FLUID & ELECTROLYTES

:Done By
Tahani Al-Ghamdi
Sarah Salahuddin
:Supervised By
Dr. Hatim Simbawa
BODY FLUID
Volume ml Fluid Loss
1200-1500 Urine
100-200 Faces
400 Insensible
HYPOVOLEMIA
HYPERVOLEMIA
ELECTROLYTE COMPOSITION

Cl –
Na +
HCO3
-

Intracellular Interstitial Intravascular

HYPONATRAEMIA
CAUSES
 Diuretics specially thiazides
 Water excess

 Pseudohyponatraemia
SIGNS & SYMPTOMS
 Depend on rate of change in serum sodium
 confusion, seizure

 HTN, HF, edema

 Anorexia, nausea

 Muscle weakness
MANAGEMENT
 Correct underlying cause
 If chronic fluid restriction

 If dehydrated 0.9% NS
MANAGEMENT
 In Emergency; IVI 0.9% NS or hypertonic saline
(1.8% saline) at 70mmol Na+/hr
 Can be combined with frusemide

 Watch for HF & central pontine myelinolysis

HYPERNATRAEMIA
CAUSES
 Fluid loss without water replacement
 Incorrect IV fluid replacement

 Diabetes insipidus

 Osmotic diuresis

 Primary aldosteronism
SIGNS & SYMPTOMS
 Thirst
 Confusion, coma & fit WITH signs of
dehydration

 Laboratory: increase in
• Urea
• Albumin
• PCV
MANAGEMENT
 Dextrose 5% IV slowly
 0.9% NS
POTASSIUM
 K+ & H+ in ECF vary with each together (why?)
 When H+ is high fewer k+ will excreted

 Insulin & catecholamines  Na+/k+ pump k+

uptake into cells
HYPOKALAEMIA
K+ < 2.5mmol/L
CAUSES
 Diuretics
 Vomiting & diarrhoea (Pyloric stenosis,
Purgative & liquorice abuse)
 Intestinal fistula

 Alkalosis

 Renal tubular failure

 Cushing syndrome
SIGNS & SYMPTOMS
 Muscle:
• Weakness
• hypotonia
• Cramps
• tetany

 Cardiac arrhythemia
SIGNS & SYMPTOMS
 ECG:
• Small or inverted T wave
• Prominent U wave
• Depressed ST segment
• Prolonged P-R interval
SIGNS & SYMPTOMS
 If on diuretics increase HCO3- longstanding
hypokalemia

 Mg+2 may be low *

** N.B. Hypokalemia exacerbate digoxin toxicity

MANAGEMENT
 Mild (K+ > 2.5mmol/L):
• Oral supplement e.g. (sando-K 2 tab./6-8hr)
 Sever (K+ < 2.5mmol/L):
• IV potassium cautiously
• Not > 20mmol/hr
• Not > 40mmoml/L
• Never give bolus
 N.B. DO NOT give K+ if OLIGOURIC
HYPERKALAEMIA
k+ > 6.5mmol/L
CAUSES
 Oligourea
 Drugs: K sparing diuretics & ACEI

 Excessive k+ therapy & Massive blood Tx.

 Metabolic acidosis

 Rabdomyolysis

 Addison disease

* Hemolyzed blood sample

SIGNS & SYMPTOMS
 Cardiac arrhythmia
 Sudden death

 ECG:
• Tall tented T wave
• Small P wave
• Wide QRS complex
• VF
MANAGEMENT
 Treat underlying cause

 10ml calcium gluconate (10%) IV over 2min

repeat as necessary
 Insulin + glucose e.g. 20U insulin + 50 ml of
glucose 50% IV
 Nebulized salbutamol (2.5mg) (WHY?)
MANAGEMENT
 Polystyrene sulfonate resin (Calcium resonium
15g/8hr)
 Dialysis
CALCIUM
 40% bound to alb.
 What is measured in plasma; total, bound,
free?

 Factors affect binding; Myeloma, cirrhosis,

individual variation
 Control of calcium metabolism?
HYPOCALCAEMIA
CAUSES
 Artefact from hypoalbuminaemia
 Thyroid, parathyroid surgery

 PO4-3;
• High
• N/ low

**Respiratory alkalosis (why?)

SIGNS & SYMPTOMS
 Tetany
 Depression

 Perioral paraethesia

 Carpopedal spasm
SIGNS & SYMPTOMS
 Trousseau’s sign
 Chvostic sign

 Cataract (if Ch. Ca+2 loss)

 ECG;
• QT interval elevation
MANAGEMENT
 Mild:
• Ca 5mmol/6hr PO
 Sever:
• 10ml calcium gluconate (10%) IV over 30 min
• Bolus injection needed very rarely
• Repeat if necessary
• If due to respiratory alk. Correct alk.
HYPERCALCAEMIA
CAUSES
 Most commonly MALGNANCY
 1° hyperparathyroidism

 Sarcoidosis

 Vit. D intoxication

 Familial benign hypocalciuric hypercalcaemic

POINTER TO MALIGNANCY
 Low alb.
 Low CL-

 Low K+

 Alkalosis

 Low PO4-3

 HIGH ALP
SIGNS & SYMPTOMS
 “Bones, stone, groans & psychic moans”
 General:
• Pyrexia
• anorexia
• Wt loss
• Tiredness
• High BP
SIGNS & SYMPTOMS
 GI:
• Abdominal pain
• Vomiting
• Constipation
 GU:
• Polyuria, Polydipsia
• Renal stones
• Renal failure
SIGNS & SYMPTOMS
 Depression
 CNS:
• weakness
 Corneal calcification
 Cardiac arrest

 ECG:
• QT interval depression
MANAGEMENT
 Treat underlying cause
 Sarcoidosis Prednisolone 40-60mg/d

 Malignant disease Chemothrapy

MNANGEMENT
 If Ca+2> 3.5mmol/L:
• Rehydrate with IVI 0.9% NS 4-6L/d as needed
• Correct hypokalaemia, hypomagnesaemia
• Once rehydrate Frucemide 40mg/12hr PO/IV
• Avoid thiazid
• Bisphosphonate single dose
HEMORRHAGE & BLOOD
TRANSFUSION
TYPES OF HEMORRHAGE
 3 classification:
 External & internal

 Arterial, venous & capillary

 Primary, reactionary & secondary

BLOOD TRANSFUSION
 Blood refrigeration between 35-40°F.
 Not to administer blood if stay out of
refrigerator for > 1/2hr. (return it to lab)

 The blood of donors who have ever had

malaria, or recently been in malarious areas,
should not be used as whole blood. (why?)
BLOOD TX. COMPLICATION
 Early:
• Acute haemolytic reaction
• Anaphylaxis
• Bacterial contamination
• Febrile reaction
• Allergic reaction
• Fluid overload
• TRALI
BLOOD TX. COMPLICATION
 Delay:
• Infection
• Iron overload
• Post-Tx. Pupura Ig. + platelet Tx.
PYROGENIC REACTION
 Presence of bacterial growth in anticoagulant
solution, during collection or administration.
 C/P:
• Fever during B Tx.
• Headache, Restlessness, Chills
• SEVER: Nausea, Rigor, Vomiting, (BP fall; rare)
 Mx: Slow down the Tx & IV Ca. gluconate
CONTAMINATION OF BLOOD
 Slight contamination cause febrile reaction.
 Gross infection will lead to fulminating
septicaemia.
 Rarely seen
HAEMOLYTIC REACTION
 Result of Tx. Of incompatible blood or blood
already hemolyzed.
 Incompatible blood means?

 2 Types:
• With active hemolysin
• With No hemolysin
HEMOLYTIC REACTION
 C/P:
 In both LITTLE/NO raise in Hb. after Tx.

 In the 1st type febrile reaction + jaundice

 In 2nd type No symptoms at the time of Tx

 N.B. Cross matching can’t always exclude

incompatibility.
ALLERGIC REACTION
 The characteristics are:
• Itching, Urticaria
• Angioneurotic edema
• Ashtma
• Accompanied by fever, headache, epigastric
discomfort or vomiting.
ALLERGIC REACTION
 Depend upon abnormality in the recipient
rather than in the donor.