Fluid Abnormalities

Anu Priya.J

FLUID ABNORMALITIE

S

Anu Priya

Volume of liquid ingested -thirst centre in the hypothalamus Volume of urine excreted -ADH from the post pituitary

Water regulation

• Dec in circulating volume CAUSES a)Gut-vomiting,diarrhoea,fistulae b)Skin and lungs c)bleeding,burns d)diuretic therapy

HYPOVOLEMIA

Mild: 4% loss TBW or < 15% blood volume

Moderate: 6% TBW or 15-30% BV Severe: 8% TBW or 30-40% BV Shock: >8% TBW or > 40% BV Clinical features:

◦ Thirst, sleepy, coma ◦ Orthostatic hypotension, tachycardia,

decreased JVP◦ Poor turgor, hypothermia, dry membranes◦ Oliguria, ileus, weakness

Hypovolemia

Lab: ◦ BUN:Cr ratio greater than 20◦ Inc. hematocrit◦ Increased urine spec. gravity and osmolality

Hypovolemia, continued

Treatment:◦ IV fluids◦ Blood transfusion

Hypovolemia, continued

Etiology: Cardiac failure, Renal failure,Hepatic failure, iatrogenic

Clinical features:◦ Wt gain◦ Distended neck veins, pedal/sacral edema◦ Hypertension,tachycardia,increased JVP◦ Confusion,restlessness,convulsions◦ rales or wheezing◦ Pulmonary edema on CXR

Hypervolemia

Lab:◦ Decreased Hct and albumin◦ Na may be low, normal or increased but total

body Na is usually increased Treatment:

◦ Water restrict to 1500 cc/day◦ +/- Diuretics◦ Sodium restrict to 0.5 gm/day◦ (Albumin followed by diuretics)

Hypervolemia, continued

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