FLUID AND ELCTROLYTE BALANCES

PRESENTED BY: MAJOR ADVISOR: Ajit Kumar Singh Dr.H.N.Singh V-6355/11 Dean & Head, Dept.of Veterinary M.V.Sc.(Surgery) 1st year. Surgery & Radiology. DEPT. OF VETY SURGERY & RADIOLOGY COLLEGE OF VETERINARY SCIENCES & A.H. N.D.U.A&T. KUMARGANJ FAIZABAD.-224229 : 

PRESENTED BY : MAJOR ADVISOR : Ajit Kumar Singh Dr.H.N.Singh V-6355/11 Dean & Head, Dept.of Veterinary M.V.Sc.(Surgery) 1 st year. Surgery & Radiology. DEPT. OF VETY SURGERY & RADIOLOGY COLLEGE OF VETERINARY SCIENCES & A.H. N.D.U.A&T. KUMARGANJ FAIZABAD.-224229 FLUID AND ELECTROLYTE DEFICIT AND THEIR ASSESSMENT

INTRODUCTION: 

INTRODUCTION Water is found everywhere on earth including animal body In an adult 60% of the weight is water Two third of the body’s water is found in the cell

DISTRIBUTION OF BODY FLUIDS: 

DISTRIBUTION OF BODY FLUIDS Body fluids are distributed in two distinct compartments: 1.Extracellular fluids[ECF] Which includes interstitial fliud & intravascular fluid 2.Intracellular fluids[ICF]

COMPOSITION OF BODY FLUIDS: 

COMPOSITION OF BODY FLUIDS The fluids circulating throughout the body in extracellular and intracellular fluid spaces contain 1.Electrolytes 2.Minerals 3.Cells

MOVEMENT OF BODY FLUIDS: 

MOVEMENT OF BODY FLUIDS Diffusion Osmosis Filtration Active transport

REGULATION OF BODY FLUIDS: 

REGULATION OF BODY FLUIDS Fluid intake Fluid output Hormonal influence Lymphatic influences Neurologic influences Renal influences

FLUID ,ELCTROLYTE AND ACID-BASE IMBALANCES: 

FLUID ,ELCTROLYTE AND ACID-BASE IMBALANCES

FLIUD IMBALANCES: 

FLIUD IMBALANCES The five types of fluid imbalances that may occur are: Extracellular fluid imbalances(EVFVD) Extracellular fluid volume excess(ECFVE) Extracellular fluid volume shift Intracellular fluid vloume excess(ICFVE) Intrcellular fluid volume deficit(ICFVD)

EXTRACELULLAR FLUID VOLUME DEFICIT: 

EXTRACELULLAR FLUID VOLUME DEFICIT An ECFVD, commonly called as dehydration , is a decrease in intravascular and interstitial fluids An ECFVD can result in cellular fluid loss if it is sudden or severe

THREE TYPES OF ECFVD: 

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

ETIOLOGY AND RISK FACTORS: 

ETIOLOGY AND RISK FACTORS Severe vomiting Traumatic injuries Third space fluid shifts [percardial, pleural, pertonial and joint cavities] Fever Gatrointestinal suction Fistulas Burns Decresed ADH secretions e.t.c.

OLD ANIMALS ARE AT HIGH RISK OF ECFVD DUE TO : 

OLD ANIMALS ARE AT HIGH RISK OF ECFVD DUE TO Decreased thirst response Decreased renal concentration of urine Altered ADH response Multiple chronic diseases Debilitation Physical restraint Changes in mental status

CLINICAL MANIFESTATION : 

CLINICAL MANIFESTATION In Mild ECFVD, 1to 2 L of water or 2% of the body weight is lost In Moderate ECFVD, 3 to 5L of water loss or 5%weight loss IN Severe ECFVD , 5 to 10 L of water loss or 8% of weight loss

CLINICAL MANIFESTATION: 

CLINICAL MANIFESTATION Thirst Muscle weakness Dry mucus membrane;dry cracked lips or furrowed tongue Eyeballs soft and sunken (severe deficit) Restlessness, headache , confusion, coma in severe deficit Elevated temperature Tachycardia, weak thready pulse Peripheral vein filling > 5 seconds Weight loss Oliguria e.t.c.

LABORATORY FINDINGS: 

LABORATORY FINDINGS Increased or normal serum sodium level ( > 145mEq/ L ) Increase BUN ( > 25 mg / L ) Hyperglycemia ( > 120 mg /dl ) Increased specific gravity ( > 1.030)

Management of Hyperosmolar fluid volume deficit : 

Management of Hyperosmolar fluid volume deficit Administration of hypotonic IV solution , such as 5% dextrose in 0.2 %saline If the deficit has existed for more than 24 hours,avoid rapid correction of fluid [sodium solution to be infused at the rate of 0.5 to 0.1m Eq / L / hr]

If heamorrhage is the cause for ECFVD: 

If heamorrhage is the cause for ECFVD Packed red cells followed by hypotonic IV fluids is administered In situations where the blood loss is less than 1 L normal saline or ringer lactate may be used Animal with severe ECFVD accompanied by severe heart , liver, or kidney disease cannot tolerate large volumes of fluid and sodium .

EXTRACELLULAR FLUID VOLUME EXCESS: 

EXTRACELLULAR FLUID VOLUME EXCESS ECFVE is increased fluid retention in the intravasular and interstitial spaces

ETIOLOGY AND RISK FACTORS: 

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 decreased colloid osmotic pressure lymphatic and venous obstruction

CLINICAL MANIFESTATION: 

CLINICAL MANIFESTATION Constant irritating cough Dyspnea & crackles in lungs Cyanosis Neck vein obstruction Pitting & sacral edema Weight gain Change in level of consiousness

LAB INVESTIGATION: 

LAB INVESTIGATION Low , normal or high sodium Specific gravity below 1.010 Decreased BUN [< 8mg/ dl]

MANAGEMENT: 

MANAGEMENT Diuretics A low sodium diet

EXTRACELLULAR FLUID VOLUME SHIFT: THIRD SPACING: 

EXTRACELLULAR FLUID VOLUME SHIFT: THIRD SPACING Fluid that shifts into the interstitial spaces and remain there is called as third space fluid Common sites are abdomen , pleural cavity, peritoneal cavity and pericardial sac

RISK FACTORS : 

RISK FACTORS Crushing injuries, major tissue trauma Major surgery Extensive burns Acid –base imbalances and sepsis Intestinal obstruction Lymphatic obstruction GI tract malabsorption

CLINICAL MANIFESTATION : 

CLINICAL MANIFESTATION Cold extremities Weak and rapid pulse Hypotension Oliguria Decreased levels of consiousness LAB INVESTIGATION Elevated BUN level

MANAGEMENT: 

MANAGEMENT Treat the cause For burns and tissue injuries large volume of isosmolar IV fluid is administered Albumin is administered for protein deficit IV fluid intake is maintained after major surgery to maintain kidney perfusion Pericardiocentesis if pericarditis is the result Paracentesis for ascites

INTRACELLULAR FLUID VOULME EXCESS:WATER INTOXICATION : 

INTRACELLULAR FLUID VOULME EXCESS:WATER INTOXICATION ICFVE is increase in amount of water inside the cells

ETIOLOGY : 

ETIOLOGY Administration of excessive amount of hyposmolar IV fluids[0.45%saline or 5%dextrose in water] Consumption of excessive amount of water without adequate nutritional intake Schizophrenia[compulsive water consumption]

CLINICAL MANIFESTATIONS : 

CLINICAL MANIFESTATIONS Headaches Behavioral changes Irritability, disorientation and confusion Decreased motor and sensory function Bradycardia, elevated BP & altered respiratory patterns,, projectile vomiting, delirium, convulsions & coma.

LABORATORY FINDINGS : 

LABORATORY FINDINGS High serum sodium level- 125 mEq/L

MANAGEMENT: 

MANAGEMENT Early administration of IV fluids containing sodium chloride Perform neurologic checks every hour to see if cranial changes are present Monitor fluid intake , IV fluids and fluid output hourly and weight daily Administer antiemetics for food and fluid retention

INTRACELLULAR FLUID VOLUME DEFICIT: 

INTRACELLULAR FLUID VOLUME DEFICIT Severe hypernatremia and dehydration can cause ICFVD Relatively rare in healthy adults Common in old animals and in those conditions that result in acute water loss Symptoms include confusion, coma, and cerebral hemorrhage

PowerPoint Presentation: 

Acid-Base imbalance Definition Causes Clinical manifestation Lab findings Management Respiratory acidosis Hypoventilation & excessive CO2 production It is a clinical disorder in which the pH is less than 7.35 and the paCO2 is greater than 42mmHg COPD, neuromuscular disorder, Guillian-Barre syndrome, Myssthenia gravis, Respiratory center depression, Drugs, late ARDS, Dyspnea , disorientation, coma PH lesser than 7.35, Paco2 greater than 45mmHg, Hyperkalemia, Hypoxemia 1.Treat underlying cause 2.Support ventilation 3.Correct electrolyte imbalance 4.Intravenous NaHCO3 Respiratory Alkalosis Hyperventilation It is a clinical condition in which the arterial Ph is greater than7.45 and the paCO2 is less than 38mmHg Hypoxemia, impaired lung expansion, thickened alveolar – capillary membrane, Chemical stimulation of respiratory center, traumatic stimulation of respiratory center Tachypnea, giddiness, dizziness, syncope, convulsions, coma, weakness, paresthesia, tetany PH greater than 7.35 PaCO2 lesser than 35 mmHg, Hypokalemia, Hypocalcemia Increase CO2 retention through CO2 rebreathing & sedation and mechanical hypoventilation

PowerPoint Presentation: 

Definition causes Clinical manifestation Lab findings Management Metabolic Acidosis It is a clinical condition in which the HCO3 & pH is decreased Renal failure, Diabetic ketoacidosis, Lactic acidosis, ingested toxins, renal tubular acidosis Hyperventilation confusion, drowsiness, coma, headache PH< 7.35, HCO3< 22mEq/L 1.Treat the underlying cause 2.Intravenous NaHCO3 3.correct electrolyte imbalance Metabolic Alkalosis It is a clinical condition in which PH is raised Hypokalemia, gatric fluid loss, massive correction of whole blood, Overcorrection of acidosis with NaCO3 HypoventilationDysrythmias PH >7.45 Hypokalemia Hypocalcemia PaCO2 normal or increased 1.Treat the underlying cause 2.Administer KCL 3.intravenous acidifying salts[NH4CL] 4.Administer acetazolamide

Quick Clinical Assessment of Dehydration : 

Quick Clinical Assessment of Dehydration Fluid deficit in the extravascular space (interstitial and intracellular) causes dehydration, causing: Tenting of the skin, dry mucous membranes, sunken eyes [and accompanying protrusion of the third eyelids in the cats], and dullness to the cornea. 4-5% dehydration Semi-dry oral mucous membranes Normal skin turgor Eyes maintaining normal moisture

Cont…: 

Cont … 6-7% dehydration Dry oral mucous membranes Mild loss of skin turgor Eyes still moist 8-10% dehydration Dry mucous membranes Considerable loss of skin turgor Eyes retracted [third eyelids protruded] Weak rapid pulses

Cont…: 

Cont … 12% dehydration Very dry oral mucous membranes Complete loss of skin turgor Severe retraction of the eyes [third eyelids protruded] Dull eyes Possible alteration of consciousness Thready weak pulses

EXCEPTIONS: : 

EXCEPTIONS: (1). Chronically emaciated animal may have metabolized the fat from around its eyes and the collagen in the skin. These animals have poor skin turgor and sunken eyes but may be normally hydrated. In this situation, assessment of mucous membrane moisture, PCV, and total proteins is important. (2). The animal with rapid fluid loss (third body fluid space) will require a greater volume of fluid than would be estimated from physical signs. [Above taken from p.1245, Merck Veterinary Manual 8 th edition.]

Cont…: 

Cont … (3). Also, excess subcutaneous fat will keep the skin elastic even in a dehydrated cat, making the skin less reliable as a hydration indicator in obese cats.

Assessment by S.F.R.T. : 

Assessment by S.F.R.T. S.F.R.T. Degree of dehydration S.R.T. absent or <1sec. mild 2-5 sec. moderate >5 sec. severe

Commonly used solutions in fluid therapy : 

Commonly used solutions in fluid therapy * Saline solution * Glucose solution (5 % dextrose) * Glucose saline solution (5% D.N.S.) * Lactated Ringer’s solution * 5% Dextrose lactated Ringer’s solution e.t.c .

REFERENCES: 

REFERENCES 1. PRINCIPLES OF SURGERY COMPANION HANDBOOK , 7 th Edition , By: SEYMOUR I. SCHWARTZ. 2. RUMINANT SURGERY, 1 s t Edition By: R.P.S TYAGI & JIT SINGH. 3.TEXT BOOK OF CLINICAL VETERINARY MEDICINE, 3 rd Edition By: AMALENDU CHAKRABARTI. 4. MERCK VETERINARY MANUAL 8 th Edition.

: 

Thank you !