Fluids and electrolyte imbalance

Objectives: At the end of this lecture the student should be able to:

Define Fluids and electrolyte imbalance imbalance. y Deffrentiate between Hyponatremia, Hypernatremia and hypokalemia y Discuss causes of Hyponatremia. y List signs , symptoms and treatment of hypokalemia
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overview sodium, Electrolytes are salts that conduct electricity and are found in the body fluid, tissue, and blood. Examples are chloride, calcium, magnesium, and potassium

Sodium (Na+) is concentrated in the extracellular fluid (ECF) and potassium (K+) is concentrated in the intracellular fluid (ICF). Proper balance is essential for muscle coordination, heart function, fluid absorption and excretion, nerve function, and concentration

The kidneys regulate fluid absorption and excretion and maintain a narrow range of electrolyte fluctuation. Normally, sodium and potassium are filtered and excreted in the urine and feces according to the body's needs

Too much or too little sodium or potassium, caused by poor diet, dehydration, medication, and disease, results in an imbalance.

Too much sodium is called hypernatremia; too little is called hyponatremia. y Too much potassium is called hyperkalemia; Too little is called hypokalemia.
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Incidence and Prevalence Hyponatremia is the most common electrolyte imbalance. It is associated with kidney disease such as nephrotic syndrome and acute renal failure (ARF).

Men and women with healthy kidneys have equal chances of experiencing electrolyte imbalance, and people with eating disorders such as anorexia and bulimia, which most often affect women, are at increased risk. Very young people and old people are affected more often than young adults.

Hyponatremia
Causes Hyponatremia is caused by conditions such as water retention and renal failure that result in a low sodium level in the blood.
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Pseudohyponatremia occurs when too much water is drawn into the blood; it is commonly seen in people with hypoglycemia (low blood sugar

Psychogenic polydipsia occurs in people who compulsively drink more than four gallons of water a day.

Hypovolemic hyponatremia (with low blood volume due to fluid loss) occurs in dehydrated people who rehydrate (drink a lot of water) too quickly, in patients taking thiazide diuretics, and after severe vomiting or diarrhea.

Hypervolemic hyponatremia (high blood volume due to fluid retention) occurs in people with liver cirrhosis, heart disease, or nephrotic syndrome. Edema (swelling) often develops with fluid retention.

Euvolemic hyponatremia (decrease in total body water) occurs in people with: hypothyroidism, adrenal gland disorder, and disorders that increase the release of the antidiuretic hormone (ADH), such as tuberculosis, pneumonia, and brain trauma

Signs and Symptoms

Symptoms of hyponatremia are related to the severity and the rate at which the conditions develop. The first symptoms are fatigue, weakness, nausea, and headache. More severe cases cause confusion, seizure, coma, and death.

Treatment
The goal of treatment Is to restore electrolyte balance for proper hydration and use of total body fluid. Sodium deficiency must be corrected slowly because drastic change in sodium level can cause brain cell shrinkage and central pontine myelinolysis (damage to the pons region of the brain). Methods include

Fluid and water restriction Intravenous (IV) saline solution of 3% sodium Salt tablets

Conivaptan (Vaprisol) has been approved by the U.S. Food and Drug Administration (FDA) to treat hypervolemic hyponatremia and euvolemic hyponatremia in some hospitalized adults. Vaprisol is administered intravenously (i.e., into a vein).

Blood sodium levels should be closely monitored in patients who receive this medication.

Side effects include injection site reactions, headache, thirst, and low potassium levels.

Hypernatremia

Hypernatremia is high sodium in the blood that occurs with excessive fluid loss. When fluid is lost and not replaced, sodium is not adequately excreted from the body

causes
Diabetes insipidus (caused by deficiency of or insensitivity to ADH) y Diarrhea y Diuretic medication y Excessive salt intake y Excessive vomiting y Heavy respiration (e.g., exercise, exertion) y Severe burn y Sweating
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It is associated with the same symptoms as hyponatremia, and also causes the following: y Delerium y Irritability y Muscle twitching
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Hypernatremia commonly affects older hospitalized people, 50% of whom have underlying diseases that, when combined with excessive sodium and fluid loss, are fatal.

Hypernatremia
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Hypernatremia commonly affects older hospitalized people, 50% of whom have underlying diseases that, when combined with excessive sodium and fluid loss, are fatal.

Treatment
Treating hypernatremia involves slowly replenishing water loss, usually over 48 hours, through drinking or intravenous (IV) solution. In cases of diabetes, the imbalance is treated with adequate water intake and nonsteroidal anti-inflammatory drugs or with synthesized hormones (e.g., desmopressin) that aid in fluid retention and decrease urination

Some drugs used to treat electrolyte imbalance may be unsafe for pregnant women and should not be taken before consulting a physician.

Hypokalemia

An abnormally low level of potassium (K+) is called hypokalemia. The adrenal gland makes a hormone (aldosterone) that signals the kidneys to excrete or conserve potassium, based on the body's needs. In hypokalemia, the adrenal gland retains the hormone and the kidneys conserve potassium when more is needed

Causes
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The most common cause of potassium depletion is diuretic medication that increases urination. Diuretics are prescribed for medical conditions and are used in weight-loss programs. Other causes include:

Diarrhea y Dietary deficiency y Excessive sweating y Magnesium deficiency (causes overexcretion of fluid)
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Signs and Symptoms

Symptoms of deficiency include cardiac arrhythmia, muscle pain, general discomfort or irritability, weakness, and paralysis

Diagnosis
Diagnosis may require urinalysis and blood tests to determine the amount of potassium being excreted by the kidneys

Treatment
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Treatment involves potassium supplements, proper diet, and intravenous (IV) solution. The best way to maintain an adequate potassium level is to eat foods such as sweet potatoes, bananas, avocados, spinach, and oranges. Patients taking diuretic medication are also given potassium supplements. Potassium is given slowly to avoid hyperkalemia.
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