fluids and electrolyte imbalance

8/3/2019 Fluids and Electrolyte Imbalance

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Fluids and electrolyte imbalance



Objectives:Objectives:

At the end of this lecture the student should beAt the end of this lecture the student should be

able to:able to:

y Define Fluids and electrolyte imbalance

imbalance.

y Deffrentiate between Hyponatremia,

Hypernatremia and hypokalemia

y Discuss causes of Hyponatremia.

y List signs , symptoms and treatment of

hypokalemia



overview

sodium, Electrolytes are salts thatconduct electricity and are found in

the body fluid, tissue, and blood.

Examples are chloride, calcium,magnesium, and potassium



y Sodium (Na+) is concentrated in the

extracellular fluid (ECF) and potassium

(K+) is concentrated in the intracellular

fluid (ICF). Proper balance is essential for

muscle coordination, heart function, fluid

absorption and excretion, nerve function,

and concentration



y The kidneys regulate fluid absorption

and excretion and maintain a narrow

range of electrolyte fluctuation.

y Normally, sodium and potassium are

filtered and excreted in the urine and

feces according to the body's needs



y Too much or too little sodium orpotassium, caused by poor diet,dehydration, medication, and disease,

results in an imbalance.

y Too much sodium is called hypernatremia;too little is called hyponatremia.

y Too much potassium is calledhyperkalemia; Too little is calledhypokalemia.



y Incidence and Prevalence

Hyponatremia is the most common

electrolyte imbalance. It is associated with

kidney disease such as ne phroticsyndrome and acute renal failure (ARF).



yMen and women with healthy kidneys

have equal chances of experiencing

electrolyte imbalance, and people with

eating disorders such as anorexia and

bulimia, which most often affect

women, are at increased risk. Very

young people and old people areaffected more often than young adults.



HyponatremiaHyponatremia

Causes

Hyponatremia is caused by conditions

such as water retention and renalfailure that result in a low sodium levelin the blood.

y

Pseudohyponatremia occurs when toomuch water is drawn into the blood; itis commonly seen in people withhypoglycemia (low blood sugar



Psychogenic polydipsia occurs in people

who compulsively drink more than four

gallons of water a day.



Hypovolemic hyponatremia (with low

blood volume due to fluid loss) occurs

in dehydrated people who rehydrate

(drink a lot of water) too quickly, inpatients taking thiazide diuretics, and

after severe vomiting or diarrhea.



y Hypervolemic hyponatremia (high blood

volume

y due to fluid retention) occurs in people with

liver cirrhosis, heart disease, or nephrotic

syndrome. Edema (swelling) often develops

with fluid retention.



Euvolemic hyponatremia (decrease in

total body water) occurs in people with:

, adrenal gland disorder,hypothyroidism

and disorders that increase the release of

the antidiuretic hormone (ADH), such

as tuberculosis, pneumonia, andbrain trauma



Signs and SymptomsSigns and Symptoms

Symptoms of hyponatremia are related to

the severity and the rate at which the

conditions develop.

The first symptoms are fatigue,

weakness, nausea, and headache. More

severe cases cause confusion, seizure,

coma, and death.



TreatmentTreatment

The goal of treatment

Is to restore electrolyte balance forproper hydration and use of total bodyfluid. Sodium deficiency must becorrected slowly because drastic changein sodium level can cause brain cellshrinkage and central pontinemyelinolysis (damage to the pons regionof the brain). Methods include



y Fluid and water restriction

y Intravenous (IV) saline solution of 3%

sodium

y Salt tablets



y Conivaptan (Vaprisol®) has been

approved by the U.S. Food and Drug

Administration (FDA) to treat

hypervolemic hyponatremia andeuvolemic hyponatremia in some

hospitalized adults. Vaprisol is

administered intravenously (i.e., into avein).



y Blood sodium levels should be closely

monitored in patients who receive this

medication.

y Side effects include injection site

reactions, headache, thirst, and lowpotassium levels.



HypernatremiaHypernatremia

y Hypernatremia is high sodium in the

blood that occurs with excessive fluid

loss. When fluid is lost and not

replaced, sodium is not adequately

excreted from the body



causescauses

y Diabetes insipidus (caused by deficiencyof or insensitivity to ADH)

y Diarrhea

y

Diuretic medicationy Excessive salt intake

y Excessive vomiting

y Heavy respiration (e.g., exercise,

exertion)y Severe burn

y Sweating



y It is associated with the same symptoms

as hyponatremia, and also causes the

following:

y Delerium

y Irritability

yMuscle twitching



y Hypernatremia commonly affects older

hospitalized people, 50% of whom have

underlying diseases that, when

combined with excessive sodium and

fluid loss, are fatal.



HypernatremiaHypernatremia

y Hypernatremia commonly affects older

hospitalized people, 50% of whom have

underlying diseases that, when

combined with excessive sodium andfluid loss, are fatal.



TreatmentTreatment

Treating hypernatremia involves slowly

replenishing water loss, usually over 48 hours,

through drinking or intravenous (IV) solution.In cases of diabetes, the imbalance is treated

with adequate water intake and nonsteroidal

anti-inflammatory drugs or with synthesized

hormones (e.g., desmopressin) that aid in fluid

retention and decrease urination



y Some drugs used to treat electrolyte

imbalance may be unsafe for pregnant

women and should not be taken before

consulting a physician.



y An abnormally low level of potassium

(K+) is called hypokalemia. The adrenal

gland makes a hormone (aldosterone)

that signals the kidneys to excrete orconserve potassium, based on the

body's needs. In hypokalemia, the

adrenal gland retains the hormone andthe kidneys conserve potassium when

more is needed



CausesCauses

y

The most common cause of potassium

depletion is diuretic medication that

increases urination. Diuretics areprescribed for medical conditions and

are used in weight-loss programs. Other

causes include:



y Diarrhea

y Dietary deficiency

y Excessive sweating

yMagnesium deficiency (causes

overexcretion of fluid)



Signs and SymptomsSigns and Symptoms

Symptoms of deficiency include cardiac

arrhythmia, muscle pain, general

discomfort or irritability, weakness, andparalysis



DiagnosisDiagnosis

Diagnosis may require urinalysis and

blood tests to determine the amount of

potassium being excreted by thekidneys



TreatmentTreatment

y

Treatment involves potassiumsupplements, proper diet, and intravenous(IV) solution. The best way to maintain an

adequate potassium level is to eat foodssuch as sweet potatoes, bananas, avocados,spinach, and oranges. Patients takingdiuretic medication are also givenpotassium supplements. Potassium isgiven slowly to avoid hyperkalemia.

y

fluids and electrolyte imbalance

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