water and electrolyte imbalance.ppt

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Indra Wijaya Department of Internal Medicine Faculty of Medicine, UPH Siloam Lippo Village Hospital

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Page 1: Water and Electrolyte Imbalance.ppt

Indra WijayaDepartment of Internal Medicine

Faculty of Medicine, UPHSiloam Lippo Village Hospital

Page 2: Water and Electrolyte Imbalance.ppt

FLUID

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FLUID / WATER BALANCE•Normal plasma osmolality 275-290

mosmol/kg

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ETIOLOGY

I. ECF volume contractedA. Extrarenal Na+ lossB. Renal Na+ and water lossC. Renal water loss

II. ECF volume normal or expandedA. Decreased cardiac outputB. RedistributionC. Increased venous capacitance

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Sign and Symptoms•General weakness - fatigue•Delirium•Hangover•Thirsty•Hypotension•Dry mouth•Skin turgor •Decreased urin volume

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TREATMENT• I.V line Hidration 1 - 2 liters!

•Normonatremic and most hyponatremia: normal saline (NaCl 0.9%)

•Hypernatremia: half-normal saline (NaCl 0.45%)/ D5% infusion.

•Hemorrhage, anemia, or intravascular volume depletion: blood transfusion / colloid

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Page 9: Water and Electrolyte Imbalance.ppt

ETIOLOGYExcessive sodium and fluid intake:• IV therapy containing sodium• Transfusion reaction to a rapid blood transfusion.• High intake of sodium

Sodium and water retention:• Heart failure• Liver cirrhosis• Nephrotic syndrome• Corticosteroid therapy• Hyperaldosteronism• Low protein intake

Fluid shift into the intravascular space:• Fluid remobilization after burn treatment• Administration of hypertonic fluids• Administration of plasma proteins, such as albumin

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Sign and Symptoms•Shortness of breathing

•Paroxysmal nocturnal dyspneu

•High JVP

•Ascites

•Edema

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TREATMENT

Treat etiology / underlying cause

Loop Diuretics – monitor BP

Dialysis

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SODIUM

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Na < 135 mmol/L

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CLINICAL FEATURES

•Maybe asymptomatic

•Nausea and malaise

•Headache, lethargy, confusion, and obtundation

•Stupor, seizures, and coma: Na < 120 mmol/L

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TREATMENT

• Asymptomatic hyponatremia associated with ECF volume contraction isotonic saline

• Hyponatremia associated with edematous states restriction of Na+ and water intake

• Euvolemic and hypervolemic hyponatremia nonpeptide vasopressin antagonists

0.5–1.0 mmol/L per hor

10–12 mmol/L over the first 24 h

ODS

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Na+ > 145 mmol/L

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ETIOLOGY

•Primary hypodipsia

•Renal

•Extra renal• Skin• Respiratory tract• GI tract• CDI• NDI

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CLINICAL FEATURES

•Polyuria or thirst•Altered mental status•Weakness•Neuromuscular irritability•Focal neurologic deficits•Coma or seizures

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TREATMENT•correct the water deficit

5% dextrose / half-isotonic saline

•treating the underlying cause:• stop ongoing water loss• CDI desmopressin intranasally• NDI amiloride• Low-salt diet in combination with low-dose

thiazide diuretic therapy NDI+CDI

Plasma [Na+] should be lowered by 0.5 mmol/L per h and < 12 mmol/L over the first 24 h

Page 24: Water and Electrolyte Imbalance.ppt
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POTASSIUM

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K+ < 3.5 mmol/L

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ETIOLOGYI. Decreased intake

II. Redistribution into cellsA. Acid-baseB. HormonalC. Anabolic stateD. Other

III. Increased lossA. RenalB. Non Renal

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CLINICAL FEATURES

•Fatigue

•Myalgia

•Weakness of lower extremities

•Diaphragm paralysis

•ECG?

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TREATMENT

•Potassium chloride: p.o / i.v

•Potassium bicarbonate and citrate hypokalemia associated with chronic diarrhea/RTA

The maximum concentration of administered K+ should be no more than 40 mmol/L via peripheral vein

60 mmol/L via central vein

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K+ > 5 mmol/L

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ETIOLOGY

I. Renal Failure

II. Decreased distal flow

III. Decreased K+ secretionA. Impaired Na+ reabsorptionB. Enhanced Cl- reabsorption

(chloride shunt)

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CLINICAL FEATURES

•Weakness

•Flaccid paralysis

•Hypoventilation

•Cardiac toxicity

•ECG?

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TREATMENT

•Calcium gluconate

•10 units of regular insulin and 50 gram of glucose

•Diuretics

•Cation-exchange resin

•Dialysis

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