Patho: Water defects with/without Na loss/ Vol Overload

Question 1

What are general clinical manifestations of fluid replacement in volume depletion?

Answer 1

at %5 body loss:Thirst, dry mucous membranes
at %10 body loss:Tachycardia, oliguria (10%)
at %15-20 body loss: Tachycardia, hypotension, narrow pulse pressure (15-20%)

Question 2

what is the most sensitive indicator of volume loss

Answer 2

tachycardia with postural changes

Question 3

water deficit without solue deficit can be due to what?

what happeneds to Na levels?

who is at i ncreased risk for this type of loss?

Answer 3

Stop drinking anything for the next 24 hours they have insensible loss of breathing feces and sweating

• Poor oral intake
• Tune feeding without adequate supplementation: the solution you give is hypertonic so you must preceed and follow it up with water.
• Diabetes Insipidus: Lack ADH so they can not reabsorb water so they pee out.

what happeneds to Na? Increases

the young and the old

Question 4

Water defucut without solute deficits
Labs:
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Answer 4

Hypernatremia
Increased plasma osmolarit
Increase Secific gravity (tying to contain H2o)
Low urine sodium

Question 5

Water defucut without solute deficits
what are manifestations?
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Answer 5

Due to alot oF NA you have fluid from inside the cells to outside the cells

CNS manifestations: tired, lethargic, coma
Muscle rigidity
Tremors
Spasticity.

Question 6

Water defucut without solute deficits

Treatment:

Answer 6

GOAL: Replace water to respore the plasma Na to normal concentrations so you need to calculate how much water they need. how is that done

you take where you want the patient (140 Na) subtract that from the patients Na
and multiply by TBW

IE: (140-180) x (Wt in Kg x .6 ) = 2400meq to much Na in entire body

Per L they had 40 meq to much

then you need to determin how many L of water it will take to get 140/1L Na

so 140/L=2400/XL = 17 L of fluid

Question 7

What are general clinical manifestations of water deficit with solute deficit (MOST COMMON!)?
o Causes

Answer 7

Causes:
•GI- Remember that when you first throw up, GI content before bile is hypotonic. After bile is isotonic.
Same as with diarrhea. Watery diarrhea is hyperosmotic until you get pancreatic yellow bile → isosmotic.

• diuretics (spironolactone, lose Na+ and retain K+), profuse sweating, burns
• Profuse seating: loss of H20 and Na+
• Burns

Question 8

Manifestations
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-Labs: 
 Urine Na:
Specific Gravity
Osmolarity of the Urine
Plsama:
BUN/Creat

Answer 8

• Dry mucous membranes, skin turgor, tongue fissured (seen in elderly)
• Sunken eyes
• CV: tachycardia, hypotension, pp narrow

-Urine: Sodium concentration is low,
-specific gravity and osmolarity are high
-Plasma: Hyperosmotic
elevated BUN (reabsorb) and creatinine (excrete)….high ratio

Not perfusing kidneys now so not filtering, these will rise

Question 9

o Treatment

Answer 9

The first thing you need to do isCheck sodium levels. If they are
-Normal sodium: Isotonic losses and replace with isotonic saline
-Hyponatremia: Calculate needed sodium and bring it back to normal level
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•Hypovolemic shock: 20ml/kg bolus of NS: repeat bolus of 10-20ml/kg until systolic pressure is >80 mmhg
•If not hypovolemic shock: 1L NS over first hour, follow with 500-1,000 of NS over second hour or

o10ml/kg for every 1% of estimated dehydration: 50% in first 8 hours and the rest over the following 16 hours

Example: 70kg male with 10% dehydration

• 10ml/kg for 1% dehydrated…10ml/kg x 10% = 100ml/kg
• 70kg x 100ml/kg = 7,000ml or 7 L
• 3.5 L over first 8 hours (450ml/hr) and 3.5 L over following 16 hr

-Do not forget to include maintenance fluid replacement

Question 10

Overload!

What are the different types of volume overload?
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Answer 10

Surgical stress

• ADH release during surgical stress → retain volume
• Renal vasoconstriction and hypoperfusion
• Increased aldosterone because when cortisol is released it > SNS

Pre-existing disease

Heart failure – You retain fluid if left sided heart failure because blood pressure is low and blood backs up. Kidneys are now not perfused so renin/angiotensinogen is triggered → > volume. Now….worse heart failure

Renal disease – Kidneys not excreting volume like they should

Question 11

• Manifestations of volume overload?

Answer 11

Edema,
increased CVP
tachypnea (vessels in pulmonary are engorged),
body weight increases
elevated PAP
cardiac gallop rhythm because ventricles are so engorged

Question 12

Treatment of volume overload?

Answer 12

Mild: Sodium restriction (Volume overload and symptoms)

Severe: Diuretics (tachypnea)