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Fluid and electrolyte imbalance
Transcript of Fluid and electrolyte imbalance
IV fluids come in four different forms:
Body fluid compartment :
50-70% of the average human body is comprised of body fluid
Na+, Cl-, HCO3-
TBW at 12 wks of gestation 94%
TBW at 32 wks of gestation 80%
In the 1st few days TBW decrease by 10%
By 1½ years of age reaching the adult level 60%
Colloid solutions are IV fluids that contain solutes in the form of large proteins or other similarly sized molecules.
The proteins and molecules are so large that they cannot pass through the walls of the capillaries and onto the cells.
Crystalloids contain electrolytes (e.g., sodium, potassium, calcium, chloride) but lack the large proteins and molecules found in colloids.
Commonly used colloid solutions include:
1-Basic theoretical concepts
2-Regulation of Fluid & Electrolyte Balance
3- Fluid therapy
4- Common electrolytes disturbance in pediatrics
Crystalloids come in many preparations and are classified according to their “tonicity.”:
Isotonic (e.g Normal saline, lactated Ringer's solution )
Hypertonic ( e.g dextrose 5% in NS soulution )
Sodium (Na + )
defined as serum sodium (Na) concentration of less than
considered the most common electrolyte disorder encountered in hospitalized patients.
50% of presenting children develop symptoms when serum Na levels
fall below 120
Treatment of hypo Na :
Correct serum Na increased by no more than
in 24 hours of treatment
Check serum Na
saline in severe hyponatremia
Goal is serum Na
Avoid too rapid correction:
Central pontine demyelination
it might be asymptomatic
CNS: Headache, Decreased conscious state , Hallucinations, Obtundation
GI: Nausea, vomiting
Musculoskeletal findings:Weakness,Muscular cramps
The daily water loss in an adult is about 1500 ml. in urine and 250 ml. in stool.
with: fever, sweating, burns, tachypnea, surgical drains.
For example, it increase by 100 to 150 mL/day for each centigrade elevation of body temperature .
Normal fluid and electrolyte requirements:
Fluid management is divided into 3 phases:
Fluid and electrolyte needs from basal metabolism, it is amount of fluid lost normally (sensible and insensible losses)
it is loss from sources other than evaporative and urinary losses from NGT, stoma, fistula,
means the fluid lost through abnormal ways ..
K+, Mg+, and Phosphate -
Estimation of the severity of dehydration:
5% of body volume
eg:vomiting, diarrhea, with minimal physical findings
A guide for maintenance fluid therapy for children is as follows:
0-10 kg - 100 mL/kg/d (
10-20 kg - 1000 mL/d + 50 mL/kg/d (
40 mL/h + 2 mL/kg/h
Greater than 20 kg - 1500 mL/d + 25 mL/kg/d (
60 mL/h + 1 mL/kg/h
Common electrolytes disturbances
- serum sodium concentration of more than
- It is characterized by a deficit of total body water
relative to total body sodium levels due to either loss of
, or infrequently, the administration of
hypertonic sodium solutions
- In healthy individual, the body's 2 main defense mechanisms against hypernatremia are
thirst and the stimulation of vasopressin release
Mainly neurological symptoms
Predominant extracellular cation
Daily Sodium requirements is
2 - 3 mEq/day
Normal Na+ concentration is 135 to 145 mmol/L
Pairs with Cl- , HCO3- to neutralize charge
Most important ion in water balance
Important in nerve and muscle function
Reabsorption in renal tubule regulated by: Aldosterone and Renin/angiotensin
Hypovolemic hypotonic hyponatremia
Extrarenal losses :
caused by vomiting, diarrhea, sweat ..
Renal losses :
caused by diuretic excess, salt-wasting nephropathy, adrenal insufficiency, proximal renal tubular acidosis, metabolic alkalosis ..
Hypervolemic hypotonic hyponatremia
congestive heart failure
acute or chronic renal failure
Isovolemic hypotonic hyponatremia
Rx: Volume resuscitation with NS
urine sodium concentration is greater than 20 mEq/L
Rx: Fluid restriction 1,000 mL/day
Correct endocrine abnormality
Rx: Correct underlying state
Treatment of Hypernatremia
Calculate the free water deficit:
0.6 x wt (kg) x (patient’s sodium/140 - 1)
only one half of the water deficit should be corrected over the first
remainder being corrected over the following
2 to 3
Check serum Na q4hr
Use isotonic salt-free IV fluid
Major intracellular cation
normal serum concentration is
3.3 to 4.9
Daily Potassium requirements is
1 - 2
Regulates resting membrane potential
Regulates fluid, ion balance inside cell
Regulation : Aldosterone in the kidney and by Insulin
Serum K+ <3 mmol/L
Beware if diabetic
Causes of Hypokalemia
renal losses e.g. diuretics, fluid mobilization
GI losses e.g. Severe vomiting/diarrhea, nasogastric suctioning
cutaneous losses e.g., burns
insulin excess, metabolic alkalosis
Decreased intake of K+
of Hypokalemia :
Neuromuscular disorders Weakness, respiratory arrest, constipation
Dysrhythmias, Early (ECG) manifestations
depression, and prominent
treatment of hypokalemia in the patient with intact renal function is 40 to 100 mmol KCl
in single or divided doses
> 5 to 6
elevation in K+ may result from commonly by phlebotomy from a
Mild hyperkalemia :
: hyperactive muscles paresthesia
muscle weakness, flaccid paralysis
: symmetric peaking
of T waves and widening of the
1- Mild hyperkalemia
[K+ = 5 to 6 mmol/L]
can be treated
by the reduction in daily K+ intake and, if needed, the addition of a
2- Severe hyperkalemia
[K+ >6.5 mmol/L]
] can be infused intravenously over a 3 to 5 minute period.if ECG abnormalities persist repeat after 10 to 15 minutes.
body weight) infused with
(0.3 unit of regular
insulin/g of dextrose)
mL intravenously over 2 minutes)
should be administered to patients with profound ECG changes
- Inhaled B-agonists
e.g. albuterol sulfate 2 to 4 mL via nebulizer
definitively decrease total body potassium by increasing potassium excretion
The body tries to maintain homeostasis of fluids and electrolytes by regulating:
Solute charge and osmotic load
These functions act to keep body fluids:
Osmotically stable (specified number of particles per volume of fluid)
(15% of body volume)
have cardiovascular instability (e.g. skin mottling, tachycardia, hypotension) and neurologic involvement (e.g., irritability, coma).
10% of body volume
apparent physical findings (e.g., tenting of the skin, weight loss, sunken eyes and fontanel, slight lethargy, and dry mucous membranes.
[ sodium x 2 ] + urea + glucose
280 - 290 mosm / kg
1- Sodium polystyrene sulfonate
: can be administered orally (20 to 50 g) or rectally ( 50 g )
A decrease in serum K + level typically occurs
2 to 4
hours after administration.
with 0.9% NaCl in combination with a loop diuretic ( 20 to 100 mg intravenously) in patients with adequate renal function to promote renal K+ excretion.
3- Dialysis :
is definitive therapy in severe or life-threatening hyperkalemia.
Fluid compartments are separated by membranes that are freely permeable to water but impermeable to solutes