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    Body Fluids and Electrolytes

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    QusaiBadr
    The document discusses body fluids and electrolytes. It describes that the total body water is approximately 60% of body weight, divided into intracellular fluid (ICF) and extracellular fluid (ECF). Sodium is the most abundant cation in ECF and plays a key role in fluid balance, while potassium is most abundant in ICF and important for nerve and muscle function. Common electrolyte disorders like hypernatremia, hyponatremia, hyperkalemia, and hypokalemia are outlined along with their causes, signs/symptoms, and treatment guidelines.

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    Body Fluids and Electrolytes

    Uploaded by

    QusaiBadr
    190 views42 pages
    The document discusses body fluids and electrolytes. It describes that the total body water is approximately 60% of body weight, divided into intracellular fluid (ICF) and extracellular fluid (ECF). Sodium is the most abundant cation in ECF and plays a key role in fluid balance, while potassium is most abundant in ICF and important for nerve and muscle function. Common electrolyte disorders like hypernatremia, hyponatremia, hyperkalemia, and hypokalemia are outlined along with their causes, signs/symptoms, and treatment guidelines.

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    Body Fluid and Electrolytes Surgery

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    The document discusses body fluids and electrolytes. It describes that the total body water is approximately 60% of body weight, divided into intracellular fluid (ICF) and extracellular fluid (ECF). Sodium is the most abundant cation in ECF and plays a key role in fluid balance, while potassium is most abundant in ICF and important for nerve and muscle function. Common electrolyte disorders like hypernatremia, hyponatremia, hyperkalemia, and hypokalemia are outlined along with their causes, signs/symptoms, and treatment guidelines.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    190 views42 pages

    Body Fluids and Electrolytes

    Uploaded by

    QusaiBadr
    The document discusses body fluids and electrolytes. It describes that the total body water is approximately 60% of body weight, divided into intracellular fluid (ICF) and extracellular fluid (ECF). Sodium is the most abundant cation in ECF and plays a key role in fluid balance, while potassium is most abundant in ICF and important for nerve and muscle function. Common electrolyte disorders like hypernatremia, hyponatremia, hyperkalemia, and hypokalemia are outlined along with their causes, signs/symptoms, and treatment guidelines.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 42

    Body Fluids and Electrolytes

    Dr. Mahmoud Al-Balas, MBBS

    Higher Specialty Certificate of General Surgery JUST


    Jordanian Board of General Surgery
    E.C.F.M.G Certificate
    MRCS Ireland
    Body Fluids

    Total amount of fluid in the human body is approximately 60%


    of body weight
    Body fluid has been divided into two compartments
    Intracellular fluid (ICF)
    Inside the cells
    60% of total body water
    Extracellular fluid
    Outside the cells
    40% of total body water
    PERCENTAGE OF H2O IN TISSUES
    Average 70 kg person Total body weight

    42 L total H2O 60%

    28 L Intracellular fluid (ICF) 40%

    14 L Extracellular fluid (ECF) 20%


    ( ISF and plasma water )

    10.5 L Interstitial fluid (ISF) 15%


    3.5 L Plasma water 5%
    Body Fluid Compartments

    Extracellular fluid includes


    Interstitial fluid
    Present between the cells
    Approximately 75% of ECF
    Plasma
    Present in blood
    Approximately 25% of ECF
    Also includes
    Lymph * vitreous body
    synovial fluid * endolymph
    aqueous humor * perilymph
    cerebrospinal fluid * pleural, pericardial and
    peritoneal fluids
    Body Fluid Compartments
    Barriers separate ICF, interstitial fluid and
    plasma

    Plasma membrane
    Separates ICF from surrounding interstitial fluid
    Blood vessel wall
    Separate interstitial fluid from plasma
    Composition of body fluids

    Organic substances * Inorganic substances


    Glucose * Sodium
    Amino acids
    * Potassium
    Fatty acids
    Hormones
    * Calcium
    Enzymes * Magnesium
    * Chloride
    * Phsophate
    * Sulphate
    Difference

    ECF ICF
    Most abundant cation - Na+, Most abundant cation - K+
    muscle contraction Resting membrane potential
    Impulse transmission Action potentials
    fluid and electrolyte balance Maintains intracellular volume
    Regulation of pH
    Most abundant anion - Cl-
    Regulates osmotic pressure Anion are proteins and
    Forms HCl in gastric acid phosphates (HPO42-)

    Na+ /K+ pumps play major role in keeping K+ high inside cells and Na+ high outside
    cell
    Sodium Na+

    Most abundant ion in ECF


    90% of extracellular cations
    Plays pivotal role in fluid and electrolyte balance as it accounts
    for half of the osmolarity of ECF
    Chloride Cl -

    Most prevalent anion in ECF


    Moves easily between ECF and ICF because most plasma
    membranes contain Cl- leakage channels and transporters
    Can help balance levels of anions in different fluids
    Bicarbonate HCO3 -

    Second most prevalent extracellular anion


    Concentration increases in blood passing through systemic
    capillaries picking up carbon dioxide
    Chloride shift helps maintain correct balance of anions in ECF
    and ICF
    Potassium K+

    Most abundant cation in ICF


    Establish resting membrane potential in neurons and
    muscle fibers
    Maintains normal ICF fluid volume
    Helps regulate pH of body fluids when exchanged for H+
    Magnesium

    Mg2+ in ICF (45%) or ECF (1%)


    Second most common intracellular cation
    Cofactor for certain enzymes and sodium-potassium pump
    Essential for synaptic transmission, normal neuromuscular
    activity and myocardial function
    Serum Osmolality

    Normal serum osmolality = 280 295 mOsm/kg


    Electrolytes Disorders
    Hypernatremia

    Na+ level > 145 mEq/L

    Causes THE MODEL


    M MEDICATIONS (hypertonic saline, TPN), MEALS (excess
    intake of Na+)
    O Osmotic Diuresis (e.g. Mannitol)
    D Diabetes Insipidus
    E Excessive H2O Loss (vomiting, diarrhea, diuresis,
    sweating)
    L Low H2O intake
    Hypernatremia

    Sign and Symptoms FRIED


    F Fever (low grade), Flushed Skin
    R Restless (Irritable, Confusion, Seizures),
    Respiratory Paralysis
    I increased fluid retention and Blood Pressure
    E Edema
    D Decrease urine output, Dry mouth
    Hypernatremia

    Medical management

    Diuretic Therapy
    Hydration therapy D5W followed by or N.S
    Check underlying cause

    Note Avoid rapid correction to avoid Brain Edema


    Treatment recommendations for symptomatic
    hypernatremia

    Establish documented onset (acute, < 24 h; chronic, >24h)

    In acute hypernatremia, correct the serum sodium at an initial rate of 2-3 mEq/L/h
    (for 2-3 h) (maximum total, 12 mEq/L/d).
    Measure serum and urine electrolytes every 1-2 hours
    Perform serial neurologic examinations and decrease the rate of correction with
    improvement in symptoms

    Chronic hypernatremia with no or mild symptoms should be corrected at a rate not


    to exceed 0.5 mEq/L/h and a total of 8-10 mEq/d (eg, 160 mEq/L to 152 mEq/L in 24 h).

    If a volume deficit and hypernatremia are present, intravascular volume should be


    restored with isotonic sodium chloride prior to free-water administration
    Hyponatremia

    Causes

    Hypovolemic excess diuretics, Hypoaldosteronism,


    vomiting, NG suction, Burns, Pancreatitis, Sweating.

    Euvolemic SIADH, CNS abnormalities

    Hypervolemic Renal failure, CHF, Liver failure,


    Iatrogenic (dilutional)
    Hyponatremia
    Hyponatremia

    Clinical Manifestations
    Symptomatic BUT less impaired
    Headache, Irritability, Nausea, Vomiting, Mental
    slowing, Unstable Gait, Confusion, Disorientation
    Usually seen in Chronic cases

    Life Threatening
    Coma, Convulsions, Respiratory arrest and death from
    cerebral edema and brain herniation
    Seen in Acute cases
    Treatment Guidelines of Hyponatremia

    1. maximum correction for chronic Hyponatremia:


    12 mmol/L in the first 24 h
    18 mmol/L in the first 48 h

    2. even lower (8 mmol/L in any 24h period) if any of the following are
    present:
    serum Na 105 mEq/L
    hypokalemia
    alcoholism and/or malnutrition
    liver disease

    3. maximum correction for acute hyponatremia: not ascertained, but


    much lower risk
    Treatment Guidelines of Hyponatremia

    Short term Long term


    isotonic saline infusion fluid restriction
    hypertonic saline demeclocycline
    infusion furosemide + NaCl
    vaptan (conivaptan, mineralocorticoids
    tolvaptan) urea
    vaptan (tolvaptan)

    Note vaptans (conivaptan, tolvaptan) are vasopressin receptor antagonist


    Hypertonic Saline Correction

    choose desired correction rate of plasma [Na+ ] (e.g.,


    1.0 mEq/L/h)

    obtain or estimate patients weight (e.g., 70 kg)

    multiply weight X desired correction rate and infuse


    as ml/h of 3% NaCl (e.g., 70 kg X 1.0 mEq/L/h = 70 ml/h
    infusion)
    Cerebral Pontine Myelinolysis

    Tremor
    Incontinence
    Hyperreflexia, pathological reflexes
    Quadriparesis, quadriplegia
    Dysarthria, dysphagia
    Cranial nerve palsies
    Mutism, locked-in syndrome
    Hyperkalemia

    Normal K+ = 3.5 5.3 mEq/L

    Causes

    Iatrogenic overdose
    Blood transfusion
    Renal failure
    Diuretics
    Acidosis
    Tissue injury (e.g. Burn)
    hemolysis
    Hyperkalemia

    Signs and symptoms ECG Changes

    Weakness Peaked T waves


    Parasthesia Depressed ST segment
    Decreased deep tendon Prolonged PR interval
    reflexes Wide QRS
    Areflexia Bradycardia
    Paralysis Ventricular fibrillation
    Respiratory failure
    Treatment of Hyperkalemia

    IV calcium (cardioprotective)

    IV NaHCO3
    Glucose and Insulin
    Albuterol

    Sodium polystyrene sulfonate (kayexalate)


    Furosamide
    Dialysis
    Hypokalemia

    Causes

    Insufficient supplementation
    Vomiting
    Diarrhea
    Intestinal fistula
    Insulin
    Hyperaldosteronism (Conns) of Steroids (Cushings)
    Alkalosis
    Amphotericin
    Certain antibiotics
    Hypokalemia

    Manifestations ECG Findings:

    Weakness, Tetany Flat T wave


    Nausea and vomiting U wave
    Ileus ST depression
    Parasthesia PAC, PVC
    AF
    Hypokalemia Treatment Guidelines

    Hypokalemia Treatment Comments


    Mild (3-3.4 mmol/l) Oral Replacement Monitor Daily K+ level
    Consider I.V if not tolerated

    Moderate (2.5-2.9 Oral Replacement Monitor Daily K+ level


    mmol/l) Consider I.V if not tolerated
    Asymptomatic
    Severe (<2.5 mmol/l) I.V Replacement Check Mg2+ level If
    Symptomatic 40mEq in 1L 0.9N.S BID or hypomagnesaemic: initially
    TID give 4ml MgSO4 50%
    Standard infusion rate (8mmol) diluted to 10ml with
    10mmol/hr NaCl 0.9% over 20min
    Maximum infusion rate monitor K+ level after each
    20mmol/hr 40mmol
    Calcium

    Calcium concentration, both total and free, is characterized by a


    high physiological variation, depending on age, sex, physiological
    state (eg, pregnancy), and even season (owing to the seasonal
    variation of vitamin D)

    Normal Adult Calcium = 8.9 -10.1 mg/dl

    Corrected Ca = [0.8 x (normal albumin - patient's albumin)] + serum Ca level

    Note: The normal albumin level is defaulted to 4 mg/dL Standard Units or 40 g/L if
    using SI Units
    Hypercalcemia

    Causes

    Excessive Ca2+ supplementation


    Hyperparathyroidism (1 and 3)
    Immobility
    Milk alkali syndrome
    Bone Pagets disease
    Neoplasms, Paraneoplastic
    Metastasis
    Excessive Vitamin D or A
    Sarcoid
    Thiazides
    Hypercalcemia

    Manifestations ECG Changes

    Renal Stones Short QT interval


    Bone Pain Prolonged PR interval
    Abdominal groans
    Psychiatric symptoms
    Polyuria
    Polydipsia
    Constipation
    Hypercalcemia

    Treatment

    Volume expansion with N.S


    Furosamide

    Others

    Steroids
    Calcitonin
    Bisphosphonate
    Dialysis
    Hypocalcaemia

    Causes

    Acute Pancreatitis
    Vit. D deficiency
    Sepsis
    Osteoplastic metastasis
    Diuretics
    Renal failure
    Short bowel syndrome, intestinal fistula
    Hypomagnesaemia
    Hypocalcaemia

    Manifestations ECG Findings

    Perioral numbness Prolonged QT, ST segment


    Confusion, seizures Peaked T wave
    Abdominal cramps
    Stridor, laryngospasm
    Tetany
    Depression, hallucinations
    Chvosteks, Trousseaus signs
    Hypocalcaemia Treatment

    Calcium Gluconate

    Calcium PO

    Vitamin D
    THE END

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