Fluid & Electrolytes: Fluid Spacing & Hypervolemia vs Overhydration
Third spacing causes (think capillaries)
CHF -increases venous pressure fluid overload liver failure - causing fluid overload & no albumin. obstruction of venous return due to thrombus hypoalbuminemia - lack of protein to pull fluids back into capillaries. Capillary damage inflammation intestinal obstruction abdominal surgery
Overhydration causes
Fluid replacement with water only SAIDH syndrome of inappropriate ADH Excessive irrigation of a body cavity with water.
Fluid overload causes
Increase in Na+ in body (with water following) CHF triggering RAA in kidneys (to save H2O) Renal Failure triggering RAA in kidneys Cirrhosis Cushing's Syndrome Alka-Seltzer - Na+ ingestion in diet or medication
is it overhydration or hypervolemia?
Look at the lab results. If Na+ is low than it is overhydration of water only and solutes are diluted. If Na+ is high than it is hypervolemia and edema - pt is retaining all fluids.
Third spacing
abnormal fluid collection in areas that normally contain minimal or no fluids
Fluid overload
access fluid & SOLUTES causing hypervolemia
Third spacing spaces
ascites pulmonary edema blistering (burns to skin)
Excess fluid s/s
cardiovascular overload generalized edema pulmonary edema impaired skin due to edema polyuria
Overhydration critical complications
cerebral edema
rapid changes in weight
could indicate excess fluid. 1kg = 1L of fluid.
Excess fluid treatments
furosemide - which is a potassium waster so keep an eye on K+
Second spacing
increased fluids in the interstitial compartment: -generalized edema -pitting edema -periorbital an scrotal edema -brawny edema
Overhydration
known as water intoxication where the body gains water only! H2O goes to cells where solute concentration is higher and cells swell.
First spacing
normal distribution of fluid in the body
Excess fluid interventions
urine specific gravity <1.010