Fluid_Lyte_LectureFinal_2012

Clinically assess ecf volume hypervolemic

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Clinically Assess ECF Volume Hypervolemic Hypernatremia Isovolemic Hypernatremia Hypovolemic Hypernatremia Depleted Normal Expanded Renal Diuretics Glycosuria Acute or chronic renal failure Partial obstruction GI losses (diarrhea) Respiratory losses Skin losses (burns) Adrenal insufficiency Loss of water Diabetes insipidus Reset osmostat Iatrogenic Iatrogenic Mineralocorticoid excess
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Pathogenesis of Hyponatremia Decreased GFR Age Renal disease Congestive heart failure Cirrhosis Nephrotic syndrome Volume depletion Decreased reabsorption of NaCl Thiazide diuretics Increased ADH release or action Drugs SIADH ADH secretion
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Elevated ADH Hyponatremia Effective circulating volume depletion True volume depletion Heart failure Cirrhosis ? Nephrotic syndrome Thiazide diuretics SIADH Hormonal Changes Adrenal insufficiency Severe hypothyroidism Reset osmostat (ex. pregnancy)
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Suppressed ADH Hyponatremia Advanced kidney failure Reduced filtration volume Primary polydipsia Ecstasy (may also stimulate increased ADH) Low dietary salt intake Beer Drinker’s Potomania “Tea and Toast” diet
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Hyponatremia Symptoms Chronic condition Headache Nausea Vomiting Cramps Lethargy Disorientation Decreased DTR’s Acute condition Seizures Coma Respiratory arrest Cerebral edema Herniation
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Case # 2 A 25 year old female presents to the ED with a chief complaint of feeling dizzy upon standing. The history of present illness is significant for 4 days of diarrhea / vomiting. She has not been able to keep food or much liquid down. She has no other past medical history and is not on any medications. Wt 62 kg 122/60-100-16 108/52-131-16 PE: dry mucous membranes, sunken eyes, poor skin turgor Lungs, cardiovascular, abdomen, extremities – normal 124 / 104 / 42 97 Na / Cl / BUN glucose 4.2 / 12 / 1.4 K / HCO 3 / SCr ABG: 7.2/44 /91 uNa 8 mEq/L
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Case # 2 Q1: Estimate her total body water Q2: Is she hypo-, hyper-, or euvolemic? Q3: Explain the fluid shifts that are occurring. How will you approach the case?
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Hypotonic, Hypovolemic , Hyponatremia sOsm < 280 Hypovolemic Uosm > 450 U Na < 20 U Na > 20 Extrarenal losses: GI Skin, Lung Renal loss, Diuretics, Adrenal insufficiency Extrarenal Loss Excess sweating, diarrhea, vomiting, 3 rd spacing, wound drainage Renal Loss Diuretics (thiazides) P’col:block Na reabsorption in the distal tubule → Na & water excretion; Stimulates ADH Water < Na loss Renal tubular acidosis Adrenal insufficiency Ketonuria Osmotic diuresis
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Case # 3 Jane is a 65 y/o with a past medical history significant for heart failure (HF) secondary to an acute myocardial infarction (AMI) 3 years ago. She presents for a routine medicine clinic visit. She indicates that she has been short of breath; more recently has had swelling in her lower
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Clinically Assess ECF Volume Hypervolemic Hypernatremia...

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