Post on 12-Apr-2017
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FLUID IMBALANCE
Angel Das Y.L 2nd year MBBS student
TOTAL BODY WATER
COMPOSITION OF FLUID COMPARTMENTS
ECF compartment – Na+,Cl-,HCO3-ICF compartment –
K+,Mg2+,Phospates & proteinsConc: gradient – Na+-K+ pump
Movement of BODY FLUIDSDiffusionOsmosisActive TransportFiltration
DIFFUSION
High Solute Concentration Low Solute Concentration
Fluid
Solutes
OSMOSIS
Fluid
Low Solute Concentration,
High Fluid ConcentrationHigh solute Concentration,Low FluidConcentration
ACTIVE TRANSPORT
K +
K +
K +
K + K +
K + K +
K +K + K +
K +
K +
K +
K +
K +
K +
K +ATP
ATP
ATP
ATP Na +
Na +Na +
Na + Na +
Na +
Na +
Na +
Na +
Na +
Na +
Na +
Na +
Na +
Na +
Na +
Na +
Na +
Na +Na +
Normally INTAKE = OUTPUT
FLUID BALANCE
BODY FLUID CHANGESDisorders in fluid balance
Volume
Concentration
Composition
Volume Changes
Extracellular volume deficit most common fluid disorder.
eitherAcute
Chronic
Acute CVS & CNS signs
Chronic Tissue signs such as decrease
in skin turgor & sunken eyes
Weight loss
Cardiac
Hypotension Tachycardia Collapsed neck Veins
Renal
Oliguria.Azotemia
GI.Ileus
Common Cause – Volume deficit in Surgical Patients Loss of GI fluids- Nasogastric
suction,Vomitting,Diarrhea Sequestration secondary to soft ts injuries, burns &
intra abdominal processes such as peritonitis, obstruction or prolonged surgery
Extra cellular Volume Excess
Iatrogenic
Secondary to
Renal dysfunction
CHF
Cirrhosis
Generalized
Weight Gain Edema
Cardiac
Increased cardiac output Increased central venous pressure Distended neck Veins Murmur
GIBowel Edema
PulmonaryPulmonary edema
DECREASED FLUID VOLUME
Stimulation of thirst center in hypothalamus
Person complains of thirst
↑ ADH Secretion
↑ Water resorption
Renin-Angiotensin-Aldosterone System
Activation
↑ Sodium and Water Resorption
Volume ControlBy osmoreceptors & baroreceptors
Concentration Changes
Hyponatremia & Hypernatremia
Composition Changes
K+ abnormalities Ca2+ abnormalities Mg2+ abnormalities
FLUID THERAPY
Type of fluid- vol. status, conc, or compositional abnormality Lactated ringer soln & normal saline – isotonic useful in replacing GI loss & correcting extra cellular volume deficit
Alternative Resuscitative Fluids
1. Hypertonic saline solutions -in closed head injuries -increase cerebral perfusion & intracranial pressure -decrease brain edema
2.Colloids – Volume expanders -but under severe hemorrhagic shock – worsens edema -4 types – Albumin, dextrans, hetastarch & gelatins
Pre operative Fluid Therapy
Volume deficit – fluid replacement – isotonic crystalloid-depending on serum electrolyte values
Close monitoring
Intra operative Fluid Therapy
Hemodynamic instability during anesthesia avoided by correcting known fluid loss & providing adequate maintenance fluid therapy-pre operatively
Saline administration
Post Operative Fluid Therapy
Based on patient’s vol status & ongoing fluid loss
Initially- isotonic Later –dextrose & normal saline