M1L2: Fluid Imbalances

Hyper-osmolar imbalance

Hypo-osmolar imbalance

Osmolar Imbalances (2)

Hyper-osmolar imbalance

(Osmolar Imbalances)

H2O Deficit + Solute Excess (e.g. Na+)

H2O Deficit + Solute Excess

(Osmolar Imbalances)

Hyper-osmolar imbalance

Hyper-osmolar imbalance

(Osmolar Imbalances)

Decrease intake, increase output

Dehydration

(Osmolar Imbalances)

Clinical picture of hyper-osmolar imbalance

sunken soft spot on top of head

(Osmolar Imbalances: Dehydration - clinical presentations)

Head

10 months

(Osmolar Imbalances: Dehydration - clinical presentations)

Head; fontanelle must be closed at ___ ___ old

sunken eyes

(Osmolar Imbalances: Dehydration - clinical presentations)

Eyes

dry

cracked

(Osmolar Imbalances: Dehydration - clinical presentations)

Lips

positive

(Osmolar Imbalances: Dehydration - clinical presentations)

Skin - ___ pinch test

decreased

(Osmolar Imbalances: Dehydration - clinical presentations)

Skin - ___ turgor

elevated

(Osmolar Imbalances: Dehydration - clinical presentations)

Skin - decreased turgor = remains ___ after being pulled up and released

hand

(Osmolar Imbalances: Dehydration - clinical presentations)

Skin - pinch test
: Adult - test on ___

abdomen

(Osmolar Imbalances: Dehydration - clinical presentations)

Skin - pinch test
: Infant - test on ___

Laundry woman’s hands

(Osmolar Imbalances: Dehydration - clinical presentations)

Term for skin on fingers stick together

Increased temperature

Increased pulse rate

Increased respiratory rate

Decreased blood pressure

(Osmolar Imbalances: Dehydration - clinical presentations)

Vital signs

Dehydration

(Osmolar Imbalances: what clinical picture?)

Thirst

Dehydration

(Osmolar Imbalances: what clinical picture?)

Sluggishness, fatigue, nausea, emotional instability

Dehydration

(Osmolar Imbalances: what clinical picture?)

Clumsiness, headache, increased body temp., increased PR, increased RR

Dehydration

(Osmolar Imbalances: what clinical picture?)

Dizziness, slurred speech, weakness, confusion

Dehydration

(Osmolar Imbalances: what clinical picture?)

Delirium, swollen tongue, circulatory problem, decreased blood volume, kidney failure

Dehydration

(Osmolar Imbalances: what clinical picture?)

Inability to swallow, painful urination, cracked skin

Dehydration

(Osmolar Imbalances: what clinical picture?)

Imminent death

Home-mix rehydration drink

Oral rehydration salts

(Osmolar Imbalances: Dehydration)

Management (2)

Sugar and salt

Powdered cereal and salt

(Osmolar Imbalances: Dehydration - management)

Home-mix rehydration drink (2)

1L clean water : ½ tsp. salt : 8 level tsps. sugar

(Osmolar Imbalances: Dehydration - management)

Sugar and salt recipe

boil

(Osmolar Imbalances: Dehydration - management)

Sugar and salt recipe

If in doubt, ___ water

tears

(Osmolar Imbalances: Dehydration - management)

Sugar and salt recipe

Taste drink before adding sugar. Must be less salty than ___

1L water : ½ tsp salt : 8 heaping tsps. or 2 handfuls powdered cereal

(Osmolar Imbalances: Dehydration - management)

Powdered cereal and salt recipe

5 to 7

(Osmolar Imbalances: Dehydration - management)

Powdered cereal and salt recipe

Boil for ___ to ___ min.

“suam”

(Osmolar Imbalances: Dehydration - management)

Powdered cereal and salt recipe

Liquid powdery porridge

Hypo-osmolar imbalance

(Osmolar Imbalances)

H2O Excess + Solute Deficit

H2O Excess + Solute Deficit

(Osmolar Imbalances)

Hypo-osmolar imbalance

Edema

(Osmolar Imbalances)

Clinical picture of hypo-osmolar imbalance

Edema

(Osmolar Imbalances)

Increase intake, decrease output

Edema

(Osmolar Imbalances: what clinical picture?)

Puffy eyelids

Edema

(Osmolar Imbalances: what clinical picture?)

Moon-face (round)

Edema

(Osmolar Imbalances: what clinical picture?)

+ Finger test. Indentation. Fluid retention

Decreased temperature

PR Strong heavy pulse

RR DOB (water seeps in the spaces of lungs)

Increased BP

(Osmolar Imbalances: Edema - clinical presentations)

Vital signs

Anasarca

(Osmolar Imbalances: Edema - Types)

Generalized edema

Hydrothorax

(Osmolar Imbalances: Edema - Types)

Fluid accumulation in the pleural cavity

Hydropericardium

(Osmolar Imbalances: Edema - Types)

Fluid accumulation in the pericardial cavity (a.k.a. “cardiac tamponade”)

Hydroperitoneum

(Osmolar Imbalances: Edema - Types)

Abnormal accumulation of fluid in the peritoneal (abdomen) cavity (a.k.a “ascites”)

Diuretics

(Osmolar Imbalances: Edema - Management)

Water pills

sodium

water

(Osmolar Imbalances: Edema - Management)

Diuretics
- Helps rid the body of salt (___) and ___

sodium

(Osmolar Imbalances: Edema - Management)

Diuretics
- Works by making kidneys put more ___ in urine

Thiazide

Loop

Potassium-sparing

Osmotic

(Osmolar Imbalances: Edema - Management)

Diuretics (4)

Thiazide

(Osmolar Imbalances: Edema - Type of Diuretic)

Chlorothiazide

Thiazide

(Osmolar Imbalances: Edema - Type of Diuretic)

Hydrochlorothiazide HCTZ (Microzide)

Thiazide

(Osmolar Imbalances: Edema - Type of Diuretic)

Indapamide

Thiazide

(Osmolar Imbalances: Edema - Type of Diuretic)

Metalozone (Zaroxolyn)

Loop

(Osmolar Imbalances: Edema - Type of Diuretic)

Bumetanide

Loop

(Osmolar Imbalances: Edema - Type of Diuretic)

Ethacrynic Acid (Edecrin)

Loop

(Osmolar Imbalances: Edema - Type of Diuretic)

Furosemide (Lasix)

Loop

(Osmolar Imbalances: Edema - Type of Diuretic)

Torsemide (Demadex)

Potassium-sparing

(Osmolar Imbalances: Edema - Type of Diuretic)

Amiloride

Potassium-sparing

(Osmolar Imbalances: Edema - Type of Diuretic)

Eplerenone (Inspra)

Potassium-sparing

(Osmolar Imbalances: Edema - Type of Diuretic)

Spironolactone

Potassium-sparing

(Osmolar Imbalances: Edema - Type of Diuretic)

Triamterene (Dyrenium)

Osmotic

(Osmolar Imbalances: Edema - Type of Diuretic)

Mannitol

Proximal part of the distal convoluted tubule of the glomerulus

(Osmolar Imbalances: Edema - Diuretics ~ Affected Area of the Kidney)

Thiazide

Loop of henle

(Osmolar Imbalances: Edema - Diuretics ~ Affected Area of the Kidney)

Loop

Distal part of the convoluted tubule

(Osmolar Imbalances: Edema - Diuretics ~ Affected Area of the Kidney)

Potassium-sparing

Collecting duct and tubules

(Osmolar Imbalances: Edema - Diuretics ~ Affected Area of the Kidney)

Osmotic

Isotonic volume deficit

Isotonic volume excess

Volume Imbalances (2)

Isotonic Volume Deficit

(Volume Imbalances)

Equal loss of Na+ + H2O together

Hypovolemia

(Volume Imbalances)

Isotonic Volume Deficit clinical picture

Isotonic Volume Excess

(Volume Imbalances)

Equal gain of Na+ + H2O together

Hypervolemia

(Volume Imbalances)

Isotonic Volume Excess clinical picture

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Extreme weight loss

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Bleeding - Postpartum bleeding (uterine atony), trauma, surgical operation

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Severe vomiting - Hyperemesis gravidarum, hyperacidic condition

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Extreme weight loss

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Marasmus

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Dehydration

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Heat stroke

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Diuretic use (excessive urination)

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Blood donation

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Use of vasodilators

Hypovolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Use of ACE inhibitors (fluid loss and edema)

Hypervolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Excessive sodium/fluid intake

Hypervolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

IV therapy

Hypervolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Transfusion reaction by blood transfusion

Hypervolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Sodium/water retention

Hypervolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Heart failure (heart)

Hypervolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Liver cirrhosis (liver)

Hypervolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Nephrotic syndrome (kidney)

Hypervolemia

(Volume Imbalances: Causes - Hypovolemia or Hypervolemia)

Corticosteroid therapy (endocrine)

Fluid replacement (IV fluid)

Blood transfusion

(Volume Imbalances: Hypovolemia)

Management (2)

Use of diuretics (Heart & Liver)

Use of dialysis (Kidney)

Limit sodium intake

(Volume Imbalances: Hypovolemia)

Management (3)

Plasma - Interstitial Shift

Interstitial - Plasma Shift

Fluid shift (2)

Circulatory collapse

(Fluid shift)

Plasma-Interstitial Shift clinical picture

Circulatory overload

(Fluid shift)

Interstitial-Plasma Shift clinical picture

Pallor “lapsi”

Cold, clammy hands

BP Palpatory (0)

Oliguria

(Fluid shift: Plasma-Interstitial Shift)

Assessment cues (4)

Red flushed cheeks

Neck vein distended (pulse)

Increased BP (DOB)

Signs of pulmonary edema (DOB)

(Fluid shift: Interstitial-Plasma Shift)

Assessment cues (4)

Anaphylactic shock

(Fluid shift: Plasma-Interstitial Shift - Circulatory Collapse Shock types)

Severe allergic reaction

Injectables (antibiotics, venom/stings, contrast medium dye)

Neurogenic shock

(Fluid shift: Plasma-Interstitial Shift - Circulatory Collapse Shock types)

Trauma, Injury, Pain

Septic shock

(Fluid shift: Plasma-Interstitial Shift - Circulatory Collapse Shock types)

Severe multiple organ infection

Hypovolemic shock

(Fluid shift: Plasma-Interstitial Shift - Circulatory Collapse Shock types)

Blood loss

Cardiogenic shock

(Fluid shift: Plasma-Interstitial Shift - Circulatory Collapse Shock types)

Any cardiac condition (e.g. myocardial infarction)