1. Fluid, Electrolytes Imbalance and Hemodynamic Disorders
PCL 301
(INTRODUCTION TO DISEASE STATES I)
Pharm. Akinola Alexander

2. Objective Overview of Circulatory System Fluid and Electrolytes
Fluid and Electrolytes Imbalance/Disorders- Edema, Dehydration, Potassium Imbalance, Acidosis/Alkalosis
Hemodynamics
Hemodynamic disorders – Hemorrhage , Embolism, Thrombosis, Infarction, Shock

3. FLUID AND ELECTROLYTE DISORDERS

4. Overview Also known as Cardiovascular System
the system that circulates blood and lymph through the body, consisting of the heart, blood vessels, blood, lymph, and the lymphatic vessels and glands.
The circulatory system is a vast network of organs and vessels that is responsible for the flow of blood, nutrients, hormones, oxygen and other gases to and from cells

6. FLUID & ELECTROLYTES Water
45– 60% of the human body is composed of water
It contains electrolytes essential to maintain human life
Found within (Intracellular) and outside (extracellular) the cells.

7. FLUID COMPARTMENTS Intracellular (2/3) Extracellular (1/3)
Intravascular fluid or blood
Interstitial fluid
Cerebrospinal fluid (CSF)
Transcellular fluids present in various secretions - Pericardial cavity (Heart), Synovial (joint)

8. Causes of Fluid and Electrolyte Imbalances
Burns
Surgery
Trauma
Diabetes
Tumors
Alcohol withdrawal
Eating disorders

9. Edema
Refers to “increased or accumulation of fluid in the interstitial tissue spaces.”
Examples - Hydrothorax, hydropericardium, or hydroperitoneum (ascites) refer to fluid collection in the respective body cavity.
Localized - Any tissue or organ (Cerebral edema, pulmonary edema)
Generalized – Anasarca (↑in body weight)

10. Sustained edema – may result into
Restriction of arterial blood flow into an area of the body
Prevents normal cell function
Tissue necrosis
Development of ulcers
Varicose veins (dilated veins that have high hydrostatic pressure, Skin breakdown, fatigue, slow healing ulcers)

11. Mechanism of edema: It involve the movement of fluid between vascular and interstitial spaces, often controlled mainly by the opposing effects of vascular hydrostatic pressure and plasma colloid osmotic pressure. Occurs mostly as a result of increased vascular permeability. The resulting edema fluid may be either a transudate or exudate.

12. Edema –Clinical Manifestations
Functional Impairment - May restrict movement
Pain - Edema increases the pressure on the local nerves
Pitting edema –
Excess interstitial fluid
moves aside when firm finger pressure placed on surface.
Depression remains after finger is removed.
Rated based on how quickly skin rebounds to original shape.

13. Dehydration Also known as “Fluid Deficit”
It is also insufficient body fluid from
Inadequate intake of fluid
Excessive loss of fluid or
Combination of the both.
Dehydration - more serious for infants and elderly who lack fluid reserves and the ability to conserve fluid.
Infants also have a higher metabolic rate.

14. Etiology
Vomiting & Diarrhea
Loss of fluids and electrolytes and nutrients
Glucose
Water
Excessive sweating
Loss of water and sodium
Insufficient water intake
Elderly and unconscious

15. EFFECT OF DEHYDRATION
The body compensates by
Turgor
Decreased elasticity in the skin
Lower blood pressure
Weak pulse, fatigue
Confusion
Headache
Lethargy
Thirst
Increased heart rate
Pale cool skin
Decreasing urine output
Decreased mental function
loss of water to brain cells

16. Potassium Imbalances Hyperkalemia – result into
Hypokalemia – result into
Cardiac dysrhythmia
Interference with neuromuscular function - muscles become less responsive
Paresthesia develops
Decreased digestive tract motility
Respiratory muscles may become weak
Renal function may become impaired
Cardiac dysrhythmias
Muscle weakness progressing to paralysis
Fatigue, nausea and paresthesias

17. Acidosis process causing a relative excess of acid in body
Respiratory Acidosis
Metabolic Acidosis
Results from hypoventilation and retention of carbon dioxide
Examples of diseases -COPD, Asthma
Clinical manifestations: headache, SOB, cardiovascular abnormalities, restlessness, confusion.
Result from accumulation of acids or a deficit of bases in blood
Examples of diseases - Renal failure, diarrhea
Clinical manifestations: muscular twitching, weakness, nausea, vomiting, diarrhea, headache

18. Alkalosis Condition resulting in excess base in the body
Respiratory Alkalosis
Metabolic Alkalosis
Hyperventilation: lungs excrete excessive amounts of carbon dioxide
Early stage pulmonary problems
Clinical manifestations: deep, rapid breathing, dizziness, muscle cramps, numbness of extremities
Abnormal loss of acid or excess accumulation of bicarbonate ions
Vomiting, gastric suctioning
Diarrhea, excessive use of laxatives
Clinical manifestations: hypoventilating, muscle weakness, irritability, confusion, muscle twitching

19. HEMODYNAMIC DISORDERS

20. Hemorrhage loss of blood outside the cardiovascular system
External
Internal
Loss of blood outside the body
Often results in hypovolemia (>20%) – hemorrhagic shock
Loss of blood into various body cavities.( internal bleeding)
Causes other complications such as hemothorax, hematomas, hemoptysis, hematemesis, melena
Hemoptysis (Coughing blood from respiratory tract)
Hematemesis (Vomiting blood)
Melena (Black, discolored blood in stool)

21. Thrombosis formation of a solid or semi-solid mass from the constituents of the blood within the vascular system during life. The mass itself is called a thrombus
Thrombus
Solid mass of clotted blood
Pathogenesis involves 3 main factors
Endothelial injury
Stasis or turbulence of blood flow
Blood hypercoagulability
Often get attached to vessel walls where they grow or obstruct blood flow.

22. Clinical significance of thrombosis.
Thrombi are significant because they cause obstruction of arteries and veins.
Lungs – pulmonary thromboembolism
Heart – myocardial infarction
Legs – Deep vein thrombosis
Brain – Stroke (Ischemic or Hemorrhagic)
Kidneys – Chronic kidney disease

23. Embolism An embolus is a detached intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin.
Forms of emboli
Thromboemboli- representing a dislodged thrombus and constitutes 99% of all emboli. Fat emboli consisting of fat droplets.
Air emboli - consisting of bubbles of air or nitrogen.
Atherosclerotic emboli - cholesterol emboli
Tumor emboli - made up of fragments of a tumor.
Bone marrow emboli - consist of bits of bone marrow.
Foreign body emboli - bullets or shrapnel

24. Infarction This is defined as localized area of ischemic cell necrosis in a living organ or tissue, resulting most often from sudden reduction or cessation of its arterial blood supply or occasionally its venous drainage
Nearly 99% of all infarcts result from thrombotic or embolic events, and almost all result from arterial occlusion.
Damage often depends on
Anatomic site
Circulation to that site
Organ’s capacity for repair – Postmitotic cells (brain, heart); Mitotic cells (Liver)

25. Classification of Infarction
By Histopathology - 2 types according to the amount of blood present:
White infarctions (anemic infarcts) affect solid organs such as the spleen, heart and kidneys wherein the solidity of the tissue substantially limits the amount of nutrients (blood/oxygen/glucose/fuel) that can flow into the area of ischaemic necrosis.
Red infarctions (hemorrhagic infarcts), generally affect the lungs or other loose organs (testis, ovary, small intestines). The occlusion consists more of red blood cells and fibrin strands.

26. By Localization – target site or organ affected
Heart –
Lungs -
Spleen -
Limb -
Bone -
Testicles -

27. Clinical complications or manifestation of an infarction include;
Myocardial infarction
Lung infarction
Splenic infarction
Cerebral infarction (stroke)
Bone infarction

28. Shock
It is a state of systemic hypoperfusion that is caused either by reduced cardiac output or by reduced effective circulating blood volume.
The end results are hypotension, impaired tissue perfusion, and cellular hypoxia.
It is the final common pathway for a number of potentially lethal clinical events.
Although the hypoxic and metabolic effects of hypoperfusion initially cause only reversible cellular injury, persistence of shock eventually causes irreversible tissue injury and can culminate in the death of the patient

29. Categories of shock Cardiogenic – due to myocardial pump failure
Hypovolemic – due to inadequate blood or plasma volume (hemorrhage, vomiting or diarrhea, extensive burns
Septic – due to overwhelming microbial or fungal infection, Endotoxin
Neurogenic – less common (spinal cord injury)
Anaphylactic- less common (drug anaphylaxis)