Extracellular fluid volum deficit

ECFVD

1. EXTRACELLULAR FLUID VOLUME DEFICIT PRESENTED BY:-KHUSHNASIB ACN

2. The five types of fluid imbalances that may occur are extracellular fluid volume deficit (ECFVD), extracellular fluid volume excess (ECFVE), extracellular fluid volume shift, extracellular fluid volume deficit. (Sodium is the major ion that influences fluid balance and imbalance)

3. ECFVD:- EXTRACELLULAR FLUID VOLUME DEFICIT:-

4. An ECFVD is a decrease in intravascular and interstitial fluids. ECFVD is a common and serious fluid imbalance that results in vascular fluid volume loss ( hypovolemia ). ECFVD can lead to cellular fluid loss ( hypovolemia ) owing to fluid shifting from the cells to the vascular fluid to restore fluid balance. There are major two types of extracellular fluid volume deficits 1) Hyperosmolar fluid volume deficit, in which fluid loss is greater than the solute (sodium) loss.

5. 2) iso-osmolar fluid volume deficit, in which there is equal proportion of fluid and solute (sodium) loss. ETIOLOGY:- Severe vomitting or diarrhea Traumatic injuries with excessive blood loss Third space fluid shift Insufficient water or fluid intake

6. RISK FACTORS:- Elderly, confused or debilitated Diabetic ketoacidosis Losing large volume of blood Experiencing severe vomitting or diarrhea Difficulty swallowing Unable to procure water because of physical restraint Recieving overabundance of IV glucose waith saline or hypertonic tube feeding.

7. Elderly are at risk because of their potential for depressed mechanism. Prevention begins with adequate hydration. If fluids are being lost, fluid replacement should begin immidiately with oral fluids or intravenous solutions that contain saline as well as dextrose.

8. PATHOPHYSIOLOGY:- Insufficient water intake or massive water loss ↓ Increase in serum sodium level ↓ Shifting of water from cells to vascular space ↓ Decrease the hyperosmolarity (caused by water loss) ↓ This shift causes cells to shrink and cellular dehydration occurs

9. ↓ Severe fluid volume deficit ↓ Shock or vascular collapse can occur If ECFVD develops rapidly, symptoms are more severe. Severe brain shrinkage during water deficit may cause vascular damage and intracerebral hemorrhage . When ECFVD occurs slowly, the brain cells adapt to the increased intracellular osmolarity by producing extra

10. Intracellular particles ( idiogenic osmoles ) which prevent large amount of water from leaving the cell. CLINICAL MANIFESTATIONS:- With mild ECFVD, 1-2 L of water & 2% of body weight is lost. Moderate ECFVD is evidenced by 3-5 L of water loss & 5% weight loss. In severe ECFVD, the water loss is increased to 5-10 L & weight loss is increased to 8%, the systolic blood pressure becomes alarmingly low, as demonstrated by a reading of less than 70 mm Hg.

11. Thirst Decreased skin turgor Dry mucus memb , dry crackled lips or tongue Eyeballs soft or sunken (severe deficit) Apprehension & restlessness, coma insevere deficit Elevated temperature Tachycardia Postural systolic blood pressure>15 mmHg and diastolic fall>10 mm Hg

12. Narrowed pulse pressure, decreased central venous pressure and pulmonary capillary wedge pressure Flattened neck veins in supine position PATHOPHYSIOLOGIC BASIS:- - Cells shrink, stimulating thirst osmorecceptors in the hypothalamus, with iso-osmolar fluid loss, thirst usually does not occur. Decreased interstitial fluid causes skin tissue to stick together. Cells of mucus memb and tongue dry out.

13. Water tension in eye balls decreased Cerebral dehydration Less fluid available for evaporation Pulse greater than 100 bpm may be due to circulatory compensation by the heart. With iso-osmolar fluid loss, the plasma volume is inadequate owing to hypovolemia , systolic pressure begin to fall. Decreased venous return.

14. A lack of water component of body weight. Due to renal response to hypovolemia Serum osmolarity > 295 mOsm /Kg due to hypoosmolar fluid loss (more fluid than solutes is lost). Hypo- osmolar fluid volume loss:- serum sodium level>145mEq/L, water is lost in greater amounts tahn sodium. Iso-osmolar fluid volume loss –serum sodium level is within normal range. Slight elevation (25-35 mg/dl) caused by

15. Hemoconcentration . Sugar increases serum osmolarity , thus causing diuresis and water loss, glucose levels may be elevated owing to hemoconcentration . With hypo- osmolar fluid loss, hematocrit will be increased owing to hemoconcentration , with iso-osmolar fluid loss ( eg - hemorrhage ) hematocrit may be within normal range. Increased solute to solvent ratio

16. MEDICAL MANAGEMENT:- It depends on severity of fluid deficit. If the fluid loss is mild, the fluid intake should be increased in accordance with client’s physical condition. PHARMACOLOGIC MANAGEMENT:- If fluid loss is mild, fluid intake should be increased accordingly. When a hyperosmolar fluid volume deficit is present, an intravenous solution of dextrose in water or 5% dextrose in 0.2% saline may be prescribed. Maximal rate at which sodium solutions should be

17. Infused is 2 mEq /L per hour. If fluid is given too rapidly, cerebral edema may result. - If hemorrhage is the cause of ECFVD, blood replacement may be necessary when blood loss is greater than 1L. In situations, in which the blood losses are less than 1L, normal saline and lactated Ringer solution may be used to restore fluid volume. The fluid needs of the patient must be assessed within the context of patient’s overall condition.

18. A patient with severe ECFVD and also severe heart or kidney disease cannot be given large volume of fluids or sodium. DIETARY MANAGEMENT:- Avoid fatty or fried foods and milk products. NURSING MANAGEMENT:- 1) Fluid volume deficit r/t insufficient fluid intake, vomotting , diarrhea , hemorrhage or third space fluid loss ( ascites , burns).

19. Expected outcomes:- The patient’s fluid balance will be restored, as evidenced by vital signs within normal range, return to baseline body weight, absence of causative factors of ECFVD, equal intake and output, urine output greater than 600 ml/day. Implementation- Check vital signs 2-4 hrly Check positional BP to determine degree of orthostasis . If systolic BP falls 10-15 mm Hg or more, the results should be reported and patient protected

20. from injury while ambulating. Assess urine output hrly to indicate renal insufficiency because of decreased renal perfusion. (Absence of adequate renal perfusion for several hrs may result in permanent renal damage) Measure sp. gravity of urine, to determine osmolality . Monitor daily weight. Weight loss of approx. 3.1 Kg is indicative of fluid volume deficit. Apply lotion on skin to maintain skin integrity.

21. Provide oral care 2 hrly with non alcohol based solution. Serum sodium, BUN, glucose, hematocrit level should be monitored closely. C/M of fluid volume overload- dyspnea , crackles and jugular vein engorgement.

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