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Fluid_Lyte_LectureFinal_2012

Case 1 a 25 year old male suffered a gun shot wound

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Case # 1 A 25 year old male suffered a gun shot wound to the abdomen. He arrived to the trauma bay in shock with a blood pressure of 70/palp and a heart rate of 125. His weight is estimated at 75 kg. Initial labs revealed the following: 135 / 107 / 15 218 ABG: 7.31 / 52 / 88 3.5 / 21 / 0.7 Q: Determine his total body volume. Q: What is his ECF serum osmolality? Q: Assess his current volume status. Q: Does volume need to be provided? If so, what specific space?
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FLUID BALANCE
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Q1: What is her total body water?
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Total Body Water (60% body weight) Male IBW: 70 kg – 42 L Intracellular Water – 2/3 volume (40% body weight) Extracellular Water – 1/3 volume (20% body weight) Interstitial Plasma Transcellular 28 L ~12 L ~1 L 0.5 L Volume (L)
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Q2: Clues to Fluid Balance I/O, Daily weight, mucous membranes Heart sounds, CVP, PAP Blood pressure Heart rate Lung sounds: crackles, rales, wheezes Edema, skin turgor Pulses Vein: Hgb, Hct, [Na] Urine specific gravity
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Q3: Calculating Serum Osmolality Sosm (mOsm/kg) = (2)[Na]+[BUN/2.8]+[Glucose/18] Normal 275-290 mOsm/kg
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Q3: Movement of Fluid Water moves when conditions change the osmolality of the Intracellular and Extracellular compartment. Water will move from the lower to the higher concentration.
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Regulation of Sodium and Water Balance: ADH release
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Regulation of Sodium and Water Balance
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ADH: Stimuli for Release Stimuli Inhibitors Hyperosmolality Hypovolemia Stress (ex: Pain) Nausea Pregnancy Hypoglycemia Nicotine Morphine Other drugs Hypo-osmolality Hypervolemia Ethanol Phenytoin
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Changes in Cell Structure Secondary to Osmolality Changes Tuan DT. 3.30.10
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Case # 1 A 25 year old male suffered a gun shot wound to the abdomen. He arrived to the trauma bay in shock with a blood pressure of 70/palp and a heart rate of 125. His weight is estimated at 75 kg. Initial labs revealed the following: 135 / 107 / 15 218 ABG: 7.31 / 52 / 88 3.5 / 21 / 0.7 Q: Determine his total body volume. Q: What is his ECF serum osmolality? Q: Assess his current volume status. Q: Does volume need to be provided? If so, what specific space?
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Effect of 1 L Fluid on ECF & ICF Fluid Effect on ECF Effect on ICF End Result D5W Increases volume Decreases osmolality Water moves from ECF to ICF until = osmolality; Increases volume ECF expands by 1/3 ICF expands by 2/3 Water distributes proportionally NS Increases volume No change in osmolality None ECF expanded ICF no change 0.45%NS (consider as 500 ml NS & 500 ml D5W) 500 ml NS expands ECF No change on osmolality; 500 ml D5W expands volume, decreases osmolality NS – no change; 500 ml D5W increases volume until = osmolality, increases ICF ECF increases by 667 ml; ICF increases by 333 ml PRBC Increases (intravascular volume) None ECF expands Whitmire SJ. Nutr Clin Pract. 2008;23:108-21.
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Terminology Volume depletion (hypovolemia) = any condition when the ECF volume is reduced Dehydration – hypernatremia is always present in this condition Edema -- clinically detectable increase in interstitial fluid volume (~ 3 L)
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Edema Pathophysiology -Alteration in capillary hemodynamics -Retention of sodium and water ECF (normal) ECF (correction) Interstitial volume increased ECF Na retention H 2 O retention
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Causes of Edema
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