There are two fundamentally different disorders of water balance :
dehydration and overhydration. Depending on the extracellular sodium concentration, one can distinguish hypotonic, isotonic and hypertonic dehydration and overhydration. Hypotonic dehydration Fluid deficit associated with sodium deficiency. The low osmolality of the extracellular space produces a reduction of the extracellular volume. Isotonic dehydration Deficiency of sodium and water. The extracellular volume is reduced and serum osmolality and intracellular volume are normal. Hypertonic dehydration Water deficiency with elevation of serum osmolality and reduction of the extracellular volume. As a result of diffusion of water, the intracellular volume is also reduced and its osmolarity increased. Hypotonic overhydration xcess of water, with elevation of extracellular and intracellular volumes. The osmolalities of serum and intracellular space are reduced. Isotonic overhydration xcess of water and sodium. The serum osmolality is normal, the extracellular volume is elevated and the intracellular volume normal. Hypertonic overhydration !odium and fluid excess. !erum osmolality and extracellular volume are increased. As a result of diffusion, the intracellular volume is reduced and its osmolality elevated. Table 7a (1-3): HY!T!"I# D$HYD%&TI!" #a'ses "nade#uate sodium inta$e after vomiting, diarrhoea, sweating. "ncreased sodium losses due to adrenal failure, adrenalectomy, chronic diuretic therapy %thia&ides', diarrhoea, fistula losses. (y)pto)s Tiredness, fainting, hypotonia, vomiting, collapse, fever, muscle cramps, rapid pulse, depressed consciousness level. Treat)ent Treatment of primary disorder. Administration of: (a)l *.+,, (a)l -..-,. I(!T!"I# D$HYD%&TI!" #a'ses "sotonic fluid losses through vomiting, diarrhoea, fistulae, diuretics, drainage of ascites, with peritonitis, burns, sedative and carbon monoxide intoxication, sunstro$e. (y)pto)s Thirst, tiredness, fainting, collapse, vomiting, hypotonia, muscle cramps, rapid pulse. Treat)ent Treatment of primary disorder. Administration of: /inger 0s solution 1artmann0s solution %compound sodium lactate' HY$%T!"I# D$HYD%&TI!" #a'ses "nade#uate water inta$e, or increased water losses due to sweating, osmotic diuretics, hyperventilation, chronic nephropathy, polyuric phase of acute renal failure, diabetes insipidus. (y)pto)s Thirst, fever, dryness, restlessness, delirium, coma. Treat)ent Treatment of primary disorder. Administration of:2lucose -, %3*,, 4*,',Darrow0s solution " half5strength in glucose 4.-,. Table 7b (1-3): HY!T!"I# !*$%HYD%&TI!" #a'ses xcessive administration of salt5free solutions, gastric lavage with water, increased AD1 activity, liver failure. (y)pto)s Wea$ness, nausea, vomiting, dyspnoea, confusion, loss of consciousness. Treat)ent Treatment of primary disorder. Fluid restriction, 6smofundin 7 3-,, possibly dialysis. "f tendency to al$alosis:(a)l *.+,. I(!T!"I# !*$%HYD%&TI!" #a'ses xcessive administration of isotonic infusion solutions in oliguric or anuric states, cardiac failure, nephrotic syndrome, chronic uraemia, acute glomerulonephritis, liver cirrhosis, protein5 losing enteropathy. (y)pto)s 6edema, effusions, hypertension dyspnoea. Treat)ent Treatment of primary disorder. !odium chloride and fluid restriction. Diuretics, 6smofundin 7 3-, %see chapter 6smotic Therapy'. HY$%T!"I# !*$%HYD%&TI!" #a'ses xcessive administration of sodium chloride. Drin$ing of sea water. 6veractivity of renal cortex in )onn0s syndrome, )ushing0s syndrome, administration of steroids. )erebral sodium chloride retention syndrome. Drin$ing of sea water after shipwrec$ (y)pto)s 8omiting, diarrhoea, labile blood pressure, pulmonary oedema, restlessness, changes in central venous pressure. Treat)ent Treatment of primary disorder. !odium chloride and fluid restriction. Diuretics %thia&ides' 6smofundin 7 3-, %see chapter 6smotic Therapy'.