1. Fluid volume deficit, excess and water intoxication

2. Fluid Volume Disturbances
Fluid Volume Deficit (Hypovolemia)

3. Fluid Volume Deficit Mild – 2% of body weight loss
Moderate – 5% of body weight loss
Severe – 8% or more of body
weight loss

4. THREE TYPES OF deficit
Hyperosmolar fluid volume deficit- water loss is greater than the electrolyte loss
Isosmolar fluid volume deficit – equal proportion of fluid and electrolyte loss

5. Fluid Volume Deficit
Pathophysiology – results from loss of body fluids and occurs more rapidly when coupled with decreased fluid intake

6. Fluid Volume Deficit Clinical manifestations Acute weight loss
Decreased skin turgor

7. Fluid Volume Deficit - Oliguria - Concentrated urine
- Postural hypotension
- Weak, rapid, heart rate
- Flattened neck veins
- Increased temperature
- Decreased central venous pressure

8. ETIOLOGY AND RISK FACTORS
Severe vomiting
Traumatic injuries
Ileostomy
Burns
Use of diuretics

9. LABORATORY FINDINGS Increased osmolality(> 295 mOsm/ kg)
Increase BU (>25 mg / L )
Elevated hematocrit (> 55%)
Increased specific gravity of urine ( > 1.030)

10. MANAGEMENT
Management of fluid in patient with fluid deficit should aim at
Replacing deficit
Correcting ongoing losses
Maintenance

11. Management of mild deficit
Mild fluid volume loss can be corrected with oral fluid replacement

12. Management of moderate/severe volume deficit
IV fluids needed

13. Fluid Volume Excess (Hypervolemia)

14. Fluid Volume Excess
Pathophysiology – may be related to fluid overload or diminished function of the homeostatic mechinisms responsible for regulating fluid balance

15. ETIOLOGY AND RISK FACTORS
Heart failure
Renal disorders
Cirrhosis of liver
Increased ingestion of high sodium foods
Excessive amount of IV fluids containing sodium
Electrolyte free IV fluids
SIADH,Sepsis
decreased colloid osmotic pressure
lymphatic and venous obstruction
Cushing’s syndrome & glucocorticoids

16. Why does heart failure leads to oedema
Reduced renal perfusion--- activates renin angiotensin aldosterone mechanism---- results in fluid retention

17. Why does renal failure cause oedema?
Why does liver failure cause oedema

18. CLINICAL MANIFESTATION
Dyspnea & crackles in lungs
pleural effusion
Neck veins prominant
Bounding pulse &elevated BP
Pitting & sacral edema
Weight gain
Increased CVP
Change in level of consciousness

19. Fluid Volume Excess

20. LAB INVESTIGATION serum osmolality <275mOsm/ kg
Decreased hematocrit [ < 45%]

21. MANAGEMENT Diuretics Restrict fluids In people with HF, ACE inhibitors
A low sodium diet

22. Water intoxication
At the onset of this condition fluid outside the cells has an excessively low amount of solutes in comparison to inside the cells, the fluid shifts through osmosis into the cells in order to balance its concentration.
This causes the cells to swell. In the brain, this swelling increases ICP

23. features headache personality changes
changes in behavior, confusion, irritability
difficulty breathing during exertion
cramping, nausea, vomiting,
 seizures, brain damage, coma or death due to cerebral oedema

24. Risk factors Psychiatric conditions-polydipsia
Over replacement of IV fluids
Heat stress

25. management Restriction of fluids is sufficient in mild cases
If severe diuretics needed

26. Thank you!!