Prof. Utham Murali. M.S.,M.B.A .

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Fluids – Importance & Composition.

Fluid – Types of Transport.

Fluid Imbalances – You See & You Do.

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Between 50% and 60% of the human body by weight is water.

Water provides a medium for transporting nutrients to cells and wastes from cells and for transporting substances such as hormones, enzymes, platelets, RBC’s & WBC’s.

Helps maintain normal body temperature Facilitates digestion and promotes elimination Acts as a tissue lubricant

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Because fat cells contain little water and lean tissue is rich in water, the more obese the person, the smaller the percentage of total body water compared with body weight.

This is also true between sexes because females tend to have proportionally more body fat than males.

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60% composed of water70 kg person= 42 L2/3 ICF = 28L1/3 ECF = 14L

TBW= ECF + ICF

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Fluids and solutes constantly move within the body, which allows the body to maintain homeostasis.

Fluids along with nutrients and waste products constantly shift within the body’s compartments from the cell to the interstitial spaces, to the blood vessels and back again.

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A. Active transport

B. Passive transport

- Diffusion

- Osmosis

- Filtration

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Solutes / Molecules can be moved against a concentration gradient as they move from an area of lower concentration to an area of higher concentration and requires an energy.

Also called “pumping” Dependent on the presence of ATP

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K K ++

K K ++

K K ++

K K ++

K K ++

K K ++

K K ++K K

++K K ++

K K ++

K K ++

K K ++K K

++

K K ++

K K ++

K K ++

K K ++

ATPATP

ATPATP

ATPATP

ATPATP Na +Na +

Na +Na +Na +Na +

Na +Na + Na +Na +Na +Na +

Na +Na +

Na +Na +

Na +Na +

Na +Na +

Na +Na +

Na +Na +

Na +Na +

Na +Na +

Na +Na +

Na +Na +

Na +Na +

Na +Na +

Na +Na +Na +Na +

INTRACELLULAINTRACELLULAR FLUIDR FLUID

EXTRACELLULAEXTRACELLULAR FLUIDR FLUID

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Molecules move across a biological membrane from an area of higher to an area of lower concentration

Membrane types◦ Permeable◦ Semi-permeable◦ Impermeable

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High Solute ConcentrationHigh Solute Concentration Low Solute ConcentrationLow Solute Concentration

FluidFluid

SolutesSolutes

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Movement of solute and solvent across a membrane caused by hydrostatic (water pushing) pressure

Occurs at the capillary level If normal pressure gradient changes (as occurs

with right-sided heart failure) edema results from “third spacing”

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Movement of solvent from an area of lower solute concentration to one of higher concentration

Occurs through a semipermeable membrane using osmotic (water pulling) pressure

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FluidFluid

High Solution High Solution Concentration, Concentration,

Low Fluid Low Fluid ConcentrationConcentration

Low Solute Low Solute Concentration, Concentration,

High Fluid High Fluid ConcentrationConcentration

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Fluids in the body generally aren’t found in pure forms.

Isotonic, hypotonic, and hypertonic types.

Defined in terms of the amount of solute or dissolve substances in the solution.

Balancing these fluids involves the shifting of fluid not the solute involved.

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No net fluid shifts occur between isotonic solutions because the solution are equally concentrated

Eg - NSS or 0.9SS

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Has a lower solute concentration than another solution

Fluid from the hypotonic solution would shift into the second solution until the two solutions had equal concentrations

Eg - Half normal or 0.45%SS

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Has a higher solute concentration than another solution

Fluid from the second solution would shift into the hypertonic solution until the two solutions had equal concentrations

Eg - D5 / NSS

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Isotonic loss of water and electrolytes (fluid volume deficit) – “Hypovolaemia”

Isotonic gain of water and electrolytes (fluid volume excess) – “Hypervolaemia / Edema”

Hyperosmolar loss of only water (Dehydration) Hypo-osmolar gain of only water (Overhydration) –

“Water Intoxication”

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Loss of body fluids ⇒ increased concentration of solutes in the blood and a rise in serum Na+ levels.

Fluid shifts out of cells into the blood to restore balance.

Cells shrink from fluid loss and can no longer function properly.

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Mild = Weight loss – 5%

Moderate = Weight loss – 10%

Severe = Weight loss – 15%

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IrritabilityConfusionDizzinessWeaknessExtreme thirst⇓ urine output

FeverDry skin/mucous

membranesSunken eyesPoor skin turgorTachycardia

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Fluid Replacement - Oral or IV over 48 hrs. Monitor symptoms and vital signs Maintain I & O Maintain IV access Daily weights Skin and mouth care

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Isotonic fluid loss from the extracellular space

Can progress to hypovolemic shock

Caused by:◦ Excessive fluid loss

(hemorrhage)◦Decreased fluid

intake◦ Third space fluid

shifting

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Mild = < 2 L fluid loss

Moderate = 2 – 3 L fluid loss

Severe = > 3 L fluid loss

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Mental status deterioration

Thirst Tachycardia Delayed capillary

refill

Orthostatic hypotension

Urine output < 30 ml/hr

Cool, pale extremities

Weight loss

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Fluid replacement Albumin

replacement Blood transfusions

for hemorrhage

Dopamine to maintain BP

Assess for fluid overload with treatment

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Excess fluid in the extracellular compartment as a result of fluid or sodium retention, excessive intake, or renal failure.

Occurs when compensatory mechanisms fail to restore fluid balance.

Leads to CHF and pulmonary edema.

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Tachypnea Dyspnea Crackles Rapid, bounding pulse Hypertension S3 gallop

Increased CVP, pulmonary artery pressure and pulmonary artery wedge pressure

Acute weight gain Edema

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Fluid is forced into tissues by the hydrostatic pressure

First seen in dependent areas

Anasarca Pitting edema Pulmonary edema

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Fluid and Na+ restriction

Diuretics Monitor vital signs Hourly I&O Breath sounds

Monitor ABGs and labs

Elevate HOB and give O2 as ordered

Maintain IV access Skin & mouth care Daily weights

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Hypotonic extracellular fluid shifts into cells to attempt to restore balance

Cells swell

Causes:◦ SIADH◦ Rapid infusion of

hypotonic solution◦ Excessive tap water NG

irrigation or enemas◦ Psychogenic polydipsia◦ TURP

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Signs and symptoms of increased intracranial pressure◦ Early: change in LOC, N/V, muscle weakness,

twitching, cramping

◦ Late: bradycardia, widened pulse pressure, seizures, coma

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Prevention is the best treatment

Assess neuro status Monitor I&O and vital

signs - ICU Fluid restrictions

IV access Daily weights Monitor serum Na+ Seizure precautions

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