1. 1 Fluid Assessment Cherelle Fitzclarence 2009

2. Overview Revision Cases

3. We are approximately two- thirds water PG

6. JXZ

7. Fluid shifts / intakes Intracellular 30 litres Interstitial9 litres IV 3 litres Kidneys Gut Lungs Skin Extracellular fluid - 12 litres PG

8. Fluid shifts / intakes Intracellular 30 litres Interstitial9 litres IV 3 litres Kidneys Gut Lungs Skin Extracellular fluid - 12 litres PG

9. REGULATION OF FLUID VOLUME

10. BODY FLUID COMPARTMENTS RULE OF THIRDS 1. Intracellular: 2/3 (40% TBW) 2. Extracellular: 1/3 (20% TBW) a. Interstitial + Lymph: 2/3 (15% TBW) b. Intravascular: 1/3 (5% TBW)

11. Fluid Pressures (Starling’s Law) ECF and ICF fluid shifts occur related to changes in pressure within the compartments Fluid flows only when there is a difference in pressure 3 types of body fluids  Isotonic  Hypotonic  Hypertonic

12. Fluid shifting 1st space shifting- normal distribution of fluid in both the ECF compartment and ICF compartment. 2nd space shifting- excess accumulation of interstitial fluid (edema) 3rd space shifting- fluid accumulation in areas that are normally have no or little amounts of fluids (ascites)

13. FLUID VOLUME DEFICIT Hypovolemia: isotonic extracellular fluid deficit Deficiency of both water & electrolytes Caused by decreased intake, vomiting, diarrhea, fluid shift Dehydration: hypertonic extracellular fluid deficit Deficiency of water Caused by water loss related to high blood glucose, inadequate ADH production, high fever, excess sweating

14. Assessment of Fluid Deficit Hypotension Weak rapid pulse Temperature decreased if hypovolemic, and increased in dehydration Weight loss Skin turgor poor in dehydration and possible edema in hypovolemic Concentrated urine and blood

15. FLUID VOLUME EXCESS Extracellular: isotonic fluid excess Excess of both water and electrolytes Caused by retention of water and electrolytes related to kidney disease; overload with isotonic IV fluids Intracellular: water excess Excess of body water without excess electrolytes Caused by over-hydration in the presence of renal failure; administration of D5W

16. FLUID VOLUME EXCESS/Assessment Isotonic  Hypertension  Bounding pulse  Crackles, dyspnea  Weight gain  Edema in extremities  JVD  Irritable, confused  Hypotonic  Systolic B/P ^  Decreased pulse  Increased respirations  Weight gain  Cerebral edema  Irritable, confused

17. FLUID VOLUME EXCESS/ Treatment Isotonic  Correct cause  Restrict H2O and Na  Diuretics  Digitalis  Possible dialysis Hypotonic  Correct cause  Restrict H2O intake  IV fluids with E-lytes

21. Dehydration Occurs when fluid loss exceeds intake  sweating vs time Fluid lost mostly from ECF  decreased circulating blood volume inadequate tissue perfusion, inefficient transport of substrates to muscle, and elevated HR