Fluid, Electrolyte Imbalance and Hemodynamic Disorders I Flashcards
Mention 5 causes of fluid and electrolyte imbalance.
- Burns
- Dehydration
- Surgery
- Trauma
- Diabetes
- Alcohol withdrawal
- Renal disease
- Eating disorders
What is edema?
Increased fluid in the interstitial spaces.
Mention 3 examples of edema.
- Hydrothorax
- Hydroperitoneum
- Hydropericardium
What is Anasarca?
Severe and generalised edema with subcutaneous tissue swelling.
Sustained edema may result into ________.
- Restriction of arterial blood flow
- Prevention of normal cell function
- Tissue necrosis
- Development of ulcers
- Varicose veins
Explain the mechanisms of edema.
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.
What are 2 causes of edema?
- Lymphatic blockage
- Sodium and water retention
Mention 3 clinical manifestations of edema.
- Restriction of movement
- Pain
- Pitting edema
What is the clinical significance of edema?
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.
How do you manage mild pedal edema?
Increase locomotion to improve circulation into the body.
Raise feet above heart level with pillows when lying down.
How do you manage severe edema involving the heart, kidney and brain?
- Treat with IV diuretics (furosemide)
- IV mannitol
- Salt restriction
What is haemorrhage?
The extravasation of blood from vessels into extravascular spaces.
Mention 3 causes of haemorrhage.
- Vascular injury
- Ruptured aneurismal dilation
- Inflammatory or neoplastic erosion of vessel wall
Mention 5 forms of internal haemorrhage.
- Hematoma
- Petechiae
- Purpura : slightly larger petechiae (3-5mm)
- Ecchymoses: larger subcutaneous hematomas (1-2cm)
- Hemopericardium, hemoperitoneum, hemothorax, hemarthrosis.
Petechiae are associated with:
- Low platelet count
- Defective platelet function
- Locally increased intravascular pressure
- Clotting factor deficiencies
Explain the characteristic colour change of hematomas
Red blood cells in the haemorrhage is phagocytosed and degraded by macrophages. The hemoglobin is enzymatically converted to bilirubin and eventually hemosiderin (golden-brown).
The clinical significance of a haemorrhage depends on:
- The volume of blood loss
- The rate
- The location
Loss of more than ___% of blood volume may lead to haemorrhagic shock.
20%
Mention 3 complications of internal haemorrhage.
- Hemoptysis: coughing up blood
- Hematemesis: vomiting blood
- Melena: blood in stool
How do you manage haemorrhage?
- Control of haemorrhage
- IV isotonic crystalloid fluids (isoplasma)
- Blood transfusion.
- For conditions associated with haemorrhage, treat with antibiotics, corticosteroids ad chemotherapy.
What is dehydration?
Fluid deficit as a result of inadequate fluid intake, excessive fluid loss or a combination of both.
Mention 3 causes of dehydration.
- Vomiting & Diarrhea
- Excessive sweating
- Insufficient water intake
Mention 5 effects of dehydration.
- Hypotension
- Lethargy
- Confusion
- Decreased skin elasticity
- Headache
- Fatigue
How does the body compensate for dehydration?
- Thirst
- Increased heart rate
- Pale cool skin
- Decreasing urine output
- Decreased mental function (reduced fluid to brain cells)
Mention 5 effects of hyperkalemia.
- Cardiac dysrhythmias
- Muscle weakness
- Paralysis
- Fatigue
- Nausea
- Paresthesia
Mention 5 effects of hypokalemia.
- Cardiac dysrhythmias
- Muscle weakness
- Paresthesia
- Reduced GI motility
- Abdominal cramping
- Weakness of respiratory weakness
- Impaired renal function
Differentiate between respiratory acidosis and metabolic acidosis.
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.
What are the clinical manifestations of respiratory acidosis?
- Headache
- Shortness of breath 3. Cardiovascular abnormalities
- Restlessness
- Confusion.
- Cyanosis
What are the clinical manifestations of metabolic acidosis?
- Muscular twitching, 2. Weakness
- Nausea
- Vomiting
- Diarrhea
- headache
Differentiate between respiratory alkalosis and metabolic alkalosis.
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.
What are the clinical manifestations of respiratory alkalosis?
i. Deep, rapid breathing
ii. Dizziness
iii. Muscle cramps
iv. Numbness of extremities
What are the clinical manifestations of metabolic alkalosis?
i. Hypoventilation
ii. Muscle weakness
iii. Irritability
iv. Confusion
v. Muscle twitching
