Fluids
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This PPT is mainly to help the MBBS students to know the basic concept about Fluids. Moreover also to help them in knowing the Fluid Imbalances symptoms & their initial steps of management.
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Fluids
- 1. Prof. Utham Murali. M.S.,M.B.A.
- 2. Page 2 Fluids – Importance & Composition. Fluid – Types of Transport. Fluid Imbalances – You See & You Do.
- 3. Page 3 Between 50% and 60% of the human body by weight is water. Water provides a medium for transporting nutrients to cells and wastes from cells and for transporting substances such as hormones, enzymes, platelets, RBC’s & WBC’s. Helps maintain normal body temperature Facilitates digestion and promotes elimination Acts as a tissue lubricant
- 4. Page 4 Because fat cells contain little water and lean tissue is rich in water, the more obese the person, the smaller the percentage of total body water compared with body weight. This is also true between sexes because females tend to have proportionally more body fat than males.
- 6. Page 6
- 7. Page 7
- 8. Page 8
- 9. Page 9 60% composed of water 70 kg person= 42 L 2/3 ICF = 28L 1/3 ECF = 14L TBW= ECF + ICF
- 10. Page 10 Fluids and solutes constantly move within the body, which allows the body to maintain homeostasis. Fluids along with nutrients and waste products constantly shift within the body’s compartments from the cell to the interstitial spaces, to the blood vessels and back again.
- 11. Page 11 A. Active transport B. Passive transport - Diffusion - Osmosis - Filtration
- 12. Page 12 Solutes / Molecules can be moved against a concentration gradient as they move from an area of lower concentration to an area of higher concentration and requires an energy. Also called “pumping” Dependent on the presence of ATP
- 13. Page 13 KK ++ KK ++ KK ++ KK ++ KK ++ KK ++ KK ++ KK ++KK ++ KK ++ KK ++ KK ++ KK ++ KK ++ KK ++ KK ++ KK ++ ATPATP ATPATP ATPATP ATPATP Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + Na +Na + INTRACELLULAINTRACELLULA R FLUIDR FLUID EXTRACELLULAEXTRACELLULA R FLUIDR FLUID
- 14. Page 14 Molecules move across a biological membrane from an area of higher to an area of lower concentration Membrane types ◦ Permeable ◦ Semi-permeable ◦ Impermeable
- 15. Page 15 High Solute ConcentrationHigh Solute Concentration Low Solute ConcentrationLow Solute Concentration FluidFluid SolutesSolutes
- 16. Page 16 Movement of solute and solvent across a membrane caused by hydrostatic (water pushing) pressure Occurs at the capillary level If normal pressure gradient changes (as occurs with right-sided heart failure) edema results from “third spacing”
- 17. Page 17
- 18. Page 18 Movement of solvent from an area of lower solute concentration to one of higher concentration Occurs through a semipermeable membrane using osmotic (water pulling) pressure
- 19. Page 19 FluidFluid High SolutionHigh Solution Concentration,Concentration, Low FluidLow Fluid ConcentrationConcentration Low SoluteLow Solute Concentration,Concentration, High FluidHigh Fluid ConcentrationConcentration
- 20. Page 20 Fluids in the body generally aren’t found in pure forms. Isotonic, hypotonic, and hypertonic types. Defined in terms of the amount of solute or dissolve substances in the solution. Balancing these fluids involves the shifting of fluid not the solute involved.
- 21. Page 21 No net fluid shifts occur between isotonic solutions because the solution are equally concentrated Eg - NSS or 0.9SS
- 22. Page 22 Has a lower solute concentration than another solution Fluid from the hypotonic solution would shift into the second solution until the two solutions had equal concentrations Eg - Half normal or 0.45%SS
- 23. Page 23 Has a higher solute concentration than another solution Fluid from the second solution would shift into the hypertonic solution until the two solutions had equal concentrations Eg - D5 / NSS
- 24. Page 24 Isotonic loss of water and electrolytes (fluid volume deficit) – “Hypovolaemia” Isotonic gain of water and electrolytes (fluid volume excess) – “Hypervolaemia / Edema” Hyperosmolar loss of only water (Dehydration) Hypo-osmolar gain of only water (Overhydration) – “Water Intoxication”
- 25. Page 25 Loss of body fluids ⇒ increased concentration of solutes in the blood and a rise in serum Na+ levels. Fluid shifts out of cells into the blood to restore balance. Cells shrink from fluid loss and can no longer function properly.
- 26. Page 26 Mild = Weight loss – 5% Moderate = Weight loss – 10% Severe = Weight loss – 15%
- 27. Page 27 Irritability Confusion Dizziness Weakness Extreme thirst ⇓ urine output Fever Dry skin/mucous membranes Sunken eyes Poor skin turgor Tachycardia
- 28. Page 28 Fluid Replacement - Oral or IV over 48 hrs. Monitor symptoms and vital signs Maintain I & O Maintain IV access Daily weights Skin and mouth care
- 29. Page 29 Isotonic fluid loss from the extracellular space Can progress to hypovolemic shock Caused by: ◦ Excessive fluid loss (hemorrhage) ◦ Decreased fluid intake ◦ Third space fluid shifting
- 30. Page 30 Mild = < 2 L fluid loss Moderate = 2 – 3 L fluid loss Severe = > 3 L fluid loss
- 31. Page 31 Mental status deterioration Thirst Tachycardia Delayed capillary refill Orthostatic hypotension Urine output < 30 ml/hr Cool, pale extremities Weight loss
- 32. Page 32 Fluid replacement Albumin replacement Blood transfusions for hemorrhage Dopamine to maintain BP Assess for fluid overload with treatment
- 33. Page 33 Excess fluid in the extracellular compartment as a result of fluid or sodium retention, excessive intake, or renal failure. Occurs when compensatory mechanisms fail to restore fluid balance. Leads to CHF and pulmonary edema.
- 34. Page 34 Tachypnea Dyspnea Crackles Rapid, bounding pulse Hypertension S3 gallop Increased CVP, pulmonary artery pressure and pulmonary artery wedge pressure Acute weight gain Edema
- 35. Page 35 Fluid is forced into tissues by the hydrostatic pressure First seen in dependent areas Anasarca Pitting edema Pulmonary edema
- 36. Page 36 Fluid and Na+ restriction Diuretics Monitor vital signs Hourly I&O Breath sounds Monitor ABGs and labs Elevate HOB and give O2 as ordered Maintain IV access Skin & mouth care Daily weights
- 37. Page 37 Hypotonic extracellular fluid shifts into cells to attempt to restore balance Cells swell Causes: ◦ SIADH ◦ Rapid infusion of hypotonic solution ◦ Excessive tap water NG irrigation or enemas ◦ Psychogenic polydipsia ◦ TURP
- 38. Page 38 Signs and symptoms of increased intracranial pressure ◦ Early: change in LOC, N/V, muscle weakness, twitching, cramping ◦ Late: bradycardia, widened pulse pressure, seizures, coma
- 39. Page 39 Prevention is the best treatment Assess neuro status Monitor I&O and vital signs - ICU Fluid restrictions IV access Daily weights Monitor serum Na+ Seizure precautions
- 40. Page 40
Notes de l'éditeur
- ECF can be further subdivided into plasma approx 3l and IF 10-11 L
- Figure 52-5 Schematic of filtration pressure changes within a capillary bed. On the arterial side, arterial blood pressure exceeds colloid osmotic pressure, so that water and dissolved substances move out of the capillary into the interstitial space. On the venous side, venous blood pressure is less than colloid osmotic pressure, so that water and dissolved substances move into the capillary.