Fluid_Lyte_LectureFinal_2012

Obstruction of lymphatic flow malignant obstruction

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Obstruction of lymphatic flow Malignant obstruction Lymph node removal Increased capillary pressure Increased vascular volume (HF, CKD, thiazolidinedione (Glitazone) therapy Venous obstruction (liver dz, acute pulmonary edema) Decreased arteriolar resistance (Ca channel blockers) Decreased colloidal osmotic pressure Increased loss of plasma proteins (CKD, burns) Decreased production of plasma proteins (liver dz, malnutrition) Increased Capillary permeability Inflammation Allergic reaction Malignancy Tissue injury / burns
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3 rd Spacing
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SODIUM
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Mary had a little lamb & everywhere Mary went the lamb was sure to go. Moral of this story: Where Na goes Water follows Na H 2 O
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Hypotonic, Volume term, Hyponatremia sOsm < 280 Hypovolemic Hypervolemic Euvolemic Uosm > 450 U Na < 20 U Na > 20 Extrarenal losses: GI Skin, Lung Renal loss, Diuretics, Adrenal insufficiency Uosm > 100 U Na < 20 HF, Cirrhosis, Nephrosis Uosm > 100 Uosm < 100 U Na > 20 r/o hypothyroid, SIADH, renal failure U Na < 20 Primary polydipsia Low solute intake
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Serum Osmolality Measure blood glucose, lipid, protein Clinically assess ECF volume Measure blood glucose Isotonic (280-290 mOsm) Hypertonic (>290 mOsm) Hypotonic (<280 mOsm) Isotonic Hyponatremia 1.Pseudohyponatremia a. Hyperlipidemia b. Hyperproteinemia 2.Isotonic infusions a. Glucose b. Mannitol c. Glycine Hypertonic Hyponatremia 1.Hyperglycemia 2.HYpertonic infusions a. Glucose b. Mannitol c. Glycine Isovolemic Hypotonic Hyponatremia 1.Water intoxication 2.K + loss 3.Reset osmostat 4.SIADH Hypovolemic Hypotonic Hyponatremia 1.GI losses 2.Skin losses 3.Lung losses 4.Third space losses 5.Renal losses Hypervolemic Hypotonic Hyponatremia 1.CHF 2.Cirhosis 3.Nephrotic syndrome
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Clinically Assess ECF Volume Hypervolemic Hypernatremia Isovolemic Hypernatremia Hypovolemic Hypernatremia Depleted Normal Expanded Loss of water & Na 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 Gain of water & Na 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
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