IASM Case 3: Fluid balance Flashcards
***Occurrence and disclosure of medical errors
- Why error rate so high?
- lack of awareness to severity of problem
- most errors do little / no harm
- punitive approach to errors —> fail to report
- complicated procedures - How to lower medical errors
- Root-cause analysis
- Reporting system
- educational resource about patient safety
- creating a non-punitive environment
- ensure compliance of systems and guidelines
- review patient feedback - Disclosing medical error
- The legal right of patient
- maintain trust between doctor and patient
How: - Begin by stating there has been an error
- Describe the course of events, using nontechnical language
- State the nature of the mistake, consequences, and corrective action
- Express personal regret and apologize
- Elicit questions or concerns and address them
- Plan the next step and next contact with the patient
Fluid distribution
See lecture
Sensible and insensible fluid losses
Intake:
- liquid
- food
- metabolically production
Output:
- insensible water loos (skin and lungs)
- sweat
- urine
- faeces
Ways of fluid and solutes move inside body
- Physical
—> bulk flow
—> simple diffusion
—> osmosis - Biological
—> facilitated diffusion
—> active transport
—> vesicular transport (exocytosis, endocytosis, pinocytosis, receptor mediated clarthrin coated vesicles)
Osmolarity vs Osmolality
Osmolarity: number of Osmoles of solute per volume of solution
Osmolality: number of Osmoles of solute per kg of water
Electrolyte composition of extra- and intra-cellular fluid
ICF: K, PO4
ECF: Na, Cl
Roles of hormones and kidneys in water and electrolyte balance
See CPRS lecture
Importance of electrolytes on resting membrane potential and action potential in excitable cells
See lecture
Signs and symptoms of dehydration
Symptoms:
- thirst
- cramps
- postural dizziness
- confusion
- coma
- nausea, voluminous
Signs
- loss of skin tugor
- postural hypotension
- low JVP
- peripheral vasoconstriction
- tachycardia
Causes:
- haemorrhage
- burns
- GI losses (vomiting, diarrhoea)
- renal loss
Signs and symptoms of water intoxication
- increases intracranial pressure (ICP)
- Hyponatremia
—> confusion
—> seizure
—> cardiac failure
—> oedema
—> muscle weakenss
Risk factors for fluid imbalance
- diarrhoea
- vomiting
- fever
- diabetes
- renal disease
How to interpret serum electrolyte results
Electrolyte panel: Na, K, Cl, HCO3
—> identify electrolyte / acid-base imbalance
—> monitor effect of treatment
Scientific approaches for determining effective diagnostics, treatments and interventions
See EBP:
- Spans the field of Evidence Based Medicine
- Principles of EBP
- Level of evidence
- Foundation of any medical decision are scientific evidences from clinical research —> clinical experience are of great help, but not the main basis
How reliable is health information provided through the media
- Depends on source
- fact-checking
- sensationalism
- publication bias
- social media: ulterior motives
- News truncated?
- conflict of interest, personal agenda - Generalisability
- not always generalisable
- Knowledge-gap hypothesis:
—> infusion of mass media information into a social system increases
—> higher socioeconomic status tend to acquire this information at a faster rate than the lower status segments
—> gap in knowledge between these segments tends to increase rather than decrease
Issues involved in public heath message which encourage people to drink more water
- Definition (at least 8 glasses of 8 ounces water)
- no scientific basis
- many publications state the opposite
- risk of hyponatremia
- mean daily fluid intake of many healthy people is below 8x8
Myths about water intake
- thirst is too late: rise in plasma osmolality of 2% trigger thirst, however at least 5% to lead to dehydration
- “dark urine means dehydration”: moderately yellow urine is normal
- letting thirsty be guide is adequate
- In general, 2.7L/day for women, 3.7L/day for men
