Fluids and Electrolyte

8/9/2019 Fluids and Electrolyte

1/83

FLUID AND ELECTROLYTE

MICHAEL ARITONANG, MD


2/83

Total Body Water (TBW)• ar!e" #!t$ a%e, %e&der, 'ody $a'!t"

• *+ 'ody #e!%$t !& ale"

• -*+ 'ody #e!%$t !& .eale"

• /*+ 'ody #e!%$t !& !&.a&t"• Le"" !& o'e"e0 .at 1o&ta!&" l!ttle #ater


3/83

Body Water Co2arte&t"• I&tra1elllar #ater0 345 o. TBW

• E6tra1elllar #ater0 745 TBW

8 E6tra9a"1lar #ater0 :4- o. e6tra1elllar #ater

8 I&tra9a"1lar #ater0 74- o. e6tra1elllar #ater


4/83

Fl!d a&d Ele1trolyte

Re%lat!o&• ole Re%lat!o&8 Ar%!&!&e8a"o2re""!& (ADH)

8 Re&!&4a&%!ote&"!&4aldo"tero&e "y"te

8 Barore1e2tor" !& 1arot!d arter!e" a&d aorta8 AN; (


5/83

Fl!d a&d Ele1trolyte Re%lat!o&• ;la"a O"olal!ty Re%lat!o&

8 Ar%!&!&e8a"o2re""!& (ADH)

8 Ce&tral a&d ;er!2$eral o"ore1e2tor"

•


6/83

;reo2erat!9e E9alat!o& o. Fl!d


7/83

Ort$o"tat!1 Hy2ote&"!o&•


8/83

;er!o2erat!9e Fl!d

Re!ree&t"The ollowing actors must be taken into account:• Ma!&te&a&1e @!d re!ree&t"

• N;O a&d ot$er de1!t"0 NG "1t!o&, 'o#el 2re2

• T$!rd "2a1e lo""e"

• Re2la1ee&t o. 'lood lo""

•


9/83

Ma!&te&a&1e Fl!dRe!ree&t"

• I&"e&"!'le lo""e" "1$ a" e9a2orat!o& o. #ater.ro re"2!ratory tra1t, "#eat, .e1e", r!&arye61ret!o& Occurs continually

• Adlt"0 a22ro6!ately 7- l4?%4$r

• :8387 Rle

8 : l4?%4$r .or t$e r"t 7* ?% o. 'ody #e!%$t

8 3 l4?%4$r .or t$e "e1o&d 7* ?% 'ody #e!%$t

8 7 l4?%4$r "'"ee&t ?% 'ody #e!%$t

8 E6tra @!d .or .e9er, tra1$eotoy, de&ded

"r.a1e"


10/83

N;O a&d ot$er de1!t"

• N;O de1!t &'er o. $or" N;O 6a!&te&a&1e @!d re!ree&t

• Bo#el 2re2 ay re"lt !& 2 to 7 L @!d lo""

• Mea"ra'le @!d lo""e", e% NG "1t!o&!&%,9o!t!&%, o"toy ot2t


11/83

T$!rd


12/83

Re2la1!&% T$!rd


13/83

Blood Lo""• Re2la1e 3 cc o. 1ry"tallo!d "olt!o& 2er 11 o.

'lood lo"" (1ry"tallo!d "olt!o&" lea9e t$e!&tra9a"1lar "2a1e)

•W$e& "!&% 'lood 2rod1t" or 1ollo!d" re2la1e'lood lo"" 9ole 2er 9ole


14/83

Allo#a'le 'lood lo""

7 E"t!ate 'lood 9ole

3 E"t!ate t$e red 'lood 1ell 9ole (RBC) att$e 2reo2erat!9e $eato1r!t (RBC2reo2)

5 E"t!ate RBC at a $eato1r!t o. 5*+(RBC5*+), a""!&% &oral 'lood 9ole !"

a!&ta!&ed

: Cal1late t$e red 1ell 9ole lo"t #$e& t$e

$eato1r!t !" 5*+ RBClo"t RBC2reo2 RBC5*+ - Allo#a'le 'lood lo"" RBClo"t 6 5


15/83

E6a2leA& /-8?% #oa& $a" a 2reo2erat!9e $eato1r!t

o. 5-+ Ho# 1$ 'lood lo"" #!ll de1rea"e $er$eato1r!t to 5*+

E"t!ated 'lood 9ole - L4?% 6 /- ?% --3- L

RBC5-+ --3- 6 5-+ 7J5: L

RBC5*+ --3- 6 5*+ 7-/ L

Red 1ell lo"" at 5*+ 7J5: 7-/ 3K LAllo#a'le 'lood lo"" 5 6 3K L /3/ L


16/83

Ot$er .a1tor"• O&%o!&% @!d lo""e" .ro ot$er "!te"0

8 %a"tr!1 dra!&a%e

8 o"toy ot2t

8 d!arr$ea• Re2la1e 9ole 2er 9ole #!t$ 1ry"tallo!d"olt!o&"


17/83

I&tra9e&o" Fl!d"0• Co&9e&t!o&al Cry"tallo!d"

• Collo!d"

• Hy2erto&!1


18/83

Cry"tallo!d"• Co'!&at!o& o. #ater a&d ele1trolyte"

8 Bala&1ed "alt "olt!o&0 ele1trolyte 1o2o"!t!o&a&d o"olal!ty "!!lar to 2la"a e6a2le0la1tated R!&%er" Noro"ol

8 Hy2oto&!1 "alt "olt!o&0 ele1trolyte 1o2o"!t!o&lo#er t$a& t$at o. 2la"a e6a2le0 D-W


19/83

Collo!d"• Fl!d" 1o&ta!&!&% ole1le" "1!e&tly lar%e

e&o%$ to 2re9e&t tra&".er a1ro"" 1a2!llarye'ra&e"

•


20/83

Ad9a&ta%e o. 1ollo!d" 9" 1ry"tallo!d

!9 @!d"Collo!d"aller !&."ed 9ole

2rolo&%ed !&1rea"ed !& 2la"a 9ole

le"" 2er!2$eral edeaCry"tallo!d

lo#e"t 1o"t

%reater r!&ary @o#

!&ter"t!t!al @!d re2la1ee&t


21/83

D!"ad9a&ta%e"Collo!d

%reater 1o"t

1oa%lo2a$ty (de6tra& HE


22/83

Hy2erto&!1


23/83

Co2o"!t!o&

Cl! ! l E l t! . Fl !d


24/83

Cl!&!1al E9alat!o& o. Fl!dRe2la1ee&t

7 Ur!&e Ot2t0 at lea"t *-8 7* l4?%4$r

3 !tal

5 ;$y"!1al A""e""e&t0


25/83

Ele1trolyte Bala&1e• Ele1trolyte" are "alt", a1!d", a&d 'a"e", 't

ele1trolyte 'ala&1e "ally re.er" o&ly to "alt'ala&1e

•


26/83


27/83


28/83


29/83

Re%lat!o& o.


30/83

Re%lat!o& o.


31/83

Re%lat!o& o.


32/83

Re%lat!o& o.


33/83

Card!o9a"1lar


34/83

Card!o9a"1lar


35/83

Figure 2

Ma!&te&a&1e o. Blood ;re""re Hoeo"ta"!"


36/83

Atr!al Natr!ret!1 ;e2t!de

(AN;)• Red1e" 'lood 2re""re a&d 'lood 9ole 'y!&$!'!t!&%0• E9e&t" t$at 2roote 9a"o1o&"tr!1t!o&• NaQ a&d #ater rete&t!o&

• I" relea"ed !& t$e $eart atr!a a" a re"2o&"e to"tret1$ (ele9ated 'lood 2re""re)

• Ha" 2ote&t d!ret!1 a&d &atr!ret!1 ePe1t"• ;roote" e61ret!o& o. "od! a&d #ater

• I&$!'!t" a&%!ote&"!& II 2rod1t!o&


37/83

Figure 26

Me1$a&!"" a&d Co&"ee&1e" o. AN;Relea"e


38/83

I&@e&1e o. Ot$er Horo&e" o&


39/83

I&@e&1e o. Ot$er Horo&e" o&


40/83

Re%lat!o& o. ;ota""!

Bala&1e• Relat!9e ICF8ECF 2ota""! !o& 1o&1e&trat!o&aPe1t" a 1ell" re"t!&% e'ra&e 2ote&t!al

• E61e""!9e ECF 2ota""! de1rea"e"e'ra&e 2ote&t!al

• Too l!ttle S Q 1a"e" $y2er2olar!at!o& a&d&o&re"2o&"!9e&e""


41/83

Re%lat!o& o. ;ota""!

Bala&1e• Hy2er?ale!a a&d $y2o?ale!a 1a&0• D!"r2t ele1tr!1al 1o&d1t!o& !& t$e $eart

• Lead to "dde& deat$

• Hydro%e& !o&" "$!.t !& a&d ot o. 1ell"• Lead" to 1orre"2o&d!&% "$!.t" !& 2ota""! !&

t$e o22o"!te d!re1t!o&

• I&ter.ere" #!t$ a1t!9!ty o. e61!ta'le 1ell"

Re%latory


42/83

Re%latory

d1t" 'y 1$a&%!&% t$e ao&t o. 2ota""!"e1reted !&to ltrate

• E61e""!9e S Q !" e61reted o9er 'a"al le9el" 'y1ort!1al 1olle1t!&% d1t"

• W$e& S Q le9el" are lo#, t$e ao&t o. "e1ret!o&a&d e61ret!o& !" ?e2t to a !&!

• Ty2e A !&ter1alated 1ell" 1a& rea'"or' "oe S Q

le.t !& t$e ltrate


43/83

I&@e&1e o. ;la"a ;ota""!Co&1e&trat!o&

• H!%$ S Q 1o&te&t o. ECF .a9or" 2r!&1!2al 1ell" to"e1rete S Q

• Lo# S Q or a11elerated S Q lo"" de2re""e" !t"

"e1ret!o& 'y t$e 1olle1t!&% d1t"


44/83

I&@e&1e o. Aldo"tero&e• Aldo"tero&e "t!late" 2ota""! !o& "e1ret!o&

'y 2r!&1!2al 1ell"

• I& 1ort!1al 1olle1t!&% d1t", .or ea1$ NaQ rea'"or'ed, a S Q !" "e1reted

• I&1rea"ed S Q !& t$e ECF aro&d t$e adre&al1orte6 1a"e"0

• Relea"e o. aldo"tero&e

• ;ota""! "e1ret!o&

• ;ota""! 1o&trol" !t" o#& ECF 1o&1e&trat!o& 9!a.eed'a1? re%lat!o& o. aldo"tero&e relea"e


45/83

Re%lat!o& o. Cal1!

• Io&!1 1al1! !& ECF !" !2orta&t .or0• Blood 1lott!&%

• Cell e'ra&e 2erea'!l!ty

•


46/83

Re%lat!o& o. Cal1!

• Hy2er1al1e!a0

• I&$!'!t" &ero&" a&d "1le 1ell"

• May 1a"e $eart arr$yt$!a"

• Cal1! 'ala&1e !" 1o&trolled 'y 2arat$yro!d$oro&e (;TH) a&d 1al1!to&!&


47/83

Re%lat!o& o. Cal1! a&d

;$o"2$ate• ;TH 2roote" !&1rea"e !& 1al1! le9el" 'ytar%et!&%0

• Bo&e" ;TH a1t!9ate" o"teo1la"t" to 'rea?do#& 'o&e atr!6

•


48/83

Re%lat!o& o. Cal1! a&d

;$o"2$ate• F!ltered 2$o"2$ate !" a1t!9ely rea'"or'ed !& t$e2ro6!al t'le"• I& t$e a'"e&1e o. ;TH, 2$o"2$ate rea'"or2t!o& !"

re%lated 'y !t" tra&"2ort a6! a&d e61e""e"

are e61reted !& r!&e• H!%$ or &oral ECF 1al1! le9el" !&$!'!t ;TH"e1ret!o&• Relea"e o. 1al1! .ro 'o&e !" !&$!'!ted• Lar%er ao&t" o. 1al1! are lo"t !& .e1e" a&d

r!&e• More 2$o"2$ate !" reta!&ed


49/83

I&@e&1e o. Cal1!to&!&• Relea"ed !& re"2o&"e to r!"!&% 'lood 1al1!

le9el"

• Cal1!to&!& !" a ;TH a&ta%o&!"t, 't !t"1o&tr!'t!o& to 1al1! a&d 2$o"2$ate

$oeo"ta"!" !" !&or to &e%l!%!'le


50/83

Hy2er&atre!aNa 7:-

Ma=or 1a"e"

I2a!red t$!r"t o't&ded , a&e"t$et!ed 26 a&d

!&.a&t"


51/83

Hy2er&atre!a

Cl!&!1al a&!.e"tat!o&• Re"tle""&e""

• Let$ar%y

• $y2erre@e6!a

• "e!re• 1oa

A1te "e9ere $y2er&atr!!a ( a1te !&1rea"e.ro 7:87K*E4L) 1a"e &erolo%!1aldaa%eat 3: $or" 0 Ce&tral ;o&t!&e Myel!&o"!"


52/83

Hy2er&atre!a Treate&t

A! re"tor!&% 2la"a o"olal!ty to &oral

Water de1!t "$old 'e 1orre1ted o9er :/ $or"


53/83

A1te treate&t


54/83

A1te treate&t Co&tNoral Total 'ody "od! (e9ole!a)

re2la1e #ater d!1!t ($y2oto&!1 @!d")

1o&trol D!a'et!1 I&"!2!d"

7 Ce&tral DI0DDA;,7*83*1% !&tra&a"ally 38:1%


55/83

Hy2er&atre!a

Hypernatremia

Water & Na loss Water Loss Increased Na ontent

Loop diuretic!eplace "ater de#icit!eplace isotonic loss

!eplace ani "ater de# !aplace "ater de#icit


56/83

Hy2er&atre!a

A&e"t$et!1 Co&"!derat!o&"I&1rea"e" MAC

Hy2o9ole!a a11e&tate" a&y 9a"od!latat!o& or1ard!a1 de2re""!o& .ro a&e"t$et!1 a%e&t"

Ele1t!9e "r%ery "$old 'e 2o"t2o&ed !& 2at!e&t"#!t$ Na 7-* E4L


57/83

Hy2o&atre!aNaQ 75- E4L

Fl!d lo""e" re"lt!&% !& $y2o&atre!a ay 'ere&al a&d e6tra re&al

Re&al related to t$!a!de d!ret!1E6tra re&al are ty2!1ally %a"tro!&te"t!&al


58/83


59/83


60/83

H !


61/83

Hy2o&atre!a

A&e"t$e"!a Co&"!derat!o&

;la"a "od! 1o&1e&trat!o&" "$old 'e1ore1ted a'o9e 75* E4L .or ele1t!9e 2ro1edre

Lo#er 1o&1e&trat!o& ay re"lt !& "!%&!1a&t1ere'ral edea ( a1, 2o"t o2 a%!tat!o&,1o&."!o&, or "o&ole&1e)

H ? l !


62/83

Hy2o?ale!a

;la"a S 5- E4L

Ca& o11r a" re"lt

a& !&ter1o2artee&tal "$!.t o. S

!&1rea"e 2ota""! lo"" !&adeate 2ota""! !&ta?e

Ca"e" o. Re&al ;ota""!


63/83

Lo""Drugs Bicarbonaturia D!ret1" D!"tal re&al T'lar A1!do"!"

T$!a!de D!ret!1" Magnesium defciency

Loo2 D!ret!1" Ot$er le"" 1oo& 1a"e"

O"ot!1 D!ret!1" C!"2lat!&

A&t!'!ot!1" Car'o&!1 a&$ydra"e !&$!'!tor";e&!1!ll!&" Le?e!a

Hormones Intrinsic renal deect

Aldo"tero&e Barter "y&droe

Gl1o1ort!1o!d" G!tela& "y&droe


64/83

Hy2o?ale!aEPe1t"

Card!o9a"1lar

Nero"1lar

Re&alHoro&al

Meta'ol!1


65/83

Hy2o?ale!a Treate&t de2e&d" o& 2re"e&1e a&d "e9er!ty o.

a&y a""o1!ated or%a& dy".&%t!o&

Oral re2la1ee&t #!t$ 2ota""! 1$lor!de "ol !"%e&erally "a.e"t ( *8/* E4dl)

;er!2$eral I re2la1ee&t "$old &ot e61eed /E4$or"

A9o!d De6tro"e81o&ta!&!&% "ol


66/83

Hy2o?ale!aA&e"t$et!1 Co&"!derat!o&

C$ro&!1 !ld $y2o?ale!a (585-E4L) #o ECG1$a&%e" &ot !&1rea"e a&e"t$et!1 r!"?

Do"a%e" o. &ero"1lar 'lo1?!&% a%e&t""$old t$ere.ore 'e red1ed 3-8-*+


67/83

Hy2er?ale!a;la"a S e61eed" -- E4L

Ca& o11r"

a& !&ter1o2artee&tal "$!.t o. 2otta"!

de1rea"ed r!&ary e61ret!o& o. 2ota""! a& !&1rea"e 2ota""! !&ta?e


68/83

Hy2er?ale!aEPe1t o& "?eletal a&d 1ard!a1 "1le


69/83

Hy2er?ale!a Treate&t

Hy2er?ale!a e61eed!&% E4L "$old al#ay"'e treated


70/83

Hy2er?ale!aA&e"t$e"!a 1o&"!derat!o&Ele1t!9e "r%ery "$old &ot 'e &derta?!&% !&

2at!e&t" #!t$ $y2er?ale!a


71/83

Hy2er1al1e!a

Ca"e" o. $y2er1al1e!aHy2er2arat$yro!d!"Mal!%&a&1yE61e""!9e 9!t D I&ta?e

;a%et" d!"ea"eGra&loato" d!"order"C$ro&!1 !o'!l!at!o&M!l?8al?al! "y&droeAdre&al !&"1!e&1yDr% !&d1ed


72/83

Hy2er1al1e!aCl!&!1al Ma&!.e"tat!o&A&ore6!,Na"ea,o!t!&%,Wea?&e"",;olyr!a,ata

6!a,Letar%!a,Co&."!o&

H;N, Arr$yt$!a", Heart 'lo1?, a&d Card!a1Arre"t

ECG "!%&"


73/83

Hy2er1al1e!a

Treate&tRe$ydrat!o& .ollo#ed 'y a 'r!"? d!re"!" ( r!&ary

ot2t 3**85** l4$or) #!t$ ad!&!"trat!o& o. !9"al!&e !&."!o& a&d loo2 d!ret!1 to a11elerate

1al1! e61ret!o&B!2$o"2$o&ate, 7"t l!&e dr%" .or a&a%ee&t o.

$y2er1al1e!a de to o"teo1la"t!1 'o&e re"or2t!o&

Cal1!to&!&

Hydro1ort!"o&e

l !


74/83

Hy2er1al1e!aA&e"t$et!1 1o&"!derat!o&Hy2er1al1e!a !" a ed!1al eer%e&1y

Re"2o&"e" to a&e"t$et!1 a%e&t are &ot2red!1ta'le

H l !


75/83

Hy2o1al1e!aCa"e"Hy2o2arat$yro!d!"

;"edo$y2o2arat$yro!d!"

!ta!& D de1!e&1yHy2er2$o"2$at$e!a

;re1!2!tat!o& o. 1a

C$elat!o& o. 1a

Hy2o1al1e!a


76/83

Hy2o1al1e!a

Cl!&!1al a&!.e"tat!o&;are"t$e"!", 1o&."!o&, lary&%eal

"tr!dor,1ar2o2edal "2a", a""eter "2a" a&d"e!re"

B!l!ary 1ol!1, 'ro&1$o "2a"Card!a1 !rr!ta'!l!ty

Hy2o1al1e!a


77/83

y2 Treate&t

Ad!&!"ter Cal1!I90 7* L 7*+ 1al1! %l1o&ate o9er 7*!&, .ollo#ed 'yelee&tal 1al1!

oral0 -**87**% elee&tal 1al1! $r

Ad!&!"ter 9!ta!& DEr%o1al1!.erol, 7,3**1%4day

Dy$ydrota1$y"terol,3**8:**1%4day

73- d!$ydro6y1$ole1al1!.erol, *,3-87* 1%4day

Hy2o1al1e!a


78/83

Hy2o1al1e!a

A&e"t$et!1 1o&"!derat!o&


79/83

Hy2er2$o"2$ate!a


80/83

Hy2o2$o"2$ate!a

Re"lt o. e!t$er a &e%at!9e 2$o"2$oro" 'ala&1eor 1elllar 2ta?e o. e6tra1ellarCl!&!1al a&!.e"tat!o&" "e9ere

$y2o2$o"2$ate!a o.te& a""o1!ated #!t$#!de"2read or%a& dy".&1t!o& Treate&t8 ;ota""! or "od! 2$o"2$ate ( 38-

% o. elee&tal 2$o"2$oro" 2er ?!lo%ra, or7*8 :- ol "lo#ly o9er 73 $or")A&e"t$et!1 1o&"!derat!o& &ero"1lar

.&1t!o& "t 'e o&!tored #$e& &ero"1lar'lo1?!&% a%e& are %!9!&%

H 2era%&e"e!a


81/83

Hy2era%&e"e!aCl!&!1al Ma&!.e"tat!o& &erolo%!1 ,

&ero"1lar a&!.e"tat!o&

Treate&t I 1al1!

A&e"t$e"!a 1o&"!derat!o&

Do"a%e" o. &ero"1lar 'lo1?!&% a%e&t""$old 'e red1ed

Hy2oa%&e"e!a


82/83

Hy2oa%&e"e!aA"y2toat!1A""o1!ated #!t$ 'ot$ $y2o1al1e!a a&d

$y2o?ale!a

Card!a1 a&!.e"tat!o&

Treate&t a%&e"! "l.ate


83/83

THANS YOU ;O

Fluids and Electrolyte

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