Fluid, Electrolyte Imbalance and Hemodynamic Disorders I

Question 1

Mention 5 causes of fluid and electrolyte imbalance.

Answer 1

1. Burns
2. Dehydration
3. Surgery
4. Trauma
5. Diabetes
6. Alcohol withdrawal
7. Renal disease
8. Eating disorders

Question 2

What is edema?

Answer 2

Increased fluid in the interstitial spaces.

Question 3

Mention 3 examples of edema.

Answer 3

1. Hydrothorax
2. Hydroperitoneum
3. Hydropericardium

Question 4

What is Anasarca?

Answer 4

Severe and generalised edema with subcutaneous tissue swelling.

Question 5

Sustained edema may result into ________.

Answer 5

1. Restriction of arterial blood flow
2. Prevention of normal cell function
3. Tissue necrosis
4. Development of ulcers
5. Varicose veins

Question 6

Explain the mechanisms of edema.

Answer 6

The movement of fluid between vascular and interstitial spaces is controlled mainly by two opposing forces: vascular hydrostatic pressure and plasma colloid osmotic pressure (also called oncotic pressure).
VHP is the pressure exerted by fluid within blood vessels against the walls of the vessels, pushing fluid into the interstitial spaces.
PCOP is the pressure exerted by proteins (albumin) which helps to maintain balance by pulling fluid back into the capillaries from the interstitial space.

An increase in vascular hydrostatic pressure and/or a decrease in plasma colloid osmotic pressure leads to increased interstitial fluid.
The lymphatic drainage system plays a crucial role in returning fluid into the bloodstream. A blockage of the lymphatic system or a dysfunction leads to edema.

Occurs mostly as a result of increased vascular permeability. The resulting edema fluid may be either a transudate or exudate.

Question 7

What are 2 causes of edema?

Answer 7

1. Lymphatic blockage
2. Sodium and water retention

Question 8

Mention 3 clinical manifestations of edema.

Answer 8

1. Restriction of movement
2. Pain
3. Pitting edema

Question 9

What is the clinical significance of edema?

Answer 9

Subcutaneous tissue edema in cardiac or renal failure is an indication of an underlying disease.
Significant edema impairs wound healing and clearance of infection.

Pulmonary edema leads to death by interfering with ventilation
Brain edema may be rapidly fatal due to increase intracranial pressure
Marked larynx edema causes suffocation.

Question 10

How do you manage mild pedal edema?

Answer 10

Increase locomotion to improve circulation into the body.
Raise feet above heart level with pillows when lying down.

Question 11

How do you manage severe edema involving the heart, kidney and brain?

Answer 11

1. Treat with IV diuretics (furosemide)
2. IV mannitol
3. Salt restriction

Question 12

What is haemorrhage?

Answer 12

The extravasation of blood from vessels into extravascular spaces.

Question 13

Mention 3 causes of haemorrhage.

Answer 13

1. Vascular injury
2. Ruptured aneurismal dilation
3. Inflammatory or neoplastic erosion of vessel wall

Question 14

Mention 5 forms of internal haemorrhage.

Answer 14

1. Hematoma
2. Petechiae
3. Purpura : slightly larger petechiae (3-5mm)
4. Ecchymoses: larger subcutaneous hematomas (1-2cm)
5. Hemopericardium, hemoperitoneum, hemothorax, hemarthrosis.

Question 15

Petechiae are associated with:

Answer 15

1. Low platelet count
2. Defective platelet function
3. Locally increased intravascular pressure
4. Clotting factor deficiencies

Question 16

Explain the characteristic colour change of hematomas

Answer 16

Red blood cells in the haemorrhage is phagocytosed and degraded by macrophages. The hemoglobin is enzymatically converted to bilirubin and eventually hemosiderin (golden-brown).

Question 17

The clinical significance of a haemorrhage depends on:

Answer 17

1. The volume of blood loss
2. The rate
3. The location

Question 18

Loss of more than ___% of blood volume may lead to haemorrhagic shock.

Answer 18

20%

Question 19

Mention 3 complications of internal haemorrhage.

Answer 19

1. Hemoptysis: coughing up blood
2. Hematemesis: vomiting blood
3. Melena: blood in stool

Question 20

How do you manage haemorrhage?

Answer 20

1. Control of haemorrhage
2. IV isotonic crystalloid fluids (isoplasma)
3. Blood transfusion.
4. For conditions associated with haemorrhage, treat with antibiotics, corticosteroids ad chemotherapy.

Question 21

What is dehydration?

Answer 21

Fluid deficit as a result of inadequate fluid intake, excessive fluid loss or a combination of both.

Question 22

Mention 3 causes of dehydration.

Answer 22

1. Vomiting & Diarrhea
2. Excessive sweating
3. Insufficient water intake

Question 23

Mention 5 effects of dehydration.

Answer 23

1. Hypotension
2. Lethargy
3. Confusion
4. Decreased skin elasticity
5. Headache
6. Fatigue

Question 24

How does the body compensate for dehydration?

Answer 24

1. Thirst
2. Increased heart rate
3. Pale cool skin
4. Decreasing urine output
5. Decreased mental function (reduced fluid to brain cells)

Question 25

Mention 5 effects of hyperkalemia.

Answer 25

1. Cardiac dysrhythmias
2. Muscle weakness
3. Paralysis
4. Fatigue
5. Nausea
6. Paresthesia

Question 26

Mention 5 effects of hypokalemia.

Answer 26

1. Cardiac dysrhythmias
2. Muscle weakness
3. Paresthesia
4. Reduced GI motility
5. Abdominal cramping
6. Weakness of respiratory weakness
7. Impaired renal function

Question 27

Differentiate between respiratory acidosis and metabolic acidosis.

Answer 27

Respiratory acidosis occurs when there is hypoventilation and retention of Co2, causing an increase in the partial pressure of carbon dioxide (PCO2) in the blood, leading to an increase in carbonic acid and a decrease in pH. It is caused by conditions such as chronic obstructive pulmonary disease (COPD), asthma, pneumonia, chest wall deformities, or respiratory depression due to drugs or anesthesia.

Metabolic acidosis occurs when there is an accumulation of acids or a loss of bicarbonate in the body. It can be caused by diarrhoea and renal failure.

Question 28

What are the clinical manifestations of respiratory acidosis?

Answer 28

1. Headache
2. Shortness of breath 3. Cardiovascular abnormalities
3. Restlessness
4. Confusion.
5. Cyanosis

Question 29

What are the clinical manifestations of metabolic acidosis?

Answer 29

1. Muscular twitching, 2. Weakness
2. Nausea
3. Vomiting
4. Diarrhea
5. headache

Question 30

Differentiate between respiratory alkalosis and metabolic alkalosis.

Answer 30

Respiratory alkalosis occurs when there is hyperventilation and excessive excretion of C02, causing a decrease in the partial pressure of carbon dioxide (PCO2) in the blood. It is a sign of early stage pulmonary problems

Metabolic alkalosis occurs when there is an increase in the bicarbonate concentration in the blood, leading to elevated levels of bicarbonate ions and an increase in blood pH. It is caused by vomiting, diarrhoea, gastric suctioning and excessive use of laxatives.

Question 31

What are the clinical manifestations of respiratory alkalosis?

Answer 31

i. Deep, rapid breathing
ii. Dizziness
iii. Muscle cramps
iv. Numbness of extremities

Question 32

What are the clinical manifestations of metabolic alkalosis?

Answer 32

i. Hypoventilation
ii. Muscle weakness
iii. Irritability
iv. Confusion
v. Muscle twitching