more ... » leads to loss of HCO-3 ions resulting in metabolic acidosis.
Insensible water loss is 500 ml / day.
-Insensible water loss is increased in fever, heat exposure, exercise and sweating.
Sweat is hypotonic
In hyperventilation there is increased water loss. Severe haemorrhage results in volume depletion.
Pathophysiology of Hypovolemia —-
- There is decreased plasma volume leading to hypotension, decreased venous return, decreased cardiacTricuspid Stenosis and Tricuspid Regurgitation Symptoms Investigations and Treatment. Read more ... » output, activation of RAS (renin angiotensin systemBacterial Infections LISTERIA MONOCYTOGENES Causes Diagnosis Symptoms Treatment. Read more ... »), decreased GFR, decreased sodium excretion, increased tubular reabsorption of sodium.
- Decreased ANP (atrial natriuretic peptide) and increased aldosteroneLABORATORY TESTS FOR ADRENAL FUNCTIONS. Read more ... » and AVP result in increased reabsorption of sodium by collecting ducts.
Clinical features of Hypovolemia
- There is history of vomiting, diarrhoea, polyuria and diaphoresis.
- There is fatigueFatigue diagnosis medicine and treatment. Read more ... », weakness, muscle cramps, thirst and postural dizziness.
- There is oliguria, cyanosis, abdominal and chest painApproach to Chest Pain Differential diagnosis of chest pain. Read more ... » and confusion.
- There is decreased skin turgor, dry oral mucous membrane.
- decreased JVPExamination of arterial pressure pulse with Jugular Venous Pulse (JVP). Read more ... », hypotension, tachycardiaHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... », and hypovolemic shockShock Presentation Risk Factors Pathogenesis Management Treatment. Read more ... ».
- In hypovolemic shock there is hypotensionDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... », tachycardia, peripheral vasoconstriction, cyanosis, cold and clammy hands, oliguria and altered mental state.
- Lab data
- BUN (blood urea nitrogen), plasma creatinine are increased.
- GFR (Glomerular filtration rate) is decreased BUN – creatinine ratio is 10 : 1 normally
- In prerenal azotaemia the urea is elevated greatly and BUN to serum creatinine ratio becomes 20 : 1.
- Increased urea production is seen in
- · Hyperalimentation with protein
- · Glucocorticoid therapy
- · GI (gastrointestinal) bleeding
Volume depletion and sodium:
- Volume depletion can lead to hyponatraemia, hypernatraemia or normal sodium level.
- Hypokalemia is defined as plasma K+ concentration less than 3.5 meq/L .
- Hyperkalemia is defined as plasma K+ concentration more than 5 meq/L.
Causes of Hypokalemia
- · Diarrhoea
- · Vomiting
- · Diuretics
Causes of Hyperkalemia
- · Renal failure
- · AdrenalHypothalamic, Pituitary And Other Sellar Masses. Read more ... » insufficiency
- · Metabolic acidosis.
- · Diuretics
- · Vomiting
- · Nasogastric suction.
Causes of Metabolic acidosis
- · Renal failure
- · Tubulointerstitial disorders
- · Adrenal insufficiency
- · Diarrhoea
- · KetoacidosisChronic Long-term Complications Of Diabetes Mellitus. Read more ... »
- · Lactic acidosis.
Treatment of Hypovolaemia Oral fluids —-
- IV fluids – Normal saline (Isotonic saline) 0.9% NaCI or 154 meq / L Na 3% NaCI or 513 meq / L Na
- In hyponatremia hypertonic saline is given to raise sodium concentration by 1-2 mmol/hr for first 3-4 hours and not more than 12 mmol/L during first 24 hours. Rapid correction of hyponatremia can result in ODS (Osmotic Demyelination SyndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... ») which is flaccid paralysis, dysarthria, dysphagia.
- The quantity of sodium required to increase the plasma sodium concentration can be estimated by multiplying the deficit in plasma sodium concentration by total body water.
- Total body water is 50-60% of lean body weight in women and men respectively.
- So to raise the sodium concentration from 110120 mmol in 70kg man will require (120-110) x 70 x .6 = 420 mmol of sodium.
- In hypernatremia 0.45% NaCI is given which is 77 meq/L sodium
- 5% dextrose in water
- Blood transfusion
- Albumin infusion
- Dextran IV
- For hypokalemia give potassium chloride IV or oral.
Treatment of Hyperkalemia—
- Stop food substances with high potassium. Calcium gluconate in dose of 10 ml of 10% solution in 2 – 3 minutes.
- 10 – 20 units of regular insulinDiabetes mellitus Types,Causes,Symptoms and Diagnosis. Read more ... » with 25 – 50 gm of glucose is given IV. Insulin causes potassium shift into cells and glucose is given to prevent hypoglycaemia.
This is a short description about fluid balance in patient, if you have any question you can put comment in comment box.