Fluid_Lyte_LectureFinal_2012

Q what is his ecf serum osmolality q assess his

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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 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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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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Q What is his ECF serum osmolality Q Assess his current...

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