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Fluid and electrolytes Fluid regulation ADH (antidiuretic hormone) - released when water levels are low to increase tubular reabsorption Electrolyte regulation Aldosterone - released when serum sodium is low to increase tubular reabsorption. Water balance Assess drinking ability in all patients Fluid balance charts Insensible loss, 400 mls skin, 400 mls lungs, metabolic water 400mls day Varies with stress, ambient conditions, fever Daily weight Too much water Increased intake or reduced output Iatrogenic fluid overload Big risk in children Water intoxication, polydipsia Disease states causing fluid retention Renal impairment Heart failure Hypoalbuminaemia Hepatic cirrhosis Clinical features Polyuria, light colour if normal renal function Oedema Pulmonary oedema, orthopnoea Raised jugular venous pressure May contribute to congestive cardiac failure Pleural and pericardial effusion Ascites Reduced electrolyte concentrations Overhydration of cells Treatments Underlying cause Diuretics Dialysis / haemofiltration Reduce sodium intake Not enough water Causes Lack of water intake Vomiting and diarrhoea Burns Excessive sweating - hot environment, increased work load Fever Diabetes insipidus Osmotic diuresis DKA, HONK Iatrogenic, diuretic use, alcohol Features of dehydration Dry mouth/Thirst Oliguria then anuria, ureamia Reduced CVP Tachycardia Vasoconstriction and pallor Peripheral venoconstriction Postural hypotension then hypotnesion Nausea Inelastic skin Sunken eyes Muscle cramps Increased blood viscosity - sluggish circulation Impairment in function of many organs ---- confusion ---- coma Haemoconcentration - increased plasma sodium Elevated haematocrit Sunken fontanel Treatments in diarrhoea and vomiting Replace water and electrolytes Oral rehydration solutions Oral or nasogastric fluids Sodium and glucose is actively taken up by the duodenum Potassium and sodium are lost from gastrointestinal secretions Hypoglycaemia is a problem in diarrhoea and vomiting Other treatments Haemorrhage Burns Dehydration Intravenous infusions Crystalloids Colloids Blood Subcutanious infusions, 60 mls / hour Per rectum administration of fluids may be used by people with low skill levels Blood volumes 6 months - 500 mls 2 years -1000 mls 5 years - 1.5 litres 10 years - 2 litres 12 years - 2.25 litres Electrolyte balance Normal ranges Potassium, 3.5 - 5 mmol/L Sodium, 135 - 145 mmol/L Hyponatraemia Causes Vomiting Diarrhoea Excessive sweating Impaired tubular reabsorption Excessive diuretic therapy Addisons disease Water excess Effects Reduced blood volume Hypotension Heat exhaustion, (loss of water and sodium) Stokers cramp Treatment Remove/treat cause Oral sodium IV. normal saline Hypernatraemia Causes Water deficit - increased loss or reduced intake Osmotic diuresis High levels of mineralcorticoids Cushing`s syndrome Effects Thirst Increase in blood volume Nausea Vomiting Confusion Treatment Treat underlying cause Correct over 48 hours Hypokalaemia Causes If you would like to get hold of my books, one on Physiology and another on Pathophysiology, check out my web site campbellteaching.co.uk Funds from selling books helps to finance distribution of resources to students in poorer countries. Vomiting Diarrhoea Diuretic therapy Alkalosis Increased aldosterone levels Effects Usually asymptomatic Weakness Atrial and ventricular ectopic beats Cardiac dysrhythmias

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